The association between ICD interventions and mortality is independent of their modality: clinical implications

Gianluigi Bencardino, Antonio Di Monaco, Teresa Rio, Antonio Frontera, Pasquale Santangeli, Milena Leo, Gemma Pelargonio, Francesco Perna, Maria L ucia Narducci, Francesca Gabrielli, Gaetano A ntonio Lanza, Fulvio Bellocci, Antonio Rebuzzi, Filippo Crea

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Patients with severe structural heart disease have increased mortality after implantable cardioverter-defibrillator (ICD) shocks. Whether this is limited to ICD shock therapy only or extends also to no-shock therapies, such as antitachycardia pacing (ATP), is unclear. We investigated the impact of different ICD therapies on long-term mortality.

METHODS: We enrolled 573 patients who underwent ICD implantation at our institution from 2004 to 2011. The population was divided into 3 groups: no device interventions (group 1), ATP interventions (group 2), and shock interventions (group 3). The endpoint was the all-cause mortality.

RESULTS: Over a follow-up period of 48 months (range 1-110), 447 (78%) had no device interventions, 71 (12%) had ATP therapy only, and 55 (10%) had at least one shock intervention. All-cause mortality occurred in 94 patients in group 1 (21%), 23 patients (43%) in group 2, and 21 patients (38%) in group 3. At multivariable Cox regression analysis, ATP intervention (HR: 1.8; 95% CI 1.1-3; P <0.001), shock intervention (HR: 1.39; 95% CI 1.09-1.77; P = 0.008), age (HR: 1.05; 95% CI 1.02-1.07; P <0.001), and LVEF (HR: 0.95; 95% CI 0.93-0.98; P = 0.001) were predictors of all-cause mortality. No significant difference in mortality was found between group 2 and 3.

CONCLUSION: Patients with ICDs who receive appropriate interventions are at increased risk of mortality. Such risk is not dependent on different types of ICD therapy, such as shocks or ATP. Our data suggest that sustained ventricular arrhythmias per se have a negative impact on prognosis rather than modality of ICD therapy.

Original languageEnglish
Pages (from-to)1363-1367
Number of pages5
JournalJournal of Cardiovascular Electrophysiology
Volume25
Issue number12
DOIs
Publication statusPublished - Dec 1 2014

Keywords

  • antitachycardia pacing
  • heart failure
  • ICD shock
  • implantable cardioverter-defibrillator
  • mortality
  • ventricular arrhythmias

ASJC Scopus subject areas

  • Medicine(all)

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