Clinical course and long-term follow-up of patients receiving implantable cardioverter-defibrillators

Harikrishna Tandri, Lawrence S. Griffith, Tania Tang, Khurram Nasir, Omeed Zardkoohi, Chandrasekhar Vasam Reddy, Melissa Capps, Hugh Calkins, J. Kevin Donahue

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Implantable cardioverter-defibrillators (ICDs) are increasingly used for primary and secondary prevention of sudden cardiac death. Defibrillators were introduced into clinical practice in 1980. Since that time, factors affecting long-term survival and the natural history of defibrillator patients have not been described. Objectives: The purpose of this study was to identify clinical predictors of long-term survival in patients receiving ICDs. Methods: The prognostic value of several clinical variables on the likelihood of survival or appropriate ICD therapy in 1,382 consecutive patients receiving ICDs from 1980 to 2003 were evaluated. Data were collected at the time of device implantation, and follow-up was completed through March 2005. Results: In 70 ± 51 months of follow-up (range 0-282 months), 792 patients died and 421 patients received appropriate ICD therapy at least once. Age, left ventricular ejection fraction, New York Heart Association (NYHA) functional class, Charlson comorbidity index, and antiarrhythmic drug use correlated with mortality. β-Blocker and angiotensin-converting enzyme inhibitor use was associated with improved survival. Only NYHA functional class correlated with ICD therapy. Patients free of shocks for the first 5 years after ICD implantation had continued risk of arrhythmia recurrence. Conclusion: The heart failure characteristics of patients predicted ICD shock probability and survival better than the arrhythmia characteristics or the underlying heart disease. Antiarrhythmic drug use was associated with increased mortality. Beta-blocker and angiotensin-converting enzyme inhibitor use was associated with improved survival. A measurable arrhythmic risk even after prolonged shock-free intervals indicates the need for continued ICD therapy in all patients with appropriate ICD indications.

Original languageEnglish (US)
Pages (from-to)762-768
Number of pages7
JournalHeart Rhythm
Volume3
Issue number7
DOIs
StatePublished - Jul 2006

Keywords

  • Implantable cardioverter-defibrillator
  • Long-term follow-up
  • Natural history
  • Outcomes
  • Sudden death
  • Ventricular arrhythmia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Fingerprint Dive into the research topics of 'Clinical course and long-term follow-up of patients receiving implantable cardioverter-defibrillators'. Together they form a unique fingerprint.

Cite this