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The clinical course of patients with implantable cardioverter-defibrillators: Extended experience on clinical outcome, device replacements, and device-related complications

2015; Elsevier BV; Volume: 12; Issue: 6 Linguagem: Inglês

10.1016/j.hrthm.2015.02.035

1556-3871

Aafke C. van der Heijden, C. Jan Willem Borleffs, Maurits S. Buiten, Joep Thijssen, Johannes B. van Rees, Suzanne C. Cannegieter, Martin J. Schalij, Lieselot van Erven,

Cardiomyopathy and Myosin Studies

Background Large randomized trials demonstrated the beneficial effect of implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy–defibrillator (CRT-D) treatments in selected patients. Data on long-term follow-up of patients outside the setting of clinical trials are scarce. Objective The aim of this study was to evaluate the long-term outcome of ICD and CRT-D recipients. Methods All patients who underwent ICD (n = 1729 [57%]) or CRT-D (n = 1326 [43%]) implantation at the Leiden University Medical Center since 1996 were evaluated. Follow-up visits were performed every 3–6 months, and events were registered. Cumulative incidence curves of device therapy and device-related complications were adjusted for the competing risk of all-cause mortality. Results After a median follow-up of 5.1 years (25th–75th percentile 3.1–7.8 years), 842 patients (28%) died. The cumulative incidence of all-cause mortality was 49% (95% confidence interval [CI] 45%–54%) in ICD recipients after 12 years of follow-up and 55% (95% CI 52%–58%) in CRT-D recipients after 8 years of follow-up. A total of 1081 patients (35%) received appropriate defibrillator therapy. The cumulative incidence of appropriate therapy in ICD patients was 58% (95% CI 54%–62%) after 12 years of follow-up and 39% (95% CI 35%–43%) in CRT-D patients after 8 years of follow-up. Twelve-year cumulative incidences of adverse events were 20% (95% CI 18%–22%) for inappropriate shock, 6% (95% CI 5%–8%) for device-related infection, and 17% (95% CI 14%–21%) for lead failure. Conclusion After long-term follow-up of ICD (12 years) and CRT-D (8 years) recipients, 49% of ICD recipients and 55% of CRT-D recipients had died. Appropriate ICD therapy was received by the majority (58%) of ICD recipients and by almost 40% of CRT-D recipients. Large randomized trials demonstrated the beneficial effect of implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy–defibrillator (CRT-D) treatments in selected patients. Data on long-term follow-up of patients outside the setting of clinical trials are scarce. The aim of this study was to evaluate the long-term outcome of ICD and CRT-D recipients. All patients who underwent ICD (n = 1729 [57%]) or CRT-D (n = 1326 [43%]) implantation at the Leiden University Medical Center since 1996 were evaluated. Follow-up visits were performed every 3–6 months, and events were registered. Cumulative incidence curves of device therapy and device-related complications were adjusted for the competing risk of all-cause mortality. After a median follow-up of 5.1 years (25th–75th percentile 3.1–7.8 years), 842 patients (28%) died. The cumulative incidence of all-cause mortality was 49% (95% confidence interval [CI] 45%–54%) in ICD recipients after 12 years of follow-up and 55% (95% CI 52%–58%) in CRT-D recipients after 8 years of follow-up. A total of 1081 patients (35%) received appropriate defibrillator therapy. The cumulative incidence of appropriate therapy in ICD patients was 58% (95% CI 54%–62%) after 12 years of follow-up and 39% (95% CI 35%–43%) in CRT-D patients after 8 years of follow-up. Twelve-year cumulative incidences of adverse events were 20% (95% CI 18%–22%) for inappropriate shock, 6% (95% CI 5%–8%) for device-related infection, and 17% (95% CI 14%–21%) for lead failure. After long-term follow-up of ICD (12 years) and CRT-D (8 years) recipients, 49% of ICD recipients and 55% of CRT-D recipients had died. Appropriate ICD therapy was received by the majority (58%) of ICD recipients and by almost 40% of CRT-D recipients.