Implantable Cardioverter Defibrillator in the elderly

Abstract

The elderly are often underrepresented in ICD trials and evidence of ICD relevance in patients ≥ 75 years is not clear. We aimed to evaluate the complications, and the rate of appropriate therapy in this population. This monocentric case-control study included ICD recipients ≥ 75 years (cases) matched with ICD recipients < 75 years with a 1:2 fashion according to sex, type of prevention (primary vs. secondary) and type of device (resynchonization vs not). Characteristics and outcomes were compared between the 2 groups. A total of 363 patients were enrolled: 121 cases (78 yo 82.6% male; primary prevention 74.4%; CRT 51.2%) and 242 controls (mean age 66. yo). The mean follow was 3.7 ± 3.5 years. The elderly had longer PR interval (210 ± 44 vs. 196 ± 38; P < 0.009), higher NTproBNP (4638 ± 6351 vs. 2607 ± 3405 ng/L) and lower creatinin clearance (52 ± 18 vs.73 ± 26 mL/min/1.73 m2; P < 0.001). Charlson Comorbidity Index mean scores (5.6 ± 1.7; 4.5 ± 1.6; P < 0.001) differed only by one point between groups, corresponding to the age gap between the two groups. A trend to higher complication rate was observed in elderly (12.4%; 7.9%; P = 0.16). Survival analysis showed that the elderly had more appropriate therapy compared to youngsters (P = 0.02). On the other hand, no difference was observed regarding inappropriate therapy (P = 0.1). In our study, the elderly population had very few comorbidities. ICD implantation was associated with a higher rate of appropriate therapy in the elderly group compared to youngsters without excess in inappropriate therapy.