Abstract
BackgroundBecause of previous ventricular arrhythmia (VA) episodes, patients with implantable cardioverter-defibrillator (ICD) for secondary prevention (SP) are generally considered to have a higher burden of VAs than primary prevention (PP) patients. However, when PP patients experienced VA, the difference in the prognosis of these two patient groups was unknown.MethodsThe clinical characteristics and follow-up data of 835 ICD patients (364 SP patients and 471 PP patients) with home monitoring feature were retrospectively analysed. The incidence rate and risk of subsequent VA and all-cause mortality were compared between PP patients after the first appropriate ICD therapy and SP patients.ResultsDuring a mean follow-up of 44.72 ± 20.87 months, 210 (44.59%) PP patients underwent appropriate ICD therapy. In the Kaplan-Meier survival analysis, the PP patients after appropriate ICD therapy were more prone to VA recurrence and all-cause mortality than SP patients (P<0.001 for both endpoints). The rate of appropriate ICD therapy and all-cause mortality in PP patients after the first appropriate ICD therapy was significantly higher than that in SP patients (for device therapy, 59.46 vs 20.64 patients per 100 patient-years; incidence rate ratio [IRR] 2.880, 95% confidence interval [CI]: 2.305–3.599; P<0.001; for all-cause mortality, 14.08 vs 5.40 deaths per 100 patient-years; IRR 2.607, 95% CI: 1.884–3.606; P<0.001). After propensity score matching for baseline characteristics, the risk of VA recurrence in PP patients with appropriate ICD therapy was still higher than that in SP patients (41.80 vs 19.10 patients per 100 patient-years; IRR 2.491, 95% CI: 1.889–3.287; P<0.001), but all-cause mortality rates were similar between the two groups (12.61 vs 9.33 deaths per 100 patient-years; IRR 1.352, 95% CI: 0.927–1.972; P = 0.117).ConclusionsOnce PP patients undergo appropriate ICD therapy, they will be more prone to VA recurrence and death than SP patients.
Highlights
Because of previous ventricular arrhythmia (VA) episodes, patients with implantable cardioverterdefibrillator (ICD) for secondary prevention (SP) are generally considered to have a higher burden of ventricular arrhythmias (VAs) than primary prevention (PP) patients
Patients were treated with ICD implantation after survival of a life-threatening VA, but because of the low survival rate after experiencing VA, focus shifted to the identification of patients at high risk of sudden cardiac death (SCD)
Nine hundred ten patients with ICD or Cardiac resynchronization therapy defibrillator (CRT-D) were included in SUMMIT registry. 75 (8.2%) patients were not included in analysis for no Home monitoring (HM) data transmission
Summary
Because of previous ventricular arrhythmia (VA) episodes, patients with implantable cardioverterdefibrillator (ICD) for secondary prevention (SP) are generally considered to have a higher burden of VAs than primary prevention (PP) patients. The implantable cardioverter-defibrillator (ICD) has been proven by multiple trials to be efficacious in identifying and terminating malignant ventricular arrhythmias (VAs) to prevent sudden cardiac death (SCD) since late 1990s [1,2,3,4]. Patients were treated with ICD implantation after survival of a life-threatening VA (secondary prevention, SP), but because of the low survival rate after experiencing VA, focus shifted to the identification of patients at high risk of SCD (primary prevention, PP). Because of previous VA episodes, SP patients are generally considered to have a higher burden of VAs than PP patients [5]. Many PP patients never experienced VA requiring ICD therapy before devices’ battery depletion or death
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