Abstract
Implantable cardioverter-defibrillator (ICD) in heart failure with reduced ejection fraction (EF) patients reduces risk for sudden cardiac death (SCD). Previous data suggest that the benefit of ICD therapy in real life may be lower than expected from the results of controlled studies and only about one-third of ICD patients receive appropriate therapies. Nevertheless, all ICD patients are at risk of perioperative complications and inappropriate shocks. We retrospectively studied 613 patients undergoing ICD for primary prevention in 2002-2015; we excluded inherited arrhythmogenic syndromes. Patients underwent 12-leads ECG, echocardiography, laboratory tests and quality of life questionnaire. We evaluated comorbidities, appropriate therapies, complications and all-cause mortality. Consecutive patients (age 67 ± 10 years, 81% males, 59% ischaemic aetiology) were followed for 51 ± 31 months. 198 patients (32%) received appropriate ICD therapy, 93 (15%) had inappropriate shocks, 53 (8%) had at least one complication (electrode dysfunction, infection and pocket related) and 191 (33%) died. Multivariate analysis showed atrial fibrillation (OR = 1.8, CI = 1.27 - 2.53; p
Highlights
Heart failure with reduced ejection fraction is associated with an increased risk of sudden cardiac death (SCD)
Previous data suggest that the benefit of Implantable cardioverter-defibrillator (ICD) therapy in real life may be lower than expected from the results of controlled studies and only about one-third of ICD patients receive appropriate therapies
A much higher complication rate was reported in a real-life survey of 440 ICD patients in Germany, where 31% of the patients experienced some type of complication [6]
Summary
Heart failure with reduced ejection fraction is associated with an increased risk of sudden cardiac death (SCD). Implantable cardioverter-defibrillators (ICD) have reduced mortality and become the standard of care for these patients, as recommended by current international guidelines [1] [2]. In a pooled analysis of 10 different studies on primary preventive defibrillators in patients with heart failure, all-cause mortality with ICD therapy was reduced about by 7.9% compared with optimal medical treatment only [3]. All ICD patients are at an increased risk of perioperative complications, inappropriate shocks, and secondary arrhythmias [4]. The reported complication rates vary in different studies, but in a recent review of 11 well-known randomized ICD studies, the overall lead dislodgement rate was 1.8% [5]. A much higher complication rate was reported in a real-life survey of 440 ICD patients in Germany, where 31% of the patients experienced some type of complication [6]
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