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Kuhrt N, Stevenson LW, Akhabue E, Visaria A, Lee E, Bates B, Gandhi P, Setoguchi S. Is it time to consider a "time-out" before primary prevention implantable cardioverter-defibrillator placement in currently or recently hospitalized older patients with heart failure? Heart Rhythm 2024:S1547-5271(24)02562-1. [PMID: 38750911 DOI: 10.1016/j.hrthm.2024.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 05/05/2024] [Accepted: 05/08/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Trajectories of mortality after primary prevention implantable cardioverter-defibrillator (ICD) placement for older patients with heart failure during or soon after acute hospitalization have not been assessed. OBJECTIVE The purpose of this study was to compare trajectories of mortality after primary prevention ICD placement during or soon after acute cardiac or non-cardiac hospitalization. METHODS We identified older patients with heart failure undergoing primary prevention ICD placement using 20% Medicare data (2008-2018). Placement settings were as follows: (1) Current-H-during current hospitalization, (2) Recent-H-within 90 days of hospitalization, or (3) Chronic stable. Hospitalization was categorized as cardiac vs non-cardiac. Interval mortality rates and hazard ratios (HRs) using Cox regression were estimated at 0-30, 31-90, and 91-365 days after ICD placement. RESULTS Of the 61,710 patients (mean age 76 years; 35% female; 85% white), 19% (11,947), 25% (15,147), and 56% (34,616) had ICDs in Current-H, Recent-H, and Chronic stable settings. Mortality rates (per 100 person-years) were highest during 0-30 days, with 38 (34-42) and 22 (19-24) for Current-H and Recent-H, which declined to 21 (20-22) and 16 (15-17) during 91-365 days, respectively. Compared to Chronic stable, HRs were highest during 0-30 days post-ICD placement (5.5 [4.5-6.8] for Current-H and 3.4 [2.8-4.2] for Recent-H) and decreased during 91-365 days (2.0 [1.8-2.1] for Current-H and 1.6 [1.5-1.7] for Recent-H). HR pattens were similar for cardiac and non-cardiac hospitalizations. CONCLUSION Primary prevention ICD placement during or soon after hospitalization for any reason was associated with worse mortality with diminishing risks after 90 days. Hospitalization likely identifies a sicker population in whom early mortality with or without ICD may be higher. Our results support careful consideration regarding ICD placement during the 90 days after hospitalization.
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Affiliation(s)
- Nathaniel Kuhrt
- Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; Rutgers New Jersey Medical School, Newark, New Jersey
| | - Lynne Warner Stevenson
- Division of Advanced Heart Failure and Transplant Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ehimare Akhabue
- Department of Cardiology, Zucker School of Medicine at Hofstra / Northwell, Hempstead, New York; Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Aayush Visaria
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Eileen Lee
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut; Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Benjamin Bates
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; Center for Pharmacoepidemiology and Treatment Science, Rutgers Institute for Health, Health Care Policy and Aging Research, New Brunswick, New Jersey
| | - Poonam Gandhi
- Center for Pharmacoepidemiology and Treatment Science, Rutgers Institute for Health, Health Care Policy and Aging Research, New Brunswick, New Jersey
| | - Soko Setoguchi
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; Center for Pharmacoepidemiology and Treatment Science, Rutgers Institute for Health, Health Care Policy and Aging Research, New Brunswick, New Jersey.
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Yokoshiki H, Shimizu A, Mitsuhashi T, Ishibashi K, Kabutoya T, Yoshiga Y, Kondo Y, Abe H, Shimizu W. Cardiac resynchronization therapy with a defibrillator in non-ischemic and ischemic patients for primary and secondary prevention of sudden cardiac death: Analysis of the Japan cardiac device treatment registry database. J Arrhythm 2023; 39:757-765. [PMID: 37799798 PMCID: PMC10549811 DOI: 10.1002/joa3.12916] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/04/2023] [Accepted: 08/14/2023] [Indexed: 10/07/2023] Open
Abstract
Background Panoramic studies in patients with cardiac resynchronization therapy with a defibrillator (CRT-D) focusing on the etiology and indication are scarce. Besides, a controversy exists regarding requirement of a defibrillator in non-ischemic patients for primary prevention with CRT. Methods Annual trends of de novo CRT-D implantations from 2011 to 2020 and outcomes of those between January 2011 and August 2015 were analyzed from the Japan cardiac device treatment registry (JCDTR) and New JCDTR database. Results From 2011 to 2020, 8062 CRT-D recipients were registered, whose dominant indication was primary prevention of sudden cardiac death with a steady rate of about 70%. There was no significant temporal change of the proportion of non-ischemic patients being about 70% and 65% for primary and secondary prevention, respectively. Non-ischemic patients for primary prevention were associated with increased odds of appropriate ICD therapy [adjusted hazard ratio (aHR): 1.66; 95% confidence interval (CI): 1.01-2.75; p = .047] and reduced odds of any death (aHR: 0.66; 95% CI: 0.44-0.99; p = .046) as compared to ischemic patients. Conclusions Proportion of non-ischemic etiology was much higher than that of ischemic one in the CRT-D cohort. Based on the higher odds of appropriate ICD therapy, non-ischemic patients for primary prevention appear to be prudently selected in Japan.
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Affiliation(s)
- Hisashi Yokoshiki
- Department of Cardiovascular MedicineSapporo City General HospitalSapporoJapan
| | | | - Takeshi Mitsuhashi
- Department of Cardiovascular MedicineHoshi General HospitalKoriyamaJapan
| | - Kohei Ishibashi
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Tomoyuki Kabutoya
- Division of Cardiovascular Medicine, Department of MedicineJichi Medical University School of MedicineShimotsukeJapan
| | - Yasuhiro Yoshiga
- Division of Cardiology, Department of Medicine and Clinical ScienceYamaguchi University Graduate School of MedicineYamaguchiJapan
| | - Yusuke Kondo
- Department of Cardiovascular MedicineChiba University Graduate School of MedicineChibaJapan
| | - Haruhiko Abe
- Department of Heart Rhythm ManagementUniversity of Occupational and Environmental HealthKitakyushuJapan
| | - Wataru Shimizu
- Department of Cardiovascular MedicineNippon Medical SchoolBunkyo CityJapan
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Weidner K, Schupp T, Rusnak J, El-Battrawy I, Ansari U, Hoppner J, Mueller J, Kittel M, Taton G, Reiser L, Bollow A, Reichelt T, Ellguth D, Engelke N, Große Meininghaus D, Akin M, Bertsch T, Akin I, Behnes M. Impact of age on the prognosis of patients with ventricular tachyarrhythmias and aborted cardiac arrest. Z Gerontol Geriatr 2023; 56:484-491. [PMID: 36480051 PMCID: PMC10522500 DOI: 10.1007/s00391-022-02131-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/13/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study evaluated the prognostic impact of age on patients presenting with ventricular tachyarrhythmias (VTA) and aborted cardiac arrest. MATERIAL AND METHODS The present registry-based, monocentric cohort study included all consecutive patients presenting at the University Medical Center Mannheim (UMM) between 2002 and 2016 with ventricular tachycardia (VT), ventricular fibrillation (VF) and aborted cardiac arrest. Middle-aged (40-60 years old) were compared to older patients (> 60 years old). Furthermore, age was analyzed as a continuous variable. The primary endpoint was all-cause mortality at 2.5 years. The secondary endpoints were cardiac death at 24 h, all-cause mortality at index hospitalization, all-cause mortality after index hospitalization and the composite endpoint at 2.5 years of cardiac death at 24 h, recurrent VTA, and appropriate implantable cardioverter defibrillator (ICD) treatment. RESULTS A total of 2259 consecutive patients were included (28% middle-aged, 72% older). Older patients were more often associated with all-cause mortality at 2.5 years (27% vs. 50%; hazard ratio, HR = 2.137; 95% confidence interval, CI 1.809-2.523, p = 0.001) and the secondary endpoints. Even patient age as a continuous variable was independently associated with mortality at 2.5 years in all types of VTA. Adverse prognosis in older patients was demonstrated by multivariate Cox regression analyses and propensity score matching. Chronic kidney disease (CKD), systolic left ventricular dysfunction (LVEF) < 35%, cardiopulmonary resuscitation (CPR) and cardiogenic shock worsened the prognosis for both age groups, whereas acute myocardial infarction (STEMI/NSTEMI) and the presence of an ICD improved prognosis. CONCLUSION The results of this study suggest that increasing age is associated with increased mortality in VTA patients. Compared to the middle-aged, older patients were associated with higher all-cause mortality at 2.5 years and the secondary endpoints.
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Affiliation(s)
- Kathrin Weidner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Tobias Schupp
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Jonas Rusnak
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Ibrahim El-Battrawy
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Uzair Ansari
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Jorge Hoppner
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Julian Mueller
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Maximilian Kittel
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Gabriel Taton
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Linda Reiser
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Armin Bollow
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Thomas Reichelt
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Dominik Ellguth
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Niko Engelke
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | | | - Muharrem Akin
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Michael Behnes
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
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Behon A, Merkel ED, Schwertner WR, Kuthi LK, Veres B, Masszi R, Kovács A, Lakatos BK, Zima E, Gellér L, Kosztin A, Merkely B. Long-term outcome of cardiac resynchronization therapy patients in the elderly. GeroScience 2023; 45:2289-2301. [PMID: 36800059 PMCID: PMC10651580 DOI: 10.1007/s11357-023-00739-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 01/19/2023] [Indexed: 02/18/2023] Open
Abstract
Heart failure (HF) is a leading cause of mortality and hospitalization in the elderly. However, data are scarce about their response to device treatment such as cardiac resynchronization therapy (CRT). We aimed to evaluate the age-related differences in the effectiveness of CRT, procedure-related complications, and long-term outcome. Between 2000 and 2020, 2656 patients undergoing CRT implantation were registered and analyzed retrospectively. Patients were divided into 3 groups according to their age: group I, < 65; group II, 65-75; and group III, > 75 years. The primary endpoint was the echocardiographic response defined as a relative increase > 15% in left ventricular ejection fraction (LVEF) within 6 months, and the secondary endpoint was the composite of all-cause mortality, heart transplantation, or left ventricular assist device implantation. Procedure-related complications were also assessed. After implantation, LVEF showed significant improvement both in the total cohort [28% (IQR 24/33) vs. 35% (IQR 28/40); p < 0.01)] and in each subgroup (27% vs. 34%; p < 0.01, 29% vs. 35%; p < 0.01, 30% vs. 35%; p < 0.01). Response rate was similar in the 3 groups (64% vs. 62% vs. 56%; p = 0.41). During the follow-up, 1574 (59%) patients died. Kaplan-Meier curves revealed a significantly lower survival rate in the older groups (log-rank p < 0.001). The cumulative complication rates were similar among the three age groups (27% vs. 28% vs. 24%; p = 0.15). Our results demonstrate that CRT is as effective and safe therapy in the elderly as for young ones. The present data suggest that patients with appropriate indications benefit from CRT in the long term, regardless of age.
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Affiliation(s)
- Anett Behon
- Heart and Vascular Center, Semmelweis University, Varosmajor 68 H-1122, Budapest, Hungary
| | - Eperke Dóra Merkel
- Heart and Vascular Center, Semmelweis University, Varosmajor 68 H-1122, Budapest, Hungary
| | | | - Luca Katalin Kuthi
- Heart and Vascular Center, Semmelweis University, Varosmajor 68 H-1122, Budapest, Hungary
| | - Boglárka Veres
- Heart and Vascular Center, Semmelweis University, Varosmajor 68 H-1122, Budapest, Hungary
| | - Richard Masszi
- Heart and Vascular Center, Semmelweis University, Varosmajor 68 H-1122, Budapest, Hungary
| | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, Varosmajor 68 H-1122, Budapest, Hungary
| | - Bálint Károly Lakatos
- Heart and Vascular Center, Semmelweis University, Varosmajor 68 H-1122, Budapest, Hungary
| | - Endre Zima
- Heart and Vascular Center, Semmelweis University, Varosmajor 68 H-1122, Budapest, Hungary
| | - László Gellér
- Heart and Vascular Center, Semmelweis University, Varosmajor 68 H-1122, Budapest, Hungary
| | - Annamária Kosztin
- Heart and Vascular Center, Semmelweis University, Varosmajor 68 H-1122, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Varosmajor 68 H-1122, Budapest, Hungary.
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Al-Emam AMA, Dajam A, Alrajhi M, Alfaifi W, Al-Shraim M, Helaly AM. Sudden death in the southern region of Saudi Arabia: A retrospective study. World J Clin Cases 2023; 11:4843-4851. [PMID: 37583982 PMCID: PMC10424041 DOI: 10.12998/wjcc.v11.i20.4843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/08/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Sudden death is unanticipated, non-violent death taking place within the first 24 h after the onset of symptoms. It is a major public health problem worldwide. Moreover, the effects of living at moderate altitude on mortality are poorly understood. AIM To retrospectively report the frequency and the main causes of sudden deaths in relation to total deaths at Asir Central Hospital, 2255 m above sea level, in the southern region of Saudi Arabia over a period of 4 years from 2013 to 2016. METHODS The medical records of 1821 deaths were examined and showed 353 cases (19.4%) of sudden death. RESULTS The highest incidence of sudden death was among the elderly (51%), whereas, the lowest was among children and adolescents (6.5%). With regard to gender, the incidence of sudden death was higher in males (54.4%) compared to 45.6% in females. In this study, we found that the most common direct causes of sudden death were cardiovascular diseases (29.2%), respiratory disease (22.7%), infectious disease (12.2%), cancer (9.4%) and hematological diseases (6.2%). With respect to seasonal variation, the highest incidence was during winter (31.32%) followed by summer (25.8%). CONCLUSION The results of this study will help emergency physicians and health care providers to exercise due care to reduce the incidence of sudden death and raise public awareness about the impact of sudden death.
