Long-term outcome of implantable cardioverter-defibrillator implantation in secondary prevention of sudden cardiac death

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• 作者：Sté ; phane Boulé ; ^a ; ^b ; ^{stephane.boule@chru-lille.fr" class="auth_mail" title="E-mail the corresponding author} ; Marc Sé ; michon^a ; Laurence Gué ; don-Moreau^a ; É ; lodie Drumez^c ; Claude Kouakam^a ; Christelle Marquié ; ^a ; Franç ; ois Brigadeau^a ; Salem Kacet^a ; ^b ; Charlotte Potelle^a ; ^b ; William Escande^a ; ^b ; Zouheir Souissi^b ; Dominique Lacroix^a ; ^b ; Alain Duhamel^c ; Didier Klug^a ; ^b
• 关键词：Implantable cardioverter&ndash ; defibrillator ; Sudden cardiac death ; Ventricular tachycardia ; Ventricular fibrillation ; Secondary prevention
• 刊名：Archives of Cardiovascular Diseases
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：109
• 期：10
• 页码：517-526
• 全文大小：657 K

文摘

Little is known about the long-term outcomes of patients who receive an implantable cardioverter–defibrillator (ICD) for purely secondary prevention indications.

Aims

To assess the rates and predictors of appropriate therapies over a very long-term follow-up period in this population.

Methods

Between June 2003 and August 2006, 239 consecutive patients with structural left ventricular disease and a secondary prophylaxis indication for ICD therapy (survivors of life-threatening ventricular tachyarrhythmias) were prospectively enrolled. An extended follow-up of these patients was carried out. The primary endpoint was the occurrence of appropriate device therapy. Secondary endpoints were all-cause death, electrical storm and inappropriate therapy.

Results

The study population consisted of 239 patients (90% men; mean age 64 ± 12 years; 72% ischaemic cardiomyopathy; left ventricular ejection fraction 37 ± 12%). During a median follow-up of 7.8 (3.5–9.3) years, appropriate device therapy occurred in 139 (58.2%) patients. Death occurred in 141 patients (59%), electrical storm in 73 (30.5%) and inappropriate therapy in 42 (17.6%). Multivariable analysis identified patients whose presenting arrhythmia was ventricular fibrillation as being less likely to require appropriate device therapy than those whose presenting arrhythmia was ventricular tachycardia (sub-hazard ratio 0.62, 95% confidence interval 0.40–0.97; P = 0.04). Independent predictors of all-cause death were age at implantation (P < 0.0001), wide QRS complexes (P = 0.024), creatinine concentration (P = 0.0002) and B-type natriuretic peptide at implantation (P = 0.0001).

Conclusion

Secondary prevention ICD recipients exhibit a high risk of appropriate device therapy and death over prolonged follow-up. Patients who presented initially with ventricular fibrillation were less likely to require the delivery of appropriate device therapy.