Abstract

Introduction We evaluated the use of implantable defibrillators (ICDs) in the octogenarian population to analyze the complications associated with ICD implantation; the incidence of appropriate and inappropriate discharges; as well as survival following ICD implantation. Methods We retrospectively evaluated the utilization of ICDs implanted and followed at our institution from 1998 to 2004 in the octogenarian population with systolic dysfunction. A control group was comprised of similar patients under the age of 80. Patients with preserved ventricular function were excluded. Results Two hundred twenty-six patients with systolic dysfunction were evaluated following ICD implantation. There were 51 patients over 80 years of age (mean age: 84 ± 4). A control group of 175 patients less than age 80 (mean age: 66 ± 10) was utilized for comparison. The baseline characteristics, including ejection fraction (25 ± 7%), presence of coronary disease (90%), as well as the incidence of symptomatic arrhythmias (33%) were similar in both groups. The octogenarian population did have a higher percentage of women (31% v. 18% ( p = 0.04)). The long-term device related complication rate in the older age group was low (1.9%) and did not differ between groups. Thirty-two percent of the octogenarian group received appropriate ICD therapy over a mean follow-up period of 15 ± 16 months. The older group had fewer inappropriate discharges (6.8% v. 12.6%; p = NS) in comparison to the younger patient group. Although 78.4% of the octogenarian group survived during the follow-up period, there was a significant decrease in survival in this group as evaluated by the Kaplan Meier method ( p =0.0003). In multivariate analysis, the only significant predictor of survival was age less than 80. Conclusion The octogenarian population can safely be treated with ICD therapy and in appropriately selected patients; they can be expected to have a high rate of therapeutic ICD utilization. Patients should be carefully selected for ICD implantation as mortality is higher in the octogenarian population and co-morbid conditions may limit the potential survival benefit offered by the ICD.

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