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Affiliation(s)
- Ahmed Mohamed Ahmed Al-Emam
- Department of Pathology, College of Medicine, King Khalid University, Asir 61421, Saudi Arabia
- Forensic Medicine and Clinical Toxicology, Mansoura University, Mansoura 35516, Egypt
| | | | - Mohammed Alrajhi
- Medical School, King Khalid University, Asir 61421, Saudi Arabia
| | - Waleed Alfaifi
- Medical School, King Khalid University, Asir 61421, Saudi Arabia
| | - Mubarak Al-Shraim
- Department of Pathology, College of Medicine, King Khalid University, Asir 61421, Saudi Arabia
| | - Ahmed Mohamed Helaly
- Forensic Medicine and Clinical Toxicology, Mansoura University, Mansoura 35516, Egypt
- Clinical Science, Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan
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6
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Al-Emam AMA, Dajam A, Alrajhi M, Alfaifi W, Al-Shraim M, Helaly AM. Sudden death in the southern region of Saudi Arabia: A retrospective study. World J Clin Cases 2023; 11:4839-4847. [DOI: 10.12998/wjcc.v11.i20.4839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/08/2023] [Accepted: 06/26/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Sudden death is unanticipated, non-violent death taking place within the first 24 h after the onset of symptoms. It is a major public health problem worldwide. Moreover, the effects of living at moderate altitude on mortality are poorly understood.
AIM To retrospectively report the frequency and the main causes of sudden deaths in relation to total deaths at Asir Central Hospital, 2255 m above sea level, in the southern region of Saudi Arabia over a period of 4 years from 2013 to 2016.
METHODS The medical records of 1821 deaths were examined and showed 353 cases (19.4%) of sudden death.
RESULTS The highest incidence of sudden death was among the elderly (51%), whereas, the lowest was among children and adolescents (6.5%). With regard to gender, the incidence of sudden death was higher in males (54.4%) compared to 45.6% in females. In this study, we found that the most common direct causes of sudden death were cardiovascular diseases (29.2%), respiratory disease (22.7%), infectious disease (12.2%), cancer (9.4%) and hematological diseases (6.2%). With respect to seasonal variation, the highest incidence was during winter (31.32%) followed by summer (25.8%).
CONCLUSION The results of this study will help emergency physicians and health care providers to exercise due care to reduce the incidence of sudden death and raise public awareness about the impact of sudden death.
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Affiliation(s)
- Ahmed Mohamed Ahmed Al-Emam
- Department of Pathology, College of Medicine, King Khalid University, Asir 61421, Saudi Arabia
- Forensic Medicine and Clinical Toxicology, Mansoura University, Mansoura 35516, Egypt
| | | | - Mohammed Alrajhi
- Medical School, King Khalid University, Asir 61421, Saudi Arabia
| | - Waleed Alfaifi
- Medical School, King Khalid University, Asir 61421, Saudi Arabia
| | - Mubarak Al-Shraim
- Department of Pathology, College of Medicine, King Khalid University, Asir 61421, Saudi Arabia
| | - Ahmed Mohamed Helaly
- Forensic Medicine and Clinical Toxicology, Mansoura University, Mansoura 35516, Egypt
- Clinical Science, Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan
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7
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Aktaş MK, Younis A, Saxena S, Diamond A, Ojo A, Kutyifa V, Steiner H, Steinberg JS, Zareba W, McNitt S, Polonsky B, Rosero SZ, Huang DT, Goldenberg I. Age and the Risk of Ventricular Tachyarrhythmia in Patients With an Implantable Cardioverter-Defibrillator. JACC Clin Electrophysiol 2022:S2405-500X(22)01052-0. [PMID: 36752470 DOI: 10.1016/j.jacep.2022.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/01/2022] [Accepted: 11/20/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND The benefit of implantable cardioverter-defibrillators (ICDs) in elderly patients is controversial. OBJECTIVES The aims of this study were to evaluate the risk for ventricular tachyarrhythmia (VTA) and ICD shocks by age groups and to assess the competing risk for VTA and death without prior VTA. METHODS The study included 5,170 primary prevention ICD recipients enrolled in 5 landmark ICD trials (MADIT [Multicenter Automatic Defibrillator Implantation Trial] II, MADIT-Risk, MADIT-CRT [MADIT Cardiac Resynchronization Therapy], MADIT-RIT [MADIT Reduce Inappropriate Therapy], and RAID [Ranolazine in High-Risk Patients With Implanted Cardioverter-Defibrillator]). Fine and Gray regression analysis was used to evaluate the risk for fast VTA (ventricular tachycardia ≥200 beats/min or ventricular fibrillation) vs death without prior fast VTA in 3 prespecified age groups: <65, 65 to <75, and ≥75 years. RESULTS The cumulative incidence of fast VTA at 3 years was similar for patients <65 years of age and those 65 to <75 years of age (17% vs 15%) and was lowest among patients ≥75 years of age (10%) (P < 0.001). Multivariate Fine and Gray analysis showed a 40% lower risk for fast VTA in patients ≥75 years of age (HR: 0.60; 95% CI: 0.46-0.78; P < 0.001) compared with patients <65 years of age. In patients ≥75 years of age, a risk reversal was observed whereby the risk for death without prior fast VTA exceeded the risk for developing fast VTA. A history of nonsustained ventricular tachycardia, male sex, and the presence of nonischemic cardiomyopathy were identified as predictors of fast VTA in patients ≥75 years of age. CONCLUSIONS Patients ≥75 years of age have a significantly lower risk for VTA and ICD shocks compared with younger patients. Aging is associated with a higher risk for death compared with the risk for fast VTA, the reverse of what is seen in younger patients.
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Affiliation(s)
- Mehmet K Aktaş
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York, USA.
| | - Arwa Younis
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York, USA
| | - Shireen Saxena
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York, USA
| | - Alexander Diamond
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York, USA
| | - Amole Ojo
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York, USA
| | - Valentina Kutyifa
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York, USA
| | - Hillel Steiner
- The Edith Wolfson Medical Center, Holon, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan S Steinberg
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York, USA
| | - Wojciech Zareba
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York, USA
| | - Scott McNitt
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York, USA
| | - Bronislava Polonsky
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York, USA
| | - Spencer Z Rosero
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York, USA
| | - David T Huang
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York, USA
| | - Ilan Goldenberg
- Clinical Cardiovascular Research Center, University of Rochester, Rochester, New York, USA
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Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA, Charron P, Corrado D, Dagres N, de Chillou C, Eckardt L, Friede T, Haugaa KH, Hocini M, Lambiase PD, Marijon E, Merino JL, Peichl P, Priori SG, Reichlin T, Schulz-Menger J, Sticherling C, Tzeis S, Verstrael A, Volterrani M. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J 2022; 43:3997-4126. [PMID: 36017572 DOI: 10.1093/eurheartj/ehac262] [Citation(s) in RCA: 874] [Impact Index Per Article: 437.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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NESTI M, RICCIARDI G, PIERAGNOLI P, FUMAGALLI S, PADELETTI M, PERINI AP, CAVARRETTA E, SCIARRA L. Incidence of ventricular arrhythmias after biventricular defibrillator replacement: impact on safety of downgrading from CRT-D to CRT-P. Minerva Cardiol Angiol 2022; 70:447-454. [DOI: 10.23736/s2724-5683.20.05352-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Willy K, Köbe J, Reinke F, Rath B, Ellermann C, Wolfes J, Wegner FK, Leitz PR, Lange PS, Eckardt L, Frommeyer G. Usefulness of the MADIT-ICD Benefit Score in a Large Mixed Patient Cohort of Primary Prevention of Sudden Cardiac Death. J Pers Med 2022; 12:jpm12081240. [PMID: 36013189 PMCID: PMC9410275 DOI: 10.3390/jpm12081240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background: Decision-making in primary prevention is not always trivial and many clinical scenarios are not reflected in current guidelines. To help evaluate a patient’s individual risk, a new score to predict the benefit of an implantable defibrillator (ICD) for primary prevention, the MADIT-ICD benefit score, has recently been proposed. The score tries to predict occurrence of ventricular arrhythmias and non-arrhythmic death based on data from four previous MADIT trials. We aimed at examining its usefulness in a large single-center register of S-ICD patients with various underlying cardiomyopathies. Methods and results: All S-ICD patients with a primary preventive indication for ICD implantation from our large single-center database were included in the analysis (n = 173). During a follow-up of 1227 ± 978 days, 27 patients developed sustained ventricular arrhythmias, while 6 patients died for non-arrhythmic reasons. There was a significant correlation for patients with ischemic cardiomyopathy (ICM) (n = 29, p = 0.04) to the occurrence of ventricular arrhythmia. However, the occurrence of ventricular arrhythmias could not sufficiently be predicted by the MADIT-ICD VT/VF score (p = 0.3) in patients with (n = 142, p = 0.19) as well as patients without structural heart disease (n = 31, p = 0.88) and patients with LV-EF < 35%. Of the risk factors included in the risk score calculation, only non-sustained ventricular tachycardias were significantly associated with sustained ventricular arrhythmias (p = 0.02). Of note, non-arrhythmic death could effectively be predicted by the proposed non-arrhythmic mortality score as part of the benefit score (p = 0.001, r = 0.3) also mainly driven by ICM patients. Age, diabetes mellitus, and a BMI < 23 kg/m2 were key predictors of non-arrhythmic death implemented in the score. Conclusion: The MADIT-ICD benefit score adds a new option to evaluate expected benefit of ICD implantation for primary prevention. In a large S-ICD cohort of primary prevention, the value of the score was limited to patients with ischemic cardiomyopathy. Future research should evaluate the performance of the score in different subgroups and compare it to other risk scores to assess its value for daily clinical practice.
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Affiliation(s)
- Kevin Willy
- Correspondence: ; Tel.: +49-251-83-44949; Fax: +49-251-83-49965
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11
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Butt JH, Yafasova A, Elming MB, Dixen U, Nielsen JC, Haarbo J, Videbæk L, Korup E, Bruun NE, Eiskjær H, Brandes A, Thøgersen AM, Gustafsson F, Egstrup K, Hassager C, Svendsen JH, Høfsten DE, Torp-Pedersen C, Pehrson S, Thune JJ, Køber L. NT-proBNP and ICD in Nonischemic Systolic Heart Failure: Extended Follow-Up of the DANISH Trial. JACC. HEART FAILURE 2022; 10:161-171. [PMID: 35241243 DOI: 10.1016/j.jchf.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/30/2021] [Accepted: 01/03/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In this extended follow-up study of the DANISH (Danish Study to Assess the Efficacy of Implantable Cardioverter Defibrillators in Patients with Non-ischemic Systolic Heart Failure on Mortality) trial, adding 4 years of additional follow-up, we examined the effect of implantable cardioverter-defibrillator (ICD) implantation according to baseline N-terminal pro-B-type natriuretic peptide (NT-proBNP) level. BACKGROUND In the DANISH trial, NT-proBNP level at baseline appeared to modify the response to ICD implantation. METHODS In the DANISH trial, 1,116 patients with nonischemic systolic HF were randomized to receive an ICD (N = 556) or usual clinical care (N = 550). Outcomes were analyzed according to NT-proBNP levels (below/above median) at baseline. The primary outcome was death from any cause. RESULTS All 1,116 patients in the DANISH trial had an available NT-proBNP measurement at baseline (median: 1,177 pg/mL; range: 200-22,918 pg/mL). There was a trend toward a reduction in all-cause death with ICD implantation, compared with usual clinical care, in patients with NT-proBNP levels lower than the median (HR: 0.75 [95% CI: 0.55-1.03]), but not in those with higher NT-proBNP levels (HR: 0.95 [95% CI: 0.74-1.21]) (Pinteraction = 0.28). Similarly, ICD implantation significantly reduced the rate of cardiovascular (CV) and sudden cardiovascular death (SCD) in patients with NT-proBNP levels lower than the median (CV death, HR: 0.69 [95% CI: 0.47-1.00]; SCD, HR: 0.37 [95% CI: 0.19-0.75]), but not in those with higher levels (CV death, HR: 0.94 [95% CI: 0.70-1.25]; SCD, HR: 0.86 [95% CI: 0.49-1.51]) (Pinteraction = 0.20 and 0.08 for CV death and SCD, respectively). CONCLUSIONS Lower baseline NT-proBNP levels could identify patients with nonischemic systolic HF who may derive benefit from ICD implantation. (Danish Study to Assess the Efficacy of Implantable Cardioverter Defibrillators in Patients with Non-ischemic Systolic Heart Failure on Mortality [DANISH]; NCT00542945).
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Affiliation(s)
- Jawad H Butt
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.
| | - Adelina Yafasova
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Marie B Elming
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Ulrik Dixen
- Department of Cardiology, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jens C Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jens Haarbo
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Hellerup, Denmark
| | - Lars Videbæk
- Department of Cardiology, Odense University Hospital, Svendborg, Denmark
| | - Eva Korup
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Niels E Bruun
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Cardiology, Zealand University Hospital, Roskilde, Denmark; Department of Clinical Medicine, University of Aalborg, Denmark
| | - Hans Eiskjær
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Axel Brandes
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Anna M Thøgersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Finn Gustafsson
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kenneth Egstrup
- Department of Cardiology, Odense University Hospital, Svendborg, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Hastrup Svendsen
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Dan E Høfsten
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark
| | - Steen Pehrson
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Jens Jakob Thune
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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12
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Borgeat K, Pack M, Harris J, Laver A, Seo J, Belachsen O, Hannabuss J, Todd J, Ferasin L, Payne JR. Prevalence of sudden cardiac death in dogs with atrial fibrillation. J Vet Intern Med 2021; 35:2588-2595. [PMID: 34750853 PMCID: PMC8692199 DOI: 10.1111/jvim.16297] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 11/27/2022] Open
Abstract
Background Atrial fibrillation (AF) is associated with increased risk of sudden cardiac death (SCD) in humans, independent of secondary risk factors such as thrombogenic disorders. In dogs, SCD is described in a number of heart diseases, but an association between AF and SCD is unreported. Hypothesis (a) A higher proportion of dogs with AF will experience SCD, and (b) SCD will be associated with complex ventricular arrhythmias. Animals One‐hundred forty‐two dogs with AF, and 127 dogs without AF. Methods Retrospective, multicenter, case‐control study. Dogs included in the AF group were compared to a control group of dogs in sinus rhythm, matched for echocardiographic diagnosis. Descriptive statistics were used to identify proportions of each group suffering SCD, compared using chi‐squared testing. Risk factors for SCD in dogs with AF were evaluated at the univariable and multivariable level using binary logistic regression. Significance was P < .05. Results A significantly higher proportion of dogs with AF suffered SCD than dogs in the control group (14.8% vs 5.5%; P = .01). Younger age at diagnosis, larger left atrial size, and a history of syncope all were independent predictors of SCD in dogs with AF (χ2, 16.3; P = .04). Conclusions and Clinical Importance Atrial fibrillation was associated with a higher prevalence of SCD in dogs. A history of syncope may be a useful predictor of SCD risk.
