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 journalArticle

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

Fingerprint

Implantable Defibrillators
Shock
Mortality
Convulsive Therapy
Equipment and Supplies
Therapeutics
Cardiac Arrhythmias
Heart Diseases
Regression Analysis
Population

Keywords

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

ASJC Scopus subject areas

  • Medicine(all)

Cite this

The association between ICD interventions and mortality is independent of their modality : clinical implications. / Bencardino, Gianluigi; Di Monaco, Antonio; Rio, Teresa; Frontera, Antonio; Santangeli, Pasquale; Leo, Milena; Pelargonio, Gemma; Perna, Francesco; Narducci, Maria L ucia; Gabrielli, Francesca; Lanza, Gaetano A ntonio; Bellocci, Fulvio; Rebuzzi, Antonio; Crea, Filippo.

In: Journal of Cardiovascular Electrophysiology, Vol. 25, No. 12, 01.12.2014, p. 1363-1367.

Research output: Contribution to journalArticle

Bencardino, G, Di Monaco, A, Rio, T, Frontera, A, Santangeli, P, Leo, M, Pelargonio, G, Perna, F, Narducci, MLU, Gabrielli, F, Lanza, GAN, Bellocci, F, Rebuzzi, A & Crea, F 2014, 'The association between ICD interventions and mortality is independent of their modality: clinical implications', Journal of Cardiovascular Electrophysiology, vol. 25, no. 12, pp. 1363-1367. https://doi.org/10.1111/jce.12499
Bencardino, Gianluigi ; Di Monaco, Antonio ; Rio, Teresa ; Frontera, Antonio ; Santangeli, Pasquale ; Leo, Milena ; Pelargonio, Gemma ; Perna, Francesco ; Narducci, Maria L ucia ; Gabrielli, Francesca ; Lanza, Gaetano A ntonio ; Bellocci, Fulvio ; Rebuzzi, Antonio ; Crea, Filippo. / The association between ICD interventions and mortality is independent of their modality : clinical implications. In: Journal of Cardiovascular Electrophysiology. 2014 ; Vol. 25, No. 12. pp. 1363-1367.
@article{289afe34f57c45c0bccf94711d986f4e,
title = "The association between ICD interventions and mortality is independent of their modality: clinical implications",
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.",
keywords = "antitachycardia pacing, heart failure, ICD shock, implantable cardioverter-defibrillator, mortality, ventricular arrhythmias",
author = "Gianluigi Bencardino and {Di Monaco}, Antonio and Teresa Rio and Antonio Frontera and Pasquale Santangeli and Milena Leo and Gemma Pelargonio and Francesco Perna and Narducci, {Maria L ucia} and Francesca Gabrielli and Lanza, {Gaetano A ntonio} and Fulvio Bellocci and Antonio Rebuzzi and Filippo Crea",
year = "2014",
month = "12",
day = "1",
doi = "10.1111/jce.12499",
language = "English",
volume = "25",
pages = "1363--1367",
journal = "Journal of Cardiovascular Electrophysiology",
issn = "1045-3873",
publisher = "Wiley-Blackwell",
number = "12",

}

TY - JOUR

T1 - The association between ICD interventions and mortality is independent of their modality

T2 - clinical implications

AU - Bencardino, Gianluigi

AU - Di Monaco, Antonio

AU - Rio, Teresa

AU - Frontera, Antonio

AU - Santangeli, Pasquale

AU - Leo, Milena

AU - Pelargonio, Gemma

AU - Perna, Francesco

AU - Narducci, Maria L ucia

AU - Gabrielli, Francesca

AU - Lanza, Gaetano A ntonio

AU - Bellocci, Fulvio

AU - Rebuzzi, Antonio

AU - Crea, Filippo

PY - 2014/12/1

Y1 - 2014/12/1

N2 - 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.

AB - 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.

KW - antitachycardia pacing

KW - heart failure

KW - ICD shock

KW - implantable cardioverter-defibrillator

KW - mortality

KW - ventricular arrhythmias

UR - http://www.scopus.com/inward/record.url?scp=84943365109&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84943365109&partnerID=8YFLogxK

U2 - 10.1111/jce.12499

DO - 10.1111/jce.12499

M3 - Article

C2 - 25066621

VL - 25

SP - 1363

EP - 1367

JO - Journal of Cardiovascular Electrophysiology

JF - Journal of Cardiovascular Electrophysiology

SN - 1045-3873

IS - 12

ER -