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. 2023 Sep;31(9):348-356.
doi: 10.1007/s12471-023-01785-0. Epub 2023 Jun 16.

Comparison and predictors of implantable cardioverter-defibrillator therapy for primary and secondary prevention

Reinder Evertz  1 , Tessa van der Heijden  2 , Rypko Beukema  2 , Sjoerd Westra  2 , Esther Meindersma  2 , Caroline van Deursen  2 , Kevin Vernooy  3
Affiliations

Comparison and predictors of implantable cardioverter-defibrillator therapy for primary and secondary prevention

Reinder Evertz et al. Neth Heart J. 2023 Sep.

Abstract

Background: Implantable cardioverter-defibrillators (ICDs) are effective in detecting and treating ventricular arrhythmias. Studies on ICD therapy for different indications (primary and secondary prevention) and possible predictors of ICD therapy are limited. In this study, the incidence and type of ICD therapy were related to the indication and the underlying cardiac pathology.

Methods: A single-centre, retrospective and observational study was performed of 482 patients who underwent ICD implantation for primary (53.3%) or secondary prevention (46.7%) between 2015 and 2020 at the Radboud University Medical Centre.

Results: During a median follow-up of 2.4 years (interquartile range 0.2-3.9), the occurrence of appropriate ICD therapy for primary versus secondary prevention was 9.7% and 27.6%, respectively (p < 0.001). Time to appropriate ICD therapy was significantly shorter in the secondary prevention group (p < 0.001). No difference in ICD therapy was seen for different underlying aetiologies. In the majority of cases (70%) ICD therapy was given for ventricular tachycardia (VT). The occurrence of adverse events (16.3% vs 17.3%, p = 0.772), hospitalisation for cardiovascular reasons (29.2% vs 35.1%, p = 0.559) and all-cause mortality (12.5% vs 11.6%, p = 0.763) were similar in both groups. Male gender (3.53, 95% confidence interval (CI) (1.003, 12.403), p = 0.049) and secondary prevention indication (4.90, 95% CI (1.495, 16.066), p = 0.009) were predictors of appropriate ICD therapy.

Conclusion: The risk associated with appropriate ICD therapy is higher in secondary prevention patients, who have their first therapy within a shorter time frame after device implantation. Rates of complications, hospitalisation and all-cause mortality are comparable. Future treatment options should target the prevention of ICD therapy, mainly by preventing the recurrence of VT.

Keywords: Implantable cardioverter-defibrillator therapy; Mortality; Primary prevention; Secondary prevention.

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Conflict of interest statement

R. Evertz, T. van der Heijden, R. Beukema, S. Westra,E. Meindersma, C. van Deursen and K. Vernooy declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Infographic
Fig. 2
Fig. 2
Kaplan-Meier curve of appropriate ICD therapy for primary versus secondary prevention and the cumulative incidences at 1, 3, and 5 years after device implantation
Fig. 3
Fig. 3
Kaplan-Meier curve of all-cause mortality for primary versus secondary prevention
See this image and copyright information in PMC

References

    1. Kumar A, Avishay DM, Jones CR, et al. Sudden cardiac death: epidemiology, pathogenesis and management. Rev Cardiovasc Med. 2021;22:147–158. doi: 10.31083/j.rcm.2021.01.207. - DOI - PubMed
    1. Brignole M, Auricchio A, Baron-Esquivias G, et al. ESC guidelines on cardiac pacing and cardiac resynchronization therapy: the task force on cardiac pacing and resynchronization therapy of the European society of cardiology (ESC). Developed in collaboration with the European heart rhythm association (EHRA) Eur Heart J. 2013;2013(34):2281–2329. - PubMed
    1. Konstantino Y, Shafat T, Novack V, et al. Incidence of implantable cardioverter defibrillator therapy and mortality in primary and secondary prevention of sudden cardiac death. Isr Med Assoc J. 2015;17:760–763. - PubMed
    1. Schaer B, Kühne M, Reichlin T, et al. Incidence of and predictors for appropriate implantable cardioverter-defibrillator therapy in patients with a secondary preventive implantable cardioverter-defibrillator indication. Europace. 2016;18:227–231. doi: 10.1093/europace/euv188. - DOI - PubMed
    1. van Welsenes GH, van Rees JB, Borleffs CJ, et al. Long-term follow-up of primary and secondary prevention implantable cardioverter defibrillator patients. Europace. 2011;13:389–394. doi: 10.1093/europace/euq494. - DOI - PubMed

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