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Affiliation(s)
- Kieran Borgeat
- Small Animal Hospital, Langford Vets, University of Bristol, Bristol, United Kingdom
| | - Matthew Pack
- Small Animal Hospital, Langford Vets, University of Bristol, Bristol, United Kingdom
| | | | | | - Joonbum Seo
- Queen Mother Hospital for Animals, Royal Veterinary College, London, United Kingdom
| | - Omri Belachsen
- Southern Counties Veterinary Specialists, Ringwood, United Kingdom
| | - Joshua Hannabuss
- Queen Mother Hospital for Animals, Royal Veterinary College, London, United Kingdom
| | - Julie Todd
- Pride Veterinary Centre, Derby, United Kingdom
| | - Luca Ferasin
- Specialist Veterinary Cardiology Consultancy, Alton, United Kingdom
| | - Jessie Rose Payne
- Small Animal Hospital, Langford Vets, University of Bristol, Bristol, United Kingdom
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13
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Merchant FM, Larson J, Darghosian L, Smith P, Kiani S, Westerman S, Shah AD, Hirsh DS, Lloyd MS, Leon AR, El-Chami MF. Prospective evaluation of health status, quality of life and clinical outcomes following implantable defibrillator generator exchange. J Geriatr Cardiol 2021; 18:720-727. [PMID: 34659378 PMCID: PMC8501388 DOI: 10.11909/j.issn.1671-5411.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Little is known about health status and quality of life (QoL) after implantable cardioverter-defibrillator (ICD) generator exchange (GE). METHODS We prospectively followed patients undergoing first-time ICD GE. Serial assessments of health status were performed by administering the 36-Item Short Form Survey (SF-36). RESULTS Mean age was 67.5 ± 14.3 years, left ventricle ejection fraction (LVEF) was 36.5% ± 15.0% and over 40% of the cohort had improved LVEF to > 35% at the time of GE. SF-36 scores were significantly worse in physical/general health domains compared to domains of emotional/social well-being ( P < 0.001 for each comparison). Physical health scores were significantly worse among those with medical comorbidities including diabetes, chronic obstructive pulmonary disease and atrial fibrillation. Mean follow-up was 1.6 ± 0.5 years after GE. Overall SF-36 scores remained stable across all domains during follow-up. Survival at 3 years post-GE was estimated at 80%. Five patients died during follow-up and most deaths were adjudicated as non-arrhythmic in origin. Four patients experienced appropriate ICD shocks after GE, three of whom had LVEF which remains impaired LVEF (i.e., < 35%) at the time of GE. CONCLUSION Patients undergoing ICD GE have significantly worse physical health compared to emotional/social well-being, which is associated with the presence of medical comorbidities. In terms of clinical outcomes, the incidence of appropriate shocks after GE among those with improvement in LVEF is very low, and most deaths post-procedure appear to be non-arrhythmic in origin. These data represent an attempt to more fully characterize the spectrum of QoL and clinical outcomes after GE.
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Affiliation(s)
- Faisal M Merchant
- Section of Cardiac Electrophysiology, Emory University School of Medicine, Atlanta, GA, USA
| | - John Larson
- Department of Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Leon Darghosian
- Section of Cardiac Electrophysiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Paige Smith
- Section of Cardiac Electrophysiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Soroosh Kiani
- Section of Cardiac Electrophysiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Stacy Westerman
- Section of Cardiac Electrophysiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Anand D. Shah
- Section of Cardiac Electrophysiology, Emory University School of Medicine, Atlanta, GA, USA
| | - David S. Hirsh
- Section of Cardiac Electrophysiology, Emory University School of Medicine, Atlanta, GA, USA
- Grady Health System, Atlanta, GA, USA
| | - Michael S. Lloyd
- Section of Cardiac Electrophysiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Angel R. Leon
- Section of Cardiac Electrophysiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Mikhael F. El-Chami
- Section of Cardiac Electrophysiology, Emory University School of Medicine, Atlanta, GA, USA
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14
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Scheurlen C, van den Bruck J, Wörmann J, Plenge T, Sultan A, Steven D, Lüker J. ICD therapy in the elderly: a retrospective single-center analysis of mortality. Herzschrittmacherther Elektrophysiol 2021; 32:250-256. [PMID: 33512593 PMCID: PMC8166735 DOI: 10.1007/s00399-021-00742-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/06/2021] [Indexed: 10/26/2022]
Abstract
BACKGROUND Current implantable cardioverter-defibrillator (ICD) guidelines do not impose age limitations for ICD implantation (IMPL) and generator exchange (GE); however, patients (pts) should be expected to survive for 1 year. With higher age, comorbidity and mortality due to non-sudden cardiac death increase. Thus, the benefit of ICD therapy in elderly pts remains unclear. Mortality after ICD IMPL or GE in pts ≥ 75 years was assessed. METHODS Consecutive pts aged ≥ 75 years with ICD IMPL or GE at the University Hospital Cologne, Germany, between 01/2013 and 12/2017 were included in this retrospective analysis. RESULTS Of 418 pts, 82 (20%) fulfilled the inclusion criteria; in 70 (55 = IMPL, 79%, 15 = GE, 21%) follow-up (FU) was available. The median FU was 3.1 years. During FU, 40 pts (57%) died (29/55 [53%] IMPL; 11/15 [73%] GE). Mean survival after surgery was 561 ± 462 days. The 1‑year mortality rate was 19/70 (27%) overall, 9/52 (17%) in pts ≥ 75 and 10/18 (56%) in pts ≥ 80 years. Deceased pts were more likely to suffer from chronic renal failure (85% vs. 53%, p = 0.004) and peripheral artery disease (18% vs. 0%, p = 0.02). During FU, seven pts experienced ICD shocks (four appropriate, three inappropriate). In primary prevention (n = 35) mortality was 46% and four pts experienced ICD therapies (two adequate); in secondary prevention (n = 35) mortality was 69% (p = 0.053) with three ICD therapies (two adequate). CONCLUSION Mortality in ICD pts aged ≥ 80 years was 56% at 1 and 72% at 2 years in this retrospective analysis. The decision to implant an ICD in elderly pts should be made carefully and individually.
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Affiliation(s)
- Cornelia Scheurlen
- Department of Electrophysiology, Cologne, University Heart Center Cologne, Kerpener Str. 62, 50937, Köln, Germany.
| | - Jan van den Bruck
- Department of Electrophysiology, Cologne, University Heart Center Cologne, Kerpener Str. 62, 50937, Köln, Germany
| | - Jonas Wörmann
- Department of Electrophysiology, Cologne, University Heart Center Cologne, Kerpener Str. 62, 50937, Köln, Germany
| | - Tobias Plenge
- Cardiology, Clinic Ernst von Bergmann, Potsdam, Germany
| | - Arian Sultan
- Department of Electrophysiology, Cologne, University Heart Center Cologne, Kerpener Str. 62, 50937, Köln, Germany
| | - Daniel Steven
- Department of Electrophysiology, Cologne, University Heart Center Cologne, Kerpener Str. 62, 50937, Köln, Germany
| | - Jakob Lüker
- Department of Electrophysiology, Cologne, University Heart Center Cologne, Kerpener Str. 62, 50937, Köln, Germany
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15
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Downgrade of cardiac defibrillator devices to pacemakers in elderly heart failure patients: clinical considerations and the importance of shared decision-making. Neth Heart J 2021; 29:243-252. [PMID: 33710494 PMCID: PMC8062634 DOI: 10.1007/s12471-021-01555-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2021] [Indexed: 11/11/2022] Open
Abstract
Implantable cardioverter defibrillators are implanted on a large scale in patients with heart failure (HF) for the prevention of sudden cardiac death. There are different scenarios in which defibrillator therapy is no longer desired or indicated, and this is occurring increasingly in elderly patients. Usually device therapy is continued until the device has reached battery depletion. At that time, the decision needs to be made to either replace it or to downgrade to a pacing-only device. This decision is dependent on many factors, including the vitality of the patient and his/her preferences, but may also be influenced by changes in recommendations in guidelines. In the last few years, there has been an increased awareness that discussions around these decisions are important and useful. Advanced care planning and shared decision-making have become important and are increasingly recognised as such. In this short review we describe six elderly patients with HF, in whose cases we discussed these issues, and we aim to provide some scientific and ethical rationale for clinical decision-making in this context. Current guidelines advocate the discussion of end-of-life options at the time of device implantation, and physicians should realise that their choices influence patients’ options in this critical phase of their illness.
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16
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Shen L, Jhund PS, Anand IS, Carson PE, Desai AS, Granger CB, Køber L, Komajda M, McKelvie RS, Pfeffer MA, Solomon SD, Swedberg K, Zile MR, McMurray JJV. Developing and validating models to predict sudden death and pump failure death in patients with heart failure and preserved ejection fraction. Clin Res Cardiol 2020; 110:1234-1248. [PMID: 33301080 PMCID: PMC8318942 DOI: 10.1007/s00392-020-01786-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/24/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Sudden death (SD) and pump failure death (PFD) are leading modes of death in heart failure and preserved ejection fraction (HFpEF). Risk stratification for mode-specific death may aid in patient enrichment for new device trials in HFpEF. METHODS Models were derived in 4116 patients in the Irbesartan in Heart Failure with Preserved Ejection Fraction trial (I-Preserve), using competing risks regression analysis. A series of models were built in a stepwise manner, and were validated in the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM)-Preserved and Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trials. RESULTS The clinical model for SD included older age, men, lower LVEF, higher heart rate, history of diabetes or myocardial infarction, and HF hospitalization within previous 6 months, all of which were associated with a higher SD risk. The clinical model predicting PFD included older age, men, lower LVEF or diastolic blood pressure, higher heart rate, and history of diabetes or atrial fibrillation, all for a higher PFD risk, and dyslipidaemia for a lower risk of PFD. In each model, the observed and predicted incidences were similar in each risk subgroup, suggesting good calibration. Model discrimination was good for SD and excellent for PFD with Harrell's C of 0.71 (95% CI 0.68-0.75) and 0.78 (95% CI 0.75-0.82), respectively. Both models were robust in external validation. Adding ECG and biochemical parameters, model performance improved little in the derivation cohort but decreased in validation. Including NT-proBNP substantially increased discrimination of the SD model, and simplified the PFD model with marginal increase in discrimination. CONCLUSIONS The clinical models can predict risks for SD and PFD separately with good discrimination and calibration in HFpEF and are robust in external validation. Adding NT-proBNP further improved model performance. These models may help to identify high-risk individuals for device intervention in future trials. CLINICAL TRIAL REGISTRATION I-Preserve: ClinicalTrials.gov NCT00095238; TOPCAT: ClinicalTrials.gov NCT00094302; CHARM-Preserved: ClinicalTrials.gov NCT00634712.
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Affiliation(s)
- Li Shen
- Department of Medicine, Hangzhou Normal University, Hangzhou, 310003, China.,British Heart Foundation Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Pardeep S Jhund
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Inder S Anand
- Department of Medicine, University of Minnesota Medical School and VA Medical Center, Minneapolis, USA
| | - Peter E Carson
- Department of Cardiology, Washington VA Medical Center, Washington, DC, USA
| | - Akshay S Desai
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | | | - Lars Køber
- Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Michel Komajda
- Department of Cardiology, Hospital Saint Joseph, Paris, France
| | | | - Marc A Pfeffer
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Scott D Solomon
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Karl Swedberg
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Michael R Zile
- Medical University of South Carolina and RHJ Department of Veterans Administration Medical Center, Charleston, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK.
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17
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Geriatric issues in patients with or being considered for implanted cardiac rhythm devices: a case-based review. J Geriatr Cardiol 2020; 17:710-722. [PMID: 33343650 PMCID: PMC7729179 DOI: 10.11909/j.issn.1671-5411.2020.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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18
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Yokoshiki H, Shimizu A, Mitsuhashi T, Ishibashi K, Kabutoya T, Yoshiga Y, Kohno R, Abe H, Nogami A. Trends in the use of implantable cardioverter-defibrillator and cardiac resynchronization therapy device in advancing age: Analysis of the Japan cardiac device treatment registry database. J Arrhythm 2020; 36:737-745. [PMID: 32782648 PMCID: PMC7411238 DOI: 10.1002/joa3.12377] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/25/2020] [Accepted: 05/17/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Trends of de novo implantation of cardiac implantable electronic devices (CIEDs) including implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy with a defibrillator (CRT-D) or pacemaker (CRT-P) in advancing age are unknown. METHODS Analysis of data from the Japan cardiac device treatment registry (JCDTR) with an implantation date between January 2006 and December 2016 was performed focusing on advancing age of ≧75 years. RESULTS The cohort included 17 564 ICD, 9470 CRT-D and 1087 CRT-P recipients for de novo implantation. The rate of patients ≧75 years of age increased from 17.1% to 20.5% in ICD implantation (P = .052), from 19.7% to 30.0% in CRT-D implantation (P < .0001), and from 40.0% to 64.0% in CRT-P implantation (P = .17). There was an apparent increase in the percentage of nonischemic patients aged ≧75 years receiving ICD (10.9% in 2006 to 16.4% in 2016, P = .0008) and CRT-D (17.1% in 2006 to 27.8% in 2016, P = .0001). The implantation for primary prevention ICD (P = .059) and CRT-D (P = .012) was also associated with a temporal increase in the percentage of patients aged ≧75 years. CONCLUSIONS Proportion of patients ≧75 years of age for de novo CIED implantation gradually increased from 2006 to 2016, presumably because of the growing number of nonischemic cardiomyopathy and heart failure patients requiring primary prevention of sudden cardiac death.
