Abstract
BackgroundCurrent implantable cardioverter-defibrillator (ICD) guidelines do not impose age limitations for ICD implantation (IMPL) and generator exchange (GE); however, patients (pts) should be expected to survive for 1 year. With higher age, comorbidity and mortality due to non-sudden cardiac death increase. Thus, the benefit of ICD therapy in elderly pts remains unclear. Mortality after ICD IMPL or GE in pts ≥ 75 years was assessed.MethodsConsecutive pts aged ≥ 75 years with ICD IMPL or GE at the University Hospital Cologne, Germany, between 01/2013 and 12/2017 were included in this retrospective analysis.ResultsOf 418 pts, 82 (20%) fulfilled the inclusion criteria; in 70 (55 = IMPL, 79%, 15 = GE, 21%) follow-up (FU) was available. The median FU was 3.1 years. During FU, 40 pts (57%) died (29/55 [53%] IMPL; 11/15 [73%] GE). Mean survival after surgery was 561 ± 462 days. The 1‑year mortality rate was 19/70 (27%) overall, 9/52 (17%) in pts ≥ 75 and 10/18 (56%) in pts ≥ 80 years. Deceased pts were more likely to suffer from chronic renal failure (85% vs. 53%, p = 0.004) and peripheral artery disease (18% vs. 0%, p = 0.02). During FU, seven pts experienced ICD shocks (four appropriate, three inappropriate). In primary prevention (n = 35) mortality was 46% and four pts experienced ICD therapies (two adequate); in secondary prevention (n = 35) mortality was 69% (p = 0.053) with three ICD therapies (two adequate).ConclusionMortality in ICD pts aged ≥ 80 years was 56% at 1 and 72% at 2 years in this retrospective analysis. The decision to implant an ICD in elderly pts should be made carefully and individually.
Highlights
Implantable cardioverter-defibrillators (ICD) are an effective treatment for lifethreatening ventricular tachyarrhythmias
ICD are used both for secondary prevention in patients with documented ventricular arrhythmia, as well as for primary prevention in pts with reduced left ventricular ejection fraction (EF) < 35%
The predicted life expectancy is of particular relevance in elderly pts with a guideline indication for ICD therapy, given their age, burden of comorbidities and their risk for potential complications during or after ICD implantation [20, 22]
Summary
Implantable cardioverter-defibrillators (ICD) are an effective treatment for lifethreatening ventricular tachyarrhythmias. In Germany, more than 25,000 implantations (IMPL) of ICD and more than 10,000 generator exchanges (GE) were performed in 2017. Of those new implantations, 12% were in pts aged 80 years or older [11]. The predicted life expectancy is of particular relevance in elderly pts with a guideline indication for ICD therapy, given their age, burden of comorbidities and their risk for potential complications during or after ICD implantation [20, 22]. The number of elderly pts with an indication for ICD IMPL or GE will continue to increase. We included pts aged 75 and older that were implanted with a transvenous ICD or that had received an ICD GE
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