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Affiliation(s)
- Hisashi Yokoshiki
- Department of Cardiovascular MedicineSapporo City General HospitalSapporoJapan
| | | | - Takeshi Mitsuhashi
- Cardiovascular MedicineJichi Medical University Saitama Medical CenterSaitamaJapan
| | - Kohei Ishibashi
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Tomoyuki Kabutoya
- Division of Cardiovascular MedicineDepartment of MedicineJichi Medical University School of MedicineShimotsukeJapan
| | - Yasuhiro Yoshiga
- Division of CardiologyDepartment of Medicine and Clinical ScienceYamaguchi University Graduate School of MedicineYamaguchiJapan
| | - Ritsuko Kohno
- Department of Heart Rhythm ManagementUniversity of Occupational & Environmental HealthKitakyushuJapan
| | - Haruhiko Abe
- Department of Heart Rhythm ManagementUniversity of Occupational & Environmental HealthKitakyushuJapan
| | - Akihiko Nogami
- Cardiovascular DivisionFaculty of MedicineUniversity of TsukubaTsukubaJapan
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19
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Elming MB, Thøgersen AM, Videbæk L, Bruun NE, Eiskjær H, Haarbo J, Egstrup K, Gustafsson F, Hastrup Svendsen J, Høfsten DE, Pehrson S, Nielsen JC, Køber L, Thune JJ. Duration of Heart Failure and Effect of Defibrillator Implantation in Patients With Nonischemic Systolic Heart Failure. Circ Heart Fail 2019; 12:e006022. [PMID: 31500444 DOI: 10.1161/circheartfailure.119.006022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with nonischemic systolic heart failure (HF) have increased risk of sudden cardiac death (SCD) and death from progressive pump failure. Whether the risk of SCD changes over time is unknown. We seek here to investigate the relation between duration of HF, mode of death, and effect of implantable cardioverter-defibrillator implantation. METHODS AND RESULTS We examined the risk of all-cause death and SCD according to the duration of HF among patients with nonischemic systolic HF enrolled in the DANISH (Danish Study to Assess the Efficacy of ICDs in Patients with Non-ischemic Systolic Heart Failure on Mortality). In all, 1116 patients were included. Patients were divided according to quartiles of HF duration (≤8, 9≤18, 19≤65, and ≥66 months). Patients with the longest duration of HF were older, more often men, had more comorbidity, and more often received a cardiac resynchronization therapy device. Doubling of HF duration was an independent predictor of both all-cause mortality (hazard ratio [HR], 1.27; 95% CI, 1.17-1.38; P<0.0001), and SCD (HR, 1.29; 95% CI, 1.11-1.50; P=0.0007). The proportion of deaths caused by SCD was not different between HF quartiles (P=0.91), and the effect of implantable cardioverter-defibrillator implantation on all-cause mortality was not modified by the duration of HF (P=0.59). CONCLUSIONS Duration of HF predicted both all-cause mortality and risk of SCD independently of other risk indicators. However, the proportion of death caused by SCD did not change with longer duration of HF, and the effect of implantable cardioverter-defibrillator was not modified by the duration of HF. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT00542945.
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Affiliation(s)
- Marie Bayer Elming
- Department of Cardiology, Rigshospitalet (M.B.E., J.H.S., F.G., D.E.H., S.P., L.K.), University of Copenhagen, Denmark.,Faculty of Health and Medical Sciences (M.B.E., N.E.B., F.G., J.H.S., L.K., J.J.T.), University of Copenhagen, Denmark
| | - Anna M Thøgersen
- Department of Cardiology (A.M.T.), Aalborg University Hospital, Denmark
| | - Lars Videbæk
- Department of Cardiology, Odense University Hospital, Denmark (L.V.)
| | - Niels E Bruun
- Faculty of Health and Medical Sciences (M.B.E., N.E.B., F.G., J.H.S., L.K., J.J.T.), University of Copenhagen, Denmark.,Clinical Institute (N.E.B.), Aalborg University Hospital, Denmark.,Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (N.E.B.)
| | - Hans Eiskjær
- Department of Cardiology, Aarhus University Hospital, Denmark (H.E., J.C.N.)
| | - Jens Haarbo
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H.)
| | - Kenneth Egstrup
- Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.)
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet (M.B.E., J.H.S., F.G., D.E.H., S.P., L.K.), University of Copenhagen, Denmark.,Faculty of Health and Medical Sciences (M.B.E., N.E.B., F.G., J.H.S., L.K., J.J.T.), University of Copenhagen, Denmark
| | - Jesper Hastrup Svendsen
- Department of Cardiology, Rigshospitalet (M.B.E., J.H.S., F.G., D.E.H., S.P., L.K.), University of Copenhagen, Denmark.,Faculty of Health and Medical Sciences (M.B.E., N.E.B., F.G., J.H.S., L.K., J.J.T.), University of Copenhagen, Denmark
| | - Dan E Høfsten
- Department of Cardiology, Rigshospitalet (M.B.E., J.H.S., F.G., D.E.H., S.P., L.K.), University of Copenhagen, Denmark
| | - Steen Pehrson
- Department of Cardiology, Rigshospitalet (M.B.E., J.H.S., F.G., D.E.H., S.P., L.K.), University of Copenhagen, Denmark
| | - Jens C Nielsen
- Department of Cardiology, Aarhus University Hospital, Denmark (H.E., J.C.N.)
| | - Lars Køber
- Department of Cardiology, Rigshospitalet (M.B.E., J.H.S., F.G., D.E.H., S.P., L.K.), University of Copenhagen, Denmark.,Faculty of Health and Medical Sciences (M.B.E., N.E.B., F.G., J.H.S., L.K., J.J.T.), University of Copenhagen, Denmark
| | - Jens Jakob Thune
- Faculty of Health and Medical Sciences (M.B.E., N.E.B., F.G., J.H.S., L.K., J.J.T.), University of Copenhagen, Denmark.,Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
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20
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Coiro S, Girerd N, Sharma A, Rossignol P, Tritto I, Pitt B, Pfeffer MA, McMurray JJV, Ambrosio G, Dickstein K, Moss A, Zannad F. Association of diabetes and kidney function according to age and systolic function with the incidence of sudden cardiac death and non-sudden cardiac death in myocardial infarction survivors with heart failure. Eur J Heart Fail 2019; 21:1248-1258. [PMID: 31476097 DOI: 10.1002/ejhf.1541] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 05/29/2019] [Indexed: 12/19/2022] Open
Abstract
AIMS An implantable cardioverter-defibrillator (ICD) is recommended for reducing the risk of sudden cardiac death (SCD) in myocardial infarction (MI) patients with a left ventricular ejection fraction (LVEF) ≤ 30%, as well as patients with a LVEF ≤ 35% and heart failure symptoms. Diabetes and/or impaired kidney function may confer additional SCD risk. We assessed the association between these two risk factors with SCD and non-SCD among MI survivors taking account of age and LVEF. METHODS AND RESULTS A total of 17 773 patients from the High-Risk MI Database were evaluated. Overall, diabetes and estimated glomerular filtration rate < 60 mL/min/1.73 m2 , individually and together, conferred a higher risk of SCD [adjusted competing risk: hazard ratio (HR) 1.23, 1.23, and 1.32, respectively; all P < 0.03] and non-SCD (HR 1.34, 1.52, and 2.13, respectively; all P < 0.0001). Annual SCD rates in patients with LVEF > 35% and with diabetes, impaired kidney function, or both (2.0%, 2.5% and 2.7%, respectively) were comparable to rates observed in patients with LVEF 30-35% but no such risk factors (1.7%). However, these patients had also similarly higher non-SCD rates, such that the ratio of SCD to non-SCD was not increased. Importantly, this ratio was mostly dependent on age, with higher overall ratios in youngest subgroups (0.89 in patients < 55 years vs. 0.38 in patients ≥ 75 years), regardless of risk factors. CONCLUSION Although MI survivors with LVEF > 35% with diabetes, impaired kidney function, or both are at increased risk of SCD, the risk of non-SCD risk is even higher, suggesting an extension of the current indication for an ICD to them is unlikely to be worthwhile. MI survivors with low LVEF and aged < 55 years are likely to have the greatest potential benefit from ICD implantation.
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Affiliation(s)
- Stefano Coiro
- Division of Cardiology, University of Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy.,INSERM, Centred'Investigation Clinique -1433 and Unité 1116, Nancy, France.,CHU Nancy, Institut Lorraindu Cœur et des Vaisseaux, Vandoeuvre lès, Nancy, France.,Université de Lorraine, Nancy, France.,F-CRIN INI-CRCT (Cardiovascular and RenalClinical Trialists) Network, Nancy, France
| | - Nicolas Girerd
- INSERM, Centred'Investigation Clinique -1433 and Unité 1116, Nancy, France.,CHU Nancy, Institut Lorraindu Cœur et des Vaisseaux, Vandoeuvre lès, Nancy, France.,Université de Lorraine, Nancy, France.,F-CRIN INI-CRCT (Cardiovascular and RenalClinical Trialists) Network, Nancy, France
| | - Abhinav Sharma
- Duke Clinical Research Institute, Duke University, Durham, NC, USA.,University of Alberta, Edmonton, Alberta, Canada.,Stanford University, Palo Alto, CA, USA
| | - Patrick Rossignol
- INSERM, Centred'Investigation Clinique -1433 and Unité 1116, Nancy, France.,CHU Nancy, Institut Lorraindu Cœur et des Vaisseaux, Vandoeuvre lès, Nancy, France.,Université de Lorraine, Nancy, France.,F-CRIN INI-CRCT (Cardiovascular and RenalClinical Trialists) Network, Nancy, France
| | - Isabella Tritto
- Division of Cardiology, University of Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy
| | | | - Marc A Pfeffer
- Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Giuseppe Ambrosio
- Division of Cardiology, University of Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy
| | - Kenneth Dickstein
- Division of Cardiology, Stavanger University Hospital, Stavanger, Norway.,Institute of Internal Medicine, University of Bergen, Bergen, Norway
| | - Arthur Moss
- Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, NY, USA
| | - Faiez Zannad
- INSERM, Centred'Investigation Clinique -1433 and Unité 1116, Nancy, France.,CHU Nancy, Institut Lorraindu Cœur et des Vaisseaux, Vandoeuvre lès, Nancy, France.,Université de Lorraine, Nancy, France.,F-CRIN INI-CRCT (Cardiovascular and RenalClinical Trialists) Network, Nancy, France
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21
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Curtis AB, Karki R, Hattoum A, Sharma UC. Arrhythmias in Patients ≥80 Years of Age: Pathophysiology, Management, and Outcomes. J Am Coll Cardiol 2019; 71:2041-2057. [PMID: 29724357 DOI: 10.1016/j.jacc.2018.03.019] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/12/2018] [Accepted: 03/12/2018] [Indexed: 12/14/2022]
Abstract
Advances in medical care have led to an increase in the number of octogenarians and even older patients, forming an important and unique patient subgroup. It is clear that advancing age is an independent risk factor for the development of most arrhythmias, causing substantial morbidity and mortality. Patients ≥80 years of age have significant structural and electrical remodeling of cardiac tissue; accrue competing comorbidities; react differently to drug therapy; and may experience falls, frailty, and cognitive impairment, presenting significant therapeutic challenges. Unfortunately, very old patients are under-represented in clinical trials, leading to critical gaps in evidence to guide effective and safe treatment of arrhythmias. In this state-of-the-art review, we examine the pathophysiology of aging and arrhythmias and then present the available evidence on age-specific management of the most common arrhythmias, including drugs, catheter ablation, and cardiac implantable electronic devices.
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Affiliation(s)
- Anne B Curtis
- Department of Medicine, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, Buffalo, New York.
| | - Roshan Karki
- Department of Medicine, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Alexander Hattoum
- Department of Medicine, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Umesh C Sharma
- Department of Medicine, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, Buffalo, New York
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22
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Krieger K, Lenz C. [Continuation of ICD treatment at the time of device exchange without adequate treatment?]. Herzschrittmacherther Elektrophysiol 2019; 30:191-196. [PMID: 31001686 DOI: 10.1007/s00399-019-0621-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Due to improved treatment of heart failure, patients are older and have more comorbidities at the time of an elective device exchange. This leads to higher rates of complications and represents an opportunity for re-evaluation of the implantable cardioverter defibrillator (ICD) treatment. OBJECTIVE This article reviews the current literature regarding the indications for continued ICD therapy and device exchange in patients who have never received adequate treatment through the ICD. MATERIAL AND METHODS Patients with primarily prophylactic indications, who have not received adequate treatment and have shown significant improvement in the left ventricular ejection fraction (LVEF) >35%, have a significantly lower risk of ventricular arrythmia (VA) after device exchange. Although further ventricular events can occur in these patients, the continuation of ICD treatment should be individually discussed in cases of high age and increased comorbidities. In female patients with a non-ischemic cardiac myopathy and an almost normalized LVEF, mostly during cardiac resynchronization therapy (CRT), a discontinuation of ICD treatment or downgrading to CRT with pacemaker (CRT-P) treatment should be discussed. CONCLUSION At the time of an elective device exchange for primarily prophylactic indications, the possibility to discontinue ICD treatment can be discussed with patients who have not experienced adequate treatment. Additional factors, such as LVEF, age, sex and comorbidities of the patient should be taken into consideration in order to make an individualized decision. As prospective randomized studies are lacking, it is not possible to give generally valid recommendations.
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Affiliation(s)
- Konstantin Krieger
- Klinik für Innere Medizin und Kardiologie, Unfallkrankenhaus Berlin, Warenerstraße 7, 12683, Berlin, Deutschland.
| | - Corinna Lenz
- Klinik für Innere Medizin und Kardiologie, Unfallkrankenhaus Berlin, Warenerstraße 7, 12683, Berlin, Deutschland.
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23
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Ruwald MH, Ruwald AC, Johansen JB, Gislason G, Nielsen JC, Philbert B, Riahi S, Vinther M, Lindhardt TB. Incidence of appropriate implantable cardioverter-defibrillator therapy and mortality after implantable cardioverter-defibrillator generator replacement: results from a real-world nationwide cohort. Europace 2019; 21:1211-1219. [DOI: 10.1093/europace/euz121] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 04/02/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
The safety of omitting implantable cardioverter-defibrillator (ICD) generator replacement in patients with no prior appropriate therapy, comorbid conditions, and advanced age is unclear. The aim was to investigate incidence of appropriate ICD therapy after generator replacement.
Methods and results
We identified patients implanted with a primary prevention ICD (n = 4630) from 2007 to 2016, who subsequently underwent an elective ICD generator replacement (n = 670) from the Danish Pacemaker and ICD Register. The data were linked to other databases and evaluated the outcomes of appropriate therapy and death. Predictors of ICD therapy were identified using multivariate Cox regression analyses. A total of 670 patients underwent elective ICD generator replacement. Of these, 197 (29.4%) patients had experienced appropriate therapy in their 1st generator period. During follow-up of 2.0 ± 1.6 years, 95 (14.2%) patients experienced appropriate therapy. Predictors of appropriate therapy in 2nd generator period was low initial left ventricular ejection fraction (≤25%) [hazard ratio (HR) 1.87, confidence interval (CI) 1.13–1.95] and appropriate therapy in 1st generator period (HR 3.95, CI 2.57–6.06). For patients with appropriate therapy in 1st generator period, 4-year incidence of appropriate therapy was 50.6% vs. 16.4% in those without (P < 0.001). Among patients >80 years with no prior appropriate therapy 8.8% of patients experienced appropriate therapy after replacement. Comorbidity burden and advanced age were associated with reduced device utilization after replacement and a high competing risk of death without preceding appropriate therapy.
Conclusion
A significant residual risk of appropriate therapy in the 2nd generator was present even among patients with advanced age and with a full prior generator period without any appropriate ICD events.
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Affiliation(s)
- Martin H Ruwald
- Department of Cardiology, Herlev-Gentofte University Hospitals, Kildegaardsvej 28,2900 Hellerup, Denmark
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
| | - Anne-Christine Ruwald
- Department of Cardiology, Herlev-Gentofte University Hospitals, Kildegaardsvej 28,2900 Hellerup, Denmark
| | - Jens Brock Johansen
- Department of Cardiology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Herlev-Gentofte University Hospitals, Kildegaardsvej 28,2900 Hellerup, Denmark
- National Institute of Public Health, Copenhagen, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
| | | | - Berit Philbert
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Michael Vinther
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen, Denmark
| | - Tommi B Lindhardt
- Department of Cardiology, Herlev-Gentofte University Hospitals, Kildegaardsvej 28,2900 Hellerup, Denmark
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24
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Zakine C, Garcia R, Narayanan K, Gandjbakhch E, Algalarrondo V, Lellouche N, Perier MC, Fauchier L, Gras D, Bordachar P, Piot O, Babuty D, Sadoul N, Defaye P, Deharo JC, Klug D, Leclercq C, Extramiana F, Boveda S, Marijon E. Prophylactic implantable cardioverter-defibrillator in the very elderly. Europace 2019; 21:1063-1069. [DOI: 10.1093/europace/euz041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 02/22/2019] [Indexed: 12/31/2022] Open
Abstract
Aims
Current guidelines do not propose any age cut-off for the primary prevention implantable cardioverter-defibrillator (ICD). However, the risk/benefit balance in the very elderly population has not been well studied.
Methods and results
In a multicentre French study assessing patients implanted with an ICD for primary prevention, outcomes among patients aged ≥80 years were compared with <80 years old controls matched for sex and underlying heart disease (ischaemic and dilated cardiomyopathy). A total of 300 ICD recipients were enrolled in this specific analysis, including 150 patients ≥80 years (mean age 81.9 ± 2.0 years; 86.7% males) and 150 controls (mean age 61.8 ± 10.8 years). Among older patients, 92 (75.6%) had no more than one associated comorbidity. Most subjects in the elderly group got an ICD as part of a cardiac resynchronization therapy procedure (74% vs. 46%, P < 0.0001). After a mean follow-up of 3.0 ± 2 years, 53 patients (35%) in the elderly group died, including 38.2% from non cardiovascular causes of death. Similar proportion of patients received ≥1 appropriate therapy (19.4% vs. 21.6%; P = 0.65) in the elderly group and controls, respectively. There was a trend towards more early perioperative events (P = 0.10) in the elderly, with no significant increase in late complications (P = 0.73).
Conclusion
Primary prevention ICD recipients ≥80 years in the real world had relatively low associated comorbidity. Rates of appropriate therapies and device-related complications were similar, compared with younger subjects. Nevertheless, the inherent limitations in interpreting observational data on this particular competing risk situation call for randomized controlled trials to provide definitive answers. Meanwhile, a careful multidisciplinary evaluation is needed to guide patient selection for ICD implantation in the elderly population.
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Affiliation(s)
- Cyril Zakine
- Paris Cardiovascular Research Center, Paris, France
| | | | - Kumar Narayanan
- Paris Cardiovascular Research Center, Paris, France
- Maxcure Hospitals, Hyderabad, India
| | | | | | | | - Marie-Cécile Perier
- Paris Cardiovascular Research Center, Paris, France
- European Georges Pompidou Hospital, Cardiology Department, Paris, France
| | | | | | | | - Olivier Piot
- Centre Cardiologique du Nord, Saint Denis, France
| | | | | | | | | | | | | | | | | | - Eloi Marijon
- Paris Cardiovascular Research Center, Paris, France
- European Georges Pompidou Hospital, Cardiology Department, Paris, France
- Paris Descartes University, Paris, France
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25
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Padmanabhan D, Asirvatham SJ. Non-ischemic cardiomyopathy in the elderly: A shocking conundrum. Indian Pacing Electrophysiol J 2019; 19:1-3. [PMID: 30615931 PMCID: PMC6354215 DOI: 10.1016/j.ipej.2019.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Deepak Padmanabhan
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, India.
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26
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Bokeria LA, Neminushchiy NM, Postol AS. Implantable Cardioverter-Defibrillators are the Main Link in the Modern Concept of Sudden Cardiac Death Prevention. Problems and Prospects of the Development of the Method. ACTA ACUST UNITED AC 2018; 58:76-84. [PMID: 30625100 DOI: 10.18087/cardio.2018.12.10197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 12/25/2018] [Indexed: 11/18/2022]
Abstract
The article covers the development of the problem of sudden cardiac death prevention with the implantable cardioverter-defibrillators from the moment of creation of these devices to our days. The current concept of primary prevention of sudden cardiac death, based on the severity of manifestation of heart failure and left ventricular dysfunction, is not effective enough. Its practical application is difficult because it requires mass application of implantable defibrillators, with low predictive accuracy of these criteria in terms of development of life-threatening arrhythmias. The development of methods for visualizing the myocardium, allowing to assess the severity of myocardial fibrosis, as well as the possibilities of medical genetics, at the present stage, allows us to clarify indications for implantation of cardioverter-defibrillators and thereby significantly improve the concept of preventing sudden cardiac death with these instruments.
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Affiliation(s)
- L A Bokeria
- Sechenov First Moscow State Medical University.
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27
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Blanch B, Lago LP, Sy R, Harris PJ, Semsarian C, Ingles J. Implantable cardioverter–defibrillator therapy in Australia, 2002–2015. Med J Aust 2018; 209:123-129. [DOI: 10.5694/mja17.01183] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 05/02/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Bianca Blanch
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, NSW
| | - Luise P Lago
- Centre for Health Research, University of Wollongong, Wollongong, NSW
| | - Raymond Sy
- Sydney Medical School, University of Sydney, Sydney, NSW
| | | | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, NSW
- Sydney Medical School, University of Sydney, Sydney, NSW
- Royal Prince Alfred Hospital, Sydney, NSW
| | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, NSW
- Sydney Medical School, University of Sydney, Sydney, NSW
- Royal Prince Alfred Hospital, Sydney, NSW
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28
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Eiser AR, Kirkpatrick JN, Patton KK, McLain E, Dougherty CM, Beattie JM. Putting the “Informed” in the informed consent process for implantable cardioverter-defibrillators: Addressing the needs of the elderly patient. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:312-320. [DOI: 10.1111/pace.13288] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 11/14/2017] [Accepted: 01/15/2018] [Indexed: 12/26/2022]
Affiliation(s)
- Arnold R. Eiser
- Department of Medicine; Drexel University College of Medicine; Philadelphia PA USA
- Leonard Davis Institute; University of Pennsylvania; Philadelphia PA USA
| | - James N. Kirkpatrick
- Division of Cardiology; University of Washington School of Medicine; Seattle WA USA
| | - Kristen K. Patton
- Division of Cardiology; University of Washington School of Medicine; Seattle WA USA
| | - Emily McLain
- Summit Cardiology; Northwest Hospital; Seattle WA USA
| | - Cynthia M. Dougherty
- Research Biobehavioral and Health Systems; University of Washington School of Nursing; Seattle WA USA
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29
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Ajam T, Kalra V, Shen C, Li X, Gautam S, Kambur T, Barmeda M, Yancey KW, Ajam S, Garlie J, Miller JM, Jain R. Natural History of Implantable Cardioverter-Defibrillator Implanted at or after the Age of 70 years in a Veteran Population: A Single Center Study. J Atr Fibrillation 2017; 9:1496. [PMID: 29250256 DOI: 10.4022/jafib.1496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 11/19/2016] [Accepted: 12/10/2016] [Indexed: 11/12/2022]
Abstract
Background The median age of patients in major Implantable Cardioverter-defibrillator (ICD)trials (MUSTT, MADIT-I, MADIT-II, and SCD-HeFT) was 63-67 years; with only 11% ≥70 years. There is little follow-up data on patients over 70 years of age who received an ICD for primary/secondary prevention of sudden cardiac death, particularly for veterans. Objective The aim of this study was to study the natural history of ICD implantation for veterans over 70 years of age. Methods We retrospectively reviewed single center ICD data in 216 patients with a mean age at implantation 76 ± 4 years. The ICD indication was primary prevention in 161 patients and secondary prevention in 55 patients. The ICD indication was unavailable in 4 patients. Results Mean duration of follow up was 1686 ± 1244 days during which 114 (52%) patients died. Of these, 31% died without receiving any appropriate ICD therapy. Overall, 60/216 (28%) received appropriate therapy and 28/216 (13%) received inappropriate therapy. Patients who had ICD implantation for secondary prophylaxis had statistically more (p= 0.02) appropriate therapies compared to patients who had ICD implantation for primary prevention. Indication for implantation and hypertension predicted appropriate therapy, while age at the time of implantation and presence of atrial fibrillation predicted inappropriate therapies. Overall, 7.7% had device related complications. Conclusions Although 28% septuagenarians in this study received appropriate ICD therapy, they had high rates of mortality, inappropriate therapy, and device complications. ICD implantation in the elderly merits individualized consideration, with higher benefit for secondary prevention.
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Affiliation(s)
- Tarek Ajam
- Division of Cardiology, Department of Medicine, Richard L Roudebush Veterans Affairs Medical Center, Indianapolis, IN.,Division of Cardiology, Indiana University School of Medicine, Indianapolis, IN
| | - Vikas Kalra
- Division of Cardiology, Department of Medicine, Richard L Roudebush Veterans Affairs Medical Center, Indianapolis, IN.,Division of Cardiology, Indiana University School of Medicine, Indianapolis, IN
| | - Changyu Shen
- Department of Biostatistics, School of Medicine and Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN
| | - Xiaochen Li
- Department of Biostatistics, School of Medicine and Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN
| | - Sandeep Gautam
- Division of Cardiovascular Medicine, University of Missouri, Columbia, MO
| | - Thomas Kambur
- Division of Cardiology, Department of Medicine, Richard L Roudebush Veterans Affairs Medical Center, Indianapolis, IN.,Division of Cardiology, Indiana University School of Medicine, Indianapolis, IN
| | - Mamta Barmeda
- Indiana University School of Allied Health Sciences, Indianapolis, IN
| | - Kyle W Yancey
- Division of Cardiovascular and Thoracic Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Samer Ajam
- Division of Cardiology, Department of Medicine, Richard L Roudebush Veterans Affairs Medical Center, Indianapolis, IN.,Division of Cardiology, Indiana University School of Medicine, Indianapolis, IN
| | - Jason Garlie
- Division of Cardiology, Department of Medicine, Richard L Roudebush Veterans Affairs Medical Center, Indianapolis, IN.,Division of Cardiology, Indiana University School of Medicine, Indianapolis, IN
| | - John M Miller
- Division of Cardiology, Department of Medicine, Richard L Roudebush Veterans Affairs Medical Center, Indianapolis, IN.,Division of Cardiology, Indiana University School of Medicine, Indianapolis, IN
| | - Rahul Jain
- Division of Cardiology, Department of Medicine, Richard L Roudebush Veterans Affairs Medical Center, Indianapolis, IN.,Division of Cardiology, Indiana University School of Medicine, Indianapolis, IN
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Boriani G, Malavasi VL. Extending survival by reducing sudden death with implantable cardioverter-defibrillators: a challenging clinical issue in non-ischaemic and ischaemic cardiomyopathies. Eur J Heart Fail 2017; 20:420-426. [PMID: 29164794 DOI: 10.1002/ejhf.1080] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 09/26/2017] [Accepted: 10/15/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Vincenzo Livio Malavasi
- Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
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Schleifer JW, Shen WK. Implantable Cardioverter-Defibrillator Implantation, Continuation, and Deactivation in Elderly Patients. CURRENT GERIATRICS REPORTS 2017. [DOI: 10.1007/s13670-017-0226-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Sudden cardiac death (SCD) remains a major public health burden despite revolutionary progress in the last three decades in the treatment of ventricular tachyarrhythmia with the use of implantable cardioverter defibrillator (ICD) therapy. Survivors of sudden cardiac arrest are at high risk for recurrent tachyarrhythmia events. Early recognition of low left ventricular ejection fractions (≤35%) as a strong predictor of mortality and the causal association between ventricular tachyarrhythmia and SCD has led to a significant development of not only pharmacological antiarrhythmic therapy but also device-based prevention of SCD. The ICD therapy is nowadays routinely used for primary prevention of SCD in patients with significant structural cardiomyopathy and primary electrical arrhythmia syndromes, which are associated with high a risk and secondary prevention in survivors of sudden cardiac arrest. Additionally, effective approaches exist to significantly reduce the recurrence rate of ventricular tachyarrhythmia of various origins by complex electrophysiological endocardial and epicardial catheter ablation procedures.
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Ferretto S, Zorzi A, Dalla Valle C, Migliore F, Leoni L, De Lazzari M, Corrado D, Iliceto S, Bertaglia E. Implantable cardioverter-defibrillator in the elderly: Predictors of appropriate interventions and mortality at 12-month follow-up. Pacing Clin Electrophysiol 2017; 40:1368-1373. [PMID: 28994461 DOI: 10.1111/pace.13215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 07/22/2017] [Accepted: 10/01/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The effectiveness of implantable cardioverter-defibrillator (ICD) in the elderly is uncertain, given their competing risk of nonarrhythmic death. Guidelines state that an ICD should be implanted if the expectation of survival is at least 1 year. However, survival is not easy to predict in elderly patients with severe cardiac disease. AIM To assess 12-month survival after ICD implantation in patients aged ≥75 years, to identify predictors of 12-month mortality, and to evaluate the incidence of ICD therapy during follow-up. METHODS We retrospectively analyzed all clinical, instrumental, and survival data of patients ≥75 years old who received an ICD in our center from 2000 to 2013. RESULTS We included 127 patients (mean age 78 years). ICD was implanted for primary prevention in 61%. The 12-month survival rate was 87.4%. At both univariate and multivariate analyses, left ventricular ejection fraction (EF) ≤ 25%, and moderate to severe impaired renal function (IRF) independently predicted 12-month mortality that was as high as 45.5% in patients with both risk factors. During a median follow-up of 38 months, 30 patients (23.6%) received ≥1 appropriate ICD interventions, but only 3.1% of shocks occurred during the first year, and none in the subgroup of patients with EF ≤ 25% and IRF. CONCLUSION Twelve-month survival in elderly patients after ICD implantation is good and the indication for ICD should not be based on age alone. However, the subgroup with EF ≤ 25% and IRF showed a high 12-month nonarrhythmic mortality and did not benefit from ICD implantation.
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Affiliation(s)
- Sonia Ferretto
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Chiara Dalla Valle
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Federico Migliore
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Loira Leoni
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Manuel De Lazzari
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Sabino Iliceto
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Emanuele Bertaglia
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
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Jabbari R, Glinge C, Risgaard B, Lynge TH, Winkel BG, Haunsø S, Albert CM, Engstrøm T, Tfelt-Hansen J. Differences in clinical characteristics in patients with first ST-segment elevation myocardial infarction and ventricular fibrillation according to sex. J Interv Card Electrophysiol 2017; 50:133-140. [DOI: 10.1007/s10840-017-0284-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 08/29/2017] [Indexed: 10/18/2022]
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Elming MB, Nielsen JC, Haarbo J, Videbæk L, Korup E, Signorovitch J, Olesen LL, Hildebrandt P, Steffensen FH, Bruun NE, Eiskjær H, Brandes A, Thøgersen AM, Gustafsson F, Egstrup K, Videbæk R, Hassager C, Svendsen JH, Høfsten DE, Torp-Pedersen C, Pehrson S, Køber L, Thune JJ. Age and Outcomes of Primary Prevention Implantable Cardioverter-Defibrillators in Patients With Nonischemic Systolic Heart Failure. Circulation 2017; 136:1772-1780. [PMID: 28877914 DOI: 10.1161/circulationaha.117.028829] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 08/19/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND The DANISH study (Danish Study to Assess the Efficacy of ICDs [Implantable Cardioverter Defibrillators] in Patients With Non-Ischemic Systolic Heart Failure on Mortality) did not demonstrate an overall effect on all-cause mortality with ICD implantation. However, the prespecified subgroup analysis suggested a possible age-dependent association between ICD implantation and mortality with survival benefit seen only in the youngest patients. The nature of this relationship between age and outcome of a primary prevention ICD in patients with nonischemic systolic heart failure warrants further investigation. METHODS All 1116 patients from the DANISH study were included in this prespecified subgroup analysis. We assessed the relationship between ICD implantation and mortality by age, and an optimal age cutoff was estimated nonparametrically with selection impact curves. Modes of death were divided into sudden cardiac death and nonsudden death and compared between patients younger and older than this age cutoff with the use of χ2 analysis. RESULTS Median age of the study population was 63 years (range, 21-84 years). There was a linearly decreasing relationship between ICD and mortality with age (hazard ratio [HR], 1.03; 95% confidence interval [CI], 1.003-1.06; P=0.03). An optimal age cutoff for ICD implantation was present at ≤70 years. There was an association between reduced all-cause mortality and ICD in patients ≤70 years of age (HR, 0.70; 95% CI, 0.51-0.96; P=0.03) but not in patients >70 years of age (HR, 1.05; 95% CI, 0.68-1.62; P=0.84). For patients ≤70 years old, the sudden cardiac death rate was 1.8 (95% CI, 1.3-2.5) and nonsudden death rate was 2.7 (95% CI, 2.1-3.5) events per 100 patient-years, whereas for patients >70 years old, the sudden cardiac death rate was 1.6 (95% CI, 0.8-3.2) and nonsudden death rate was 5.4 (95% CI, 3.7-7.8) events per 100 patient-years. This difference in modes of death between the 2 age groups was statistically significant (P=0.01). CONCLUSIONS In patients with systolic heart failure not caused by ischemic heart disease, the association between the ICD and survival decreased linearly with increasing age. In this study population, an age cutoff for ICD implantation at ≤70 years yielded the highest survival for the population as a whole. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT00542945.
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Affiliation(s)
- Marie Bayer Elming
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.).
| | - Jens C Nielsen
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Jens Haarbo
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Lars Videbæk
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Eva Korup
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - James Signorovitch
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Line Lisbeth Olesen
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Per Hildebrandt
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Flemming H Steffensen
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Niels E Bruun
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Hans Eiskjær
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Axel Brandes
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Anna M Thøgersen
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Finn Gustafsson
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Kenneth Egstrup
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Regitze Videbæk
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Christian Hassager
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Jesper Hastrup Svendsen
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Dan E Høfsten
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Christian Torp-Pedersen
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Steen Pehrson
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Lars Køber
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
| | - Jens Jakob Thune
- From Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (M.B.E., F.G., R.V., C.H., J.H.S., D.E.H., S.P., L.K., J.J.T.); Department of Cardiology, Aarhus University Hospital, Denmark (J.C.N., H.E.); Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (J.H., N.E.B.); Department of Cardiology, Odense University Hospital, Denmark (L.V., A.B.); Department of Health, Science and Technology (E.K., A.M.T., C.T.-P.) and Clinical Institute (N.E.B.), Aalborg University, Denmark; Department of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (E.K., A.M.T., C.T.-P.); Analysis Group Inc, Boston, MA (J.S.); Department of Cardiology, Zealand University Hospital, Roskilde, Denmark (L.L.O.); Frederiksberg Heart Clinic, Denmark (P.H.); Department of Cardiology, Lillebaelt Hospital, Vejle, Denmark (F.H.S.); Department of Cardiology, Odense University Hospital, Svendborg, Denmark (K.E.); and Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark (J.J.T.)
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Fallavollita JA, Dare JD, Carter RL, Baldwa S, Canty JM. Denervated Myocardium Is Preferentially Associated With Sudden Cardiac Arrest in Ischemic Cardiomyopathy: A Pilot Competing Risks Analysis of Cause-Specific Mortality. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.117.006446. [PMID: 28794139 DOI: 10.1161/circimaging.117.006446] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 06/19/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Previous studies have identified multiple risk factors that are associated with total cardiac mortality. Nevertheless, identifying specific factors that distinguish patients at risk of arrhythmic death versus heart failure could better target patients likely to benefit from implantable cardiac defibrillators, which have no impact on nonsudden cardiac death. METHODS AND RESULTS We performed a pilot competing risks analysis of the National Institutes of Health-sponsored PAREPET trial (Prediction of Arrhythmic Events with Positron Emission Tomography). Death from cardiac causes was ascertained in subjects with ischemic cardiomyopathy (n=204) eligible for an implantable cardiac defibrillator for the primary prevention of sudden cardiac arrest after baseline clinical evaluation and imaging at enrollment (positron emission tomography and 2-dimensional echo). Mean age was 67±11 years with an ejection fraction of 27±9%, and 90% were men. During 4.1 years of follow-up, there were 33 sudden cardiac arrests (arrhythmic death or implantable cardiac defibrillator discharge for ventricular fibrillation or ventricular tachycardia >240 bpm) and 36 nonsudden cardiac deaths. Sudden cardiac arrest was correlated with a greater volume of denervated myocardium (defect of the positron emission tomography norepinephrine analog 11C-hydroxyephedrine), lack of angiotensin inhibition therapy, elevated B-type natriuretic peptide, and larger left ventricular end-diastolic volume index. In contrast, nonsudden cardiac death was associated with a higher resting heart rate, older age, elevated creatinine, larger left atrial volume index, and larger left ventricular end-diastolic volume index. CONCLUSIONS Distinct clinical, laboratory, and imaging variables are associated with cause-specific cardiac mortality in primary-prevention candidates with ischemic cardiomyopathy. If prospectively validated, these multivariable associations may help target specific therapies to those at the greatest risk of sudden and nonsudden cardiac death. CLINICAL TRIAL REGISTRATION URL: https://clinicaltrials.gov. Unique identifier: NCT01400334.
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Affiliation(s)
- James A Fallavollita
- From the VA Western New York Health Care System at Buffalo (J.A.F., S.B., J.M.C.), Clinical and Translational Science Institute (J.A.F., J.M.C.), Population Health Observatory (J.D.D., R.L.C.), Department of Medicine (J.A.F., S.B., J.M.C.), Department of Biostatistics (J.D.D., R.L.C.), Department of Physiology and Biophysics (J.M.C.), and Department of Biomedical Engineering (J.M.C.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY.
| | - Jonathan D Dare
- From the VA Western New York Health Care System at Buffalo (J.A.F., S.B., J.M.C.), Clinical and Translational Science Institute (J.A.F., J.M.C.), Population Health Observatory (J.D.D., R.L.C.), Department of Medicine (J.A.F., S.B., J.M.C.), Department of Biostatistics (J.D.D., R.L.C.), Department of Physiology and Biophysics (J.M.C.), and Department of Biomedical Engineering (J.M.C.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY
| | - Randolph L Carter
- From the VA Western New York Health Care System at Buffalo (J.A.F., S.B., J.M.C.), Clinical and Translational Science Institute (J.A.F., J.M.C.), Population Health Observatory (J.D.D., R.L.C.), Department of Medicine (J.A.F., S.B., J.M.C.), Department of Biostatistics (J.D.D., R.L.C.), Department of Physiology and Biophysics (J.M.C.), and Department of Biomedical Engineering (J.M.C.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY
| | - Sunil Baldwa
- From the VA Western New York Health Care System at Buffalo (J.A.F., S.B., J.M.C.), Clinical and Translational Science Institute (J.A.F., J.M.C.), Population Health Observatory (J.D.D., R.L.C.), Department of Medicine (J.A.F., S.B., J.M.C.), Department of Biostatistics (J.D.D., R.L.C.), Department of Physiology and Biophysics (J.M.C.), and Department of Biomedical Engineering (J.M.C.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY
| | - John M Canty
- From the VA Western New York Health Care System at Buffalo (J.A.F., S.B., J.M.C.), Clinical and Translational Science Institute (J.A.F., J.M.C.), Population Health Observatory (J.D.D., R.L.C.), Department of Medicine (J.A.F., S.B., J.M.C.), Department of Biostatistics (J.D.D., R.L.C.), Department of Physiology and Biophysics (J.M.C.), and Department of Biomedical Engineering (J.M.C.), Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY
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Jacobson JT, Iwai S, Aronow WS. Treatment of Ventricular Arrhythmias and Use of Implantable Cardioverter-Defibrillators to Improve Survival in Older Adult Patients with Cardiac Disease. Heart Fail Clin 2017; 13:589-605. [PMID: 28602374 DOI: 10.1016/j.hfc.2017.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Ventricular arrhythmia (VA) and sudden cardiac death (SCD) are well-recognized problems in the overall heart failure population, but treatment decisions can be more complex and nuanced in older patients. Sustained VA does not always lead to SCD, but identifies a higher risk population and may cause significant symptoms. Antiarrhythmic drugs (AAD) and catheter ablation are the mainstays for prevention of VA, but have not been shown to improve mortality. The value of implantable cardiac defibrillators (ICDs) may be influenced by patient age. This article discusses long-term treatment of VA and the use of ICDs in the elderly.
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Affiliation(s)
- Jason T Jacobson
- Division of Cardiology, Department of Medicine, Westchester Medical Center, New York Medical College, Macy Pavilion, 100 Woods Road, Valhalla, NY 10595, USA
| | - Sei Iwai
- Division of Cardiology, Department of Medicine, Westchester Medical Center, New York Medical College, Macy Pavilion, 100 Woods Road, Valhalla, NY 10595, USA
| | - Wilbert S Aronow
- Division of Cardiology, Department of Medicine, Westchester Medical Center, New York Medical College, Macy Pavilion, 100 Woods Road, Valhalla, NY 10595, USA.
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Borne RT, Katz D, Betz J, Peterson PN, Masoudi FA. Implantable Cardioverter-Defibrillators for Secondary Prevention of Sudden Cardiac Death: A Review. J Am Heart Assoc 2017; 6:JAHA.117.005515. [PMID: 28258050 PMCID: PMC5524042 DOI: 10.1161/jaha.117.005515] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Ryan T Borne
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - David Katz
- Division of Cardiology, Medical Center of the Rockies, University of Colorado Health, Loveland, CO
| | - Jarrod Betz
- Division of Cardiology, The Ohio State University Medical Center, Columbus, OH
| | - Pamela N Peterson
- Division of Cardiology, Denver Health and Hospital Authority, Denver, CO
| | - Frederick A Masoudi
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
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Fauchier L, Alonso C, Anselme F, Blangy H, Bordachar P, Boveda S, Clementy N, Defaye P, Deharo JC, Friocourt P, Gras D, Halimi F, Klug D, Mansourati J, Obadia B, Pasquié JL, Pavin D, Sadoul N, Taieb J, Piot O, Hanon O. Position paper for management of elderly patients with pacemakers and implantable cardiac defibrillators: Groupe de Rythmologie et Stimulation Cardiaque de la Société Française de Cardiologie and Société Française de Gériatrie et Gérontologie. Arch Cardiovasc Dis 2016; 109:563-585. [PMID: 27595465 DOI: 10.1016/j.acvd.2016.04.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 04/01/2016] [Indexed: 02/03/2023]
Abstract
Despite the increasingly high rate of implantation of pacemakers (PMs) and implantable cardioverter defibrillators (ICDs) in elderly patients, data supporting their clinical and cost-effectiveness in this age stratum are ambiguous and contradictory. We reviewed the data regarding the applicability, safety and effectiveness of conventional pacing, ICDs and cardiac resynchronization therapy (CRT) in elderly patients. Although periprocedural risk may be slightly higher in the elderly, the implantation procedure for PMs and ICDs is still relatively safe in this age group. In older patients with sinus node disease, the general consensus is that DDD pacing with the programming of an algorithm to minimize ventricular pacing is preferred. In very old patients presenting with intermittent or suspected atrioventricular block, VVI pacing may be appropriate. In terms of correcting potentially life-threatening arrhythmias, the effectiveness of ICD therapy is similar in older and younger individuals. However, the assumption of persistent ICD benefit in the elderly population is questionable, as any advantageous effect of the device on arrhythmic death may be attenuated by higher total non-arrhythmic mortality. While septuagenarians and octogenarians have higher annual all-cause mortality rates, ICD therapy may remain effective in selected patients at high risk of arrhythmic death and with minimum comorbidities despite advanced age. ICD implantation among the elderly, as a group, may not be cost-effective, but the procedure may reach cost-effectiveness in those expected to live more than 5-7years after implantation. Elderly patients usually experience significant functional improvement after CRT, similar to that observed in middle-aged patients. Management of CRT non-responders remains globally the same, while considering a less aggressive approach in terms of reinterventions (revision of left ventricular [LV] lead placement, addition of a right ventricular or LV lead, LV endocardial pacing configuration). Overall, physiological age, general status and comorbidities rather than chronological age per se should be the decisive factors in making a decision about device implantation selection for survival and well-being benefit in elderly patients.
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Affiliation(s)
- Laurent Fauchier
- CHU Trousseau, université François-Rabelais, 37044 Tours, France.
| | | | | | - Hugues Blangy
- Institut Lorrain du Cœur et des Vaisseaux, CHU de Nancy, 54500 Vandœuvre-lès-Nancy, France
| | | | | | - Nicolas Clementy
- CHU Trousseau, université François-Rabelais, 37044 Tours, France
| | | | | | | | - Daniel Gras
- Nouvelles cliniques nantaises, 44202 Nantes, France
| | | | | | | | | | | | | | - Nicolas Sadoul
- Institut Lorrain du Cœur et des Vaisseaux, CHU de Nancy, 54500 Vandœuvre-lès-Nancy, France
| | - Jerome Taieb
- Centre hospitalier, 13616 Aix-en-Provence, France
| | - Olivier Piot
- Centre cardiologique du Nord, 93200 Saint-Denis, France
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Manian U, Gula LJ. Arrhythmia Management in the Elderly—Implanted Cardioverter Defibrillators and Prevention of Sudden Death. Can J Cardiol 2016; 32:1117-23. [DOI: 10.1016/j.cjca.2016.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 03/17/2016] [Accepted: 03/21/2016] [Indexed: 11/16/2022] Open
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Yokoshiki H, Shimizu A, Mitsuhashi T, Furushima H, Sekiguchi Y, Manaka T, Nishii N, Ueyama T, Morita N, Nitta T, Okumura K. Trends and determinant factors in the use of cardiac resynchronization therapy devices in Japan: Analysis of the Japan cardiac device treatment registry database. J Arrhythm 2016; 32:486-490. [PMID: 27920834 PMCID: PMC5129119 DOI: 10.1016/j.joa.2016.04.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 03/27/2016] [Accepted: 04/06/2016] [Indexed: 11/04/2022] Open
Abstract
Background The choice of cardiac resynchronization therapy device, with (CRT-D) or without (CRT-P) a defibrillator, in patients with heart failure largely depends on the physician׳s discretion, because it has not been established which subjects benefit most from a defibrillator. Methods We examined the annual trend of CRT device implantations between 2006 and 2014, and evaluated the factors related to the device selection (CRT-D or CRT-P) for primary prevention of sudden cardiac death in patients with heart failure by analyzing the Japan Cardiac Device Treatment Registry (JCDTR) database from January 2011 and August 2015 (CRT-D, n=2714; CRT-P, n=555). Results The proportion of CRT-D implantations for primary prevention among all the CRT-D recipients was more than 70% during the study period. The number of CRT-D implantations for primary prevention reached a maximum in 2011 and decreased gradually between 2011 and 2014, whereas CRT-P implantations increased year by year until 2011 and remained unchanged in recent years. Multivariate analysis identified age (odds ratio [OR] 0.92, 95% confidence interval [CI] 0.90–0.95, P<0.0001), male sex (OR 1.99, 95% CI 1.28–3.11, P<0.005), reduced left ventricular ejection fraction (LVEF) (OR 0.96, 95% CI 0.94–0.98, P<0.0001), and non-sustained ventricular tachycardia (NSVT) (OR 2.85, 95% CI 1.87–4.35, P<0.0001) as independent factors favoring the choice of CRT-D. Conclusions Younger age, male sex, reduced LVEF, and a history of NSVT were independently associated with the choice of CRT-D for primary prevention of sudden cardiac death in patients with heart failure in Japan.
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Affiliation(s)
- Hisashi Yokoshiki
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan
| | - Akihiko Shimizu
- Faculty of Health Sciences, Yamaguchi Graduate School of Medicine, Japan
| | - Takeshi Mitsuhashi
- Cardiovascular Medicine, Jichi Medical University Saitama Medical Center, Japan
| | | | - Yukio Sekiguchi
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Japan
| | | | - Nobuhiro Nishii
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Takeshi Ueyama
- Division of Cardiology, Department of Medicine and Clinical Sciences, Yamaguchi Graduate School of Medicine, Japan
| | - Norishige Morita
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Japan
| | - Takashi Nitta
- Cardiovascular Surgery, Nippon Medical School, Japan
| | - Ken Okumura
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Japan
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Tereshchenko LG, Berger RD. A Patient Presents with Longstanding, Severe LV Dysfunction. Is There a Role for Additional Risk Stratification Before ICD? Card Electrophysiol Clin 2016; 4:151-60. [PMID: 26939812 DOI: 10.1016/j.ccep.2012.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Increased longevity of patients with systolic heart failure caused by the use of implantable cardioverter-defibrillators (ICDs) is one of the most successful achievements in contemporary medicine. During the last 2 decades, the scientific community has striven to increase the benefits of ICD usage by specifying indications for primary prevention ICD implantation. Left ventricular ejection fraction is neither highly specific nor is it a highly sensitive risk marker of sudden cardiac death. The authors discuss risk-stratification approaches in different patient populations with structural heart disease and systolic heart failure.
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Affiliation(s)
- Larisa G Tereshchenko
- The Electrophysiology Chapter, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Carnegie 568, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Ronald D Berger
- The Electrophysiology Chapter, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Carnegie 592, 600 North Wolfe Street, Baltimore, MD 21287, USA
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Balmain S, Hawkins NM. Shocks, Resynchronization, or Both for Elderly Patients With Heart Failure? J Card Fail 2016; 22:150-2. [DOI: 10.1016/j.cardfail.2015.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 12/04/2015] [Accepted: 12/04/2015] [Indexed: 11/26/2022]
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Implantable Cardioverter-Defibrillators at End of Battery Life. J Am Coll Cardiol 2016; 67:435-444. [DOI: 10.1016/j.jacc.2015.11.033] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 11/02/2015] [Accepted: 11/11/2015] [Indexed: 11/23/2022]
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Expósito V, Rodríguez-Mañero M, González-Enríquez S, Arias MA, Sánchez-Gómez JM, Andrés La Huerta A, Bertomeu-González V, Arce-León Á, Barrio-López MT, Arguedas-Jiménez H, Seara JG, Rodriguez-Entem F. Primary prevention implantable cardioverter-defibrillator and cardiac resynchronization therapy-defibrillator in elderly patients: results of a Spanish multicentre study. Europace 2015; 18:1203-10. [PMID: 26566939 DOI: 10.1093/europace/euv337] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 09/07/2015] [Indexed: 11/13/2022] Open
Abstract
AIMS Currently, there continues to be a lack of evidence regarding outcomes associated with device-based therapy for ventricular arrhythmias in elderly patients, even more in primary-prevention indications. We aimed to describe the follow-up in terms of efficacy and safety of implantable cardioverter-defibrillator (ICD) therapy in a large cohort of elderly patients. METHODS AND RESULTS Retrospective multicentre study performed in 15 Spanish hospitals. Consecutive patients referred for ICD implantation before 2011 were included. One hundred and sixty-two of 1174 patients (13.8%) ≥75 years were considered as 'elderly'. When compared with those patients <75, this subgroup presented more co-morbid conditions, including hypertension, chronic obstructive pulmonary disease , and renal failure, and more previous hospitalizations due to heart failure (HF). During a mean follow-up of 104.4 ± 3.3 months, 162 patients (14%) died, 120 in the younger age (12.4%), and 42 (24.4%) in the elderly. Kaplan-Meier analysis showed an increased probability of death with increasing age (17, 24, 28, and 69% at 12, 24, 48, and 60 months of follow-up in the elderly group). There was neither difference regarding the rate of appropriate nor inappropriate ICD intervention. CONCLUSION In a real-world scenario, elderly patients comprise ∼15% of ICD implantations for primary prevention of sudden cardiac death (SCD). Although the rate of appropriate therapy is similar between groups, the benefit of ICD is attenuated for a major increase in mortality risk among those patients ≥75 years at the moment of device implantation.
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Affiliation(s)
- Víctor Expósito
- Hospital Universitario Marqués de Valdecilla, Av. Hospital s/n, Santander, Spain
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Adelstein EC, Liu J, Jain S, Schwartzman D, Althouse AD, Wang NC, Gorcsan J, Saba S. Clinical outcomes in cardiac resynchronization therapy-defibrillator recipients 80 years of age and older. Europace 2015; 18:420-7. [DOI: 10.1093/europace/euv222] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/29/2015] [Indexed: 11/12/2022] Open
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Abstract
Sudden cardiac death (SCD) from cardiac arrest is a major international public health problem accounting for an estimated 15%-20% of all deaths. Although resuscitation rates are generally improving throughout the world, the majority of individuals who experience a sudden cardiac arrest will not survive. SCD most often develops in older adults with acquired structural heart disease, but it also rarely occurs in the young, where it is more commonly because of inherited disorders. Coronary heart disease is known to be the most common pathology underlying SCD, followed by cardiomyopathies, inherited arrhythmia syndromes, and valvular heart disease. During the past 3 decades, declines in SCD rates have not been as steep as for other causes of coronary heart disease deaths, and there is a growing fraction of SCDs not due to coronary heart disease and ventricular arrhythmias, particularly among certain subsets of the population. The growing heterogeneity of the pathologies and mechanisms underlying SCD present major challenges for SCD prevention, which are magnified further by a frequent lack of recognition of the underlying cardiac condition before death. Multifaceted preventative approaches, which address risk factors in seemingly low-risk and known high-risk populations, will be required to decrease the burden of SCD. In this Compendium, we review the wide-ranging spectrum of epidemiology underlying SCD within both the general population and in high-risk subsets with established cardiac disease placing an emphasis on recent global trends, remaining uncertainties, and potential targeted preventive strategies.
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Affiliation(s)
- Meiso Hayashi
- From the Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (M.H., W.S.); and Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (C.M.A.)
| | - Wataru Shimizu
- From the Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (M.H., W.S.); and Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (C.M.A.).
| | - Christine M Albert
- From the Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (M.H., W.S.); and Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (C.M.A.).
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Neuzner J, Gradaus R. [ICD therapy in the primary prevention of sudden cardiac death: Risk stratification and patient selection]. Herzschrittmacherther Elektrophysiol 2015; 26:75-81. [PMID: 26041117 DOI: 10.1007/s00399-015-0371-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 04/20/2015] [Indexed: 11/28/2022]
Abstract
Without the concept of primary prevention of sudden cardiac death, therapy with implantable defibrillators would not have reached the current distribution and clinical importance. Most of the scientific evidence of the concept is based on clinical studies from 1996-2005. More than 75 % of all defibrillator implantations are currently indicated as primary prevention. Implantable converter-defibrillator (ICD) therapy in the primary prevention of sudden cardiac death was incorporated into scientific guidelines starting in 1998. The historical development of the indications for ICD therapy in the primary prevention of sudden cardiac death is presented, reflecting major results of controlled, randomized clinical studies and guideline discussions.
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Affiliation(s)
- J Neuzner
- Medizinischen Klinik II, Klinikum Kassel, Mönchebergstrasse 41-43, 34125, Kassel, Deutschland,
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Fauchier L, Marijon E, Defaye P, Piot O, Sadoul N, Perier MC, Gras D, Klug D, Algalarrondo V, Bordachar P, Deharo JC, Leclercq C, Babuty D, Boveda S, Boveda S, Marijon E, Algalarrondo V, Babuty D, Bordachar P, Bouzeman A, Providencia R, Defaye P, Gras D, Deharo JC, Klug D, Leclercq C, Piot O, Sadoul N, Beganton F, Perier MC. Effect of age on survival and causes of death after primary prevention implantable cardioverter-defibrillator implantation. Am J Cardiol 2015; 115:1415-22. [PMID: 25784518 DOI: 10.1016/j.amjcard.2015.02.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 02/11/2015] [Accepted: 02/11/2015] [Indexed: 10/24/2022]
Abstract
The benefit of implantable cardioverter-defibrillators (ICDs) remains controversial in elderly patients and may be attenuated by a greater risk of nonarrhythmic death. We examined the effect of age on outcomes after prophylactic ICD implantation. All patients with coronary artery disease or dilated cardiomyopathy implanted with an ICD for primary prevention of sudden cardiac death in 12 French medical centers were included in a retrospective observational study. The 5,534 ICD recipients were divided according to age: 18 to 59 years (n = 2,139), 60 to 74 years (n = 2,693), and ≥75 years (n = 702). Greater prevalences of coronary artery disease and atrial fibrillation at the time of implant were observed with increasing age (both p <0.0001). During a mean follow-up of 3.1 ± 2.0 years, the annual mortality rate increased with age: 3.1% per year for age 18 to 59 years, 5.7% per year for age 60 to 74 years, and 7.5% per year for age ≥75 years (p <0.001). Older age was independently associated with a greater risk of death (adjusted odds ratio 1.43, 95% confidence interval 1.14 to 1.80 for age 60 to 74 years; and adjusted odds ratio 1.65, 95% confidence interval 1.22 to 2.22 for age >75 years). Proportions of cardiac deaths (55.2%, 57.6%, and 57.0%, p = 0.84), including ICD-unresponsive sudden death (9.9%, 6.0%, and 10.6%, p = 0.08), and rates of appropriate ICD therapies were similar in the 3 age groups. Older age was independently associated with a higher rate of early complications and a lower rate of inappropriate therapies. In conclusion, older patients exhibited higher global mortality after ICD implantation for primary prevention, whereas rates of sudden deaths and of appropriate device therapies were similar across age groups.
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Hess PL, Al-Khatib SM, Han JY, Edwards R, Bardy GH, Bigger JT, Buxton A, Cappato R, Dorian P, Hallstrom A, Kadish AH, Kudenchuk PJ, Lee KL, Mark DB, Moss AJ, Steinman R, Inoue LYT, Sanders G. Survival benefit of the primary prevention implantable cardioverter-defibrillator among older patients: does age matter? An analysis of pooled data from 5 clinical trials. Circ Cardiovasc Qual Outcomes 2015; 8:179-86. [PMID: 25669833 DOI: 10.1161/circoutcomes.114.001306] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The impact of patient age on the risks of death or rehospitalization after primary prevention implantable cardioverter-defibrillator (ICD) placement is uncertain. METHODS AND RESULTS Data from 5 major ICD trials were merged: the Multicenter Automatic Defibrillator Implantation Trial I (MADIT-I), the Multicenter UnSustained Tachycardia Trial (MUSTT), the Multicenter Automatic Defibrillator Implantation Trial II (MADIT-II), the Defibrillators in Nonischemic Cardiomyopathy Treatment Evaluation Trial (DEFINITE), and the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT). Median age at enrollment was 62 (interquartile range 53-70) years. Compared with their younger counterparts, older patients had a greater burden of comorbid illness. In unadjusted exploratory analyses, ICD recipients were less likely to die than nonrecipients in all age groups: among patients aged <55 years: hazard ratio 0.48, 95% posterior credible interval 0.33 to 0.69; among patients aged 55 to 64 years: hazard ratio 0.69, 95% posterior credible interval 0.53 to 0.90; among patients aged 65 to 74 years: hazard ratio 0.67, 95% posterior credible interval, 0.53 to 0.85; and among patients aged ≥75 years: hazard ratio 0.54, 95% posterior credible interval 0.37 to 0.78. Sample sizes were limited among patients aged ≥75 years. In adjusted Bayesian-Weibull modeling, point estimates indicate ICD efficacy persists but is attenuated with increasing age. There was evidence of an interaction between age and ICD treatment on survival (two-sided posterior tail probability of no interaction <0.01). Using an adjusted Bayesian logistic regression model, there was no evidence of an interaction between age and ICD treatment on rehospitalization (two-sided posterior tail probability of no interaction 0.44). CONCLUSIONS In this analysis, the survival benefit of the ICD exists but is attenuated with increasing age. The latter finding may be because of the higher burden of comorbid illness, competing causes of death, or limited sample size of older patients. There was no evidence that age modifies the association between ICD treatment and rehospitalization.
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Affiliation(s)
- Paul L Hess
- From the Duke Clinical Research Institute, Durham, NC (P.L.H., S.M.A., R.E., K.L.L., D.B.M., G.S.); University of Washington, Seattle (J.Y.H., G.H.B., A.H., P.J.K., L.Y.T.I.); Columbia University, New York, NY (J.T.B., R.S.); Beth Israel Deaconess Medical Center, Boston, MA (A.B.); I.R.C.C.S. Policlinico San Donato, Milan, Italy (R.C.); University of Toronto, Ontario, Canada (P.D.); Northwestern Feinberg School of Medicine, Chicago, IL (A.H.K.); and University of Rochester, Rochester, NY (A.J.M.).
| | - Sana M Al-Khatib
- From the Duke Clinical Research Institute, Durham, NC (P.L.H., S.M.A., R.E., K.L.L., D.B.M., G.S.); University of Washington, Seattle (J.Y.H., G.H.B., A.H., P.J.K., L.Y.T.I.); Columbia University, New York, NY (J.T.B., R.S.); Beth Israel Deaconess Medical Center, Boston, MA (A.B.); I.R.C.C.S. Policlinico San Donato, Milan, Italy (R.C.); University of Toronto, Ontario, Canada (P.D.); Northwestern Feinberg School of Medicine, Chicago, IL (A.H.K.); and University of Rochester, Rochester, NY (A.J.M.)
| | - Joo Y Han
- From the Duke Clinical Research Institute, Durham, NC (P.L.H., S.M.A., R.E., K.L.L., D.B.M., G.S.); University of Washington, Seattle (J.Y.H., G.H.B., A.H., P.J.K., L.Y.T.I.); Columbia University, New York, NY (J.T.B., R.S.); Beth Israel Deaconess Medical Center, Boston, MA (A.B.); I.R.C.C.S. Policlinico San Donato, Milan, Italy (R.C.); University of Toronto, Ontario, Canada (P.D.); Northwestern Feinberg School of Medicine, Chicago, IL (A.H.K.); and University of Rochester, Rochester, NY (A.J.M.)
| | - Rex Edwards
- From the Duke Clinical Research Institute, Durham, NC (P.L.H., S.M.A., R.E., K.L.L., D.B.M., G.S.); University of Washington, Seattle (J.Y.H., G.H.B., A.H., P.J.K., L.Y.T.I.); Columbia University, New York, NY (J.T.B., R.S.); Beth Israel Deaconess Medical Center, Boston, MA (A.B.); I.R.C.C.S. Policlinico San Donato, Milan, Italy (R.C.); University of Toronto, Ontario, Canada (P.D.); Northwestern Feinberg School of Medicine, Chicago, IL (A.H.K.); and University of Rochester, Rochester, NY (A.J.M.)
| | - Gust H Bardy
- From the Duke Clinical Research Institute, Durham, NC (P.L.H., S.M.A., R.E., K.L.L., D.B.M., G.S.); University of Washington, Seattle (J.Y.H., G.H.B., A.H., P.J.K., L.Y.T.I.); Columbia University, New York, NY (J.T.B., R.S.); Beth Israel Deaconess Medical Center, Boston, MA (A.B.); I.R.C.C.S. Policlinico San Donato, Milan, Italy (R.C.); University of Toronto, Ontario, Canada (P.D.); Northwestern Feinberg School of Medicine, Chicago, IL (A.H.K.); and University of Rochester, Rochester, NY (A.J.M.)
| | - J Thomas Bigger
- From the Duke Clinical Research Institute, Durham, NC (P.L.H., S.M.A., R.E., K.L.L., D.B.M., G.S.); University of Washington, Seattle (J.Y.H., G.H.B., A.H., P.J.K., L.Y.T.I.); Columbia University, New York, NY (J.T.B., R.S.); Beth Israel Deaconess Medical Center, Boston, MA (A.B.); I.R.C.C.S. Policlinico San Donato, Milan, Italy (R.C.); University of Toronto, Ontario, Canada (P.D.); Northwestern Feinberg School of Medicine, Chicago, IL (A.H.K.); and University of Rochester, Rochester, NY (A.J.M.)
| | - Alfred Buxton
- From the Duke Clinical Research Institute, Durham, NC (P.L.H., S.M.A., R.E., K.L.L., D.B.M., G.S.); University of Washington, Seattle (J.Y.H., G.H.B., A.H., P.J.K., L.Y.T.I.); Columbia University, New York, NY (J.T.B., R.S.); Beth Israel Deaconess Medical Center, Boston, MA (A.B.); I.R.C.C.S. Policlinico San Donato, Milan, Italy (R.C.); University of Toronto, Ontario, Canada (P.D.); Northwestern Feinberg School of Medicine, Chicago, IL (A.H.K.); and University of Rochester, Rochester, NY (A.J.M.)
| | - Riccardo Cappato
- From the Duke Clinical Research Institute, Durham, NC (P.L.H., S.M.A., R.E., K.L.L., D.B.M., G.S.); University of Washington, Seattle (J.Y.H., G.H.B., A.H., P.J.K., L.Y.T.I.); Columbia University, New York, NY (J.T.B., R.S.); Beth Israel Deaconess Medical Center, Boston, MA (A.B.); I.R.C.C.S. Policlinico San Donato, Milan, Italy (R.C.); University of Toronto, Ontario, Canada (P.D.); Northwestern Feinberg School of Medicine, Chicago, IL (A.H.K.); and University of Rochester, Rochester, NY (A.J.M.)
| | - Paul Dorian
- From the Duke Clinical Research Institute, Durham, NC (P.L.H., S.M.A., R.E., K.L.L., D.B.M., G.S.); University of Washington, Seattle (J.Y.H., G.H.B., A.H., P.J.K., L.Y.T.I.); Columbia University, New York, NY (J.T.B., R.S.); Beth Israel Deaconess Medical Center, Boston, MA (A.B.); I.R.C.C.S. Policlinico San Donato, Milan, Italy (R.C.); University of Toronto, Ontario, Canada (P.D.); Northwestern Feinberg School of Medicine, Chicago, IL (A.H.K.); and University of Rochester, Rochester, NY (A.J.M.)
| | - Al Hallstrom
- From the Duke Clinical Research Institute, Durham, NC (P.L.H., S.M.A., R.E., K.L.L., D.B.M., G.S.); University of Washington, Seattle (J.Y.H., G.H.B., A.H., P.J.K., L.Y.T.I.); Columbia University, New York, NY (J.T.B., R.S.); Beth Israel Deaconess Medical Center, Boston, MA (A.B.); I.R.C.C.S. Policlinico San Donato, Milan, Italy (R.C.); University of Toronto, Ontario, Canada (P.D.); Northwestern Feinberg School of Medicine, Chicago, IL (A.H.K.); and University of Rochester, Rochester, NY (A.J.M.)
| | - Alan H Kadish
- From the Duke Clinical Research Institute, Durham, NC (P.L.H., S.M.A., R.E., K.L.L., D.B.M., G.S.); University of Washington, Seattle (J.Y.H., G.H.B., A.H., P.J.K., L.Y.T.I.); Columbia University, New York, NY (J.T.B., R.S.); Beth Israel Deaconess Medical Center, Boston, MA (A.B.); I.R.C.C.S. Policlinico San Donato, Milan, Italy (R.C.); University of Toronto, Ontario, Canada (P.D.); Northwestern Feinberg School of Medicine, Chicago, IL (A.H.K.); and University of Rochester, Rochester, NY (A.J.M.)
| | - Peter J Kudenchuk
- From the Duke Clinical Research Institute, Durham, NC (P.L.H., S.M.A., R.E., K.L.L., D.B.M., G.S.); University of Washington, Seattle (J.Y.H., G.H.B., A.H., P.J.K., L.Y.T.I.); Columbia University, New York, NY (J.T.B., R.S.); Beth Israel Deaconess Medical Center, Boston, MA (A.B.); I.R.C.C.S. Policlinico San Donato, Milan, Italy (R.C.); University of Toronto, Ontario, Canada (P.D.); Northwestern Feinberg School of Medicine, Chicago, IL (A.H.K.); and University of Rochester, Rochester, NY (A.J.M.)
| | - Kerry L Lee
- From the Duke Clinical Research Institute, Durham, NC (P.L.H., S.M.A., R.E., K.L.L., D.B.M., G.S.); University of Washington, Seattle (J.Y.H., G.H.B., A.H., P.J.K., L.Y.T.I.); Columbia University, New York, NY (J.T.B., R.S.); Beth Israel Deaconess Medical Center, Boston, MA (A.B.); I.R.C.C.S. Policlinico San Donato, Milan, Italy (R.C.); University of Toronto, Ontario, Canada (P.D.); Northwestern Feinberg School of Medicine, Chicago, IL (A.H.K.); and University of Rochester, Rochester, NY (A.J.M.)
| | - Daniel B Mark
- From the Duke Clinical Research Institute, Durham, NC (P.L.H., S.M.A., R.E., K.L.L., D.B.M., G.S.); University of Washington, Seattle (J.Y.H., G.H.B., A.H., P.J.K., L.Y.T.I.); Columbia University, New York, NY (J.T.B., R.S.); Beth Israel Deaconess Medical Center, Boston, MA (A.B.); I.R.C.C.S. Policlinico San Donato, Milan, Italy (R.C.); University of Toronto, Ontario, Canada (P.D.); Northwestern Feinberg School of Medicine, Chicago, IL (A.H.K.); and University of Rochester, Rochester, NY (A.J.M.)
| | - Arthur J Moss
- From the Duke Clinical Research Institute, Durham, NC (P.L.H., S.M.A., R.E., K.L.L., D.B.M., G.S.); University of Washington, Seattle (J.Y.H., G.H.B., A.H., P.J.K., L.Y.T.I.); Columbia University, New York, NY (J.T.B., R.S.); Beth Israel Deaconess Medical Center, Boston, MA (A.B.); I.R.C.C.S. Policlinico San Donato, Milan, Italy (R.C.); University of Toronto, Ontario, Canada (P.D.); Northwestern Feinberg School of Medicine, Chicago, IL (A.H.K.); and University of Rochester, Rochester, NY (A.J.M.)
| | - Richard Steinman
- From the Duke Clinical Research Institute, Durham, NC (P.L.H., S.M.A., R.E., K.L.L., D.B.M., G.S.); University of Washington, Seattle (J.Y.H., G.H.B., A.H., P.J.K., L.Y.T.I.); Columbia University, New York, NY (J.T.B., R.S.); Beth Israel Deaconess Medical Center, Boston, MA (A.B.); I.R.C.C.S. Policlinico San Donato, Milan, Italy (R.C.); University of Toronto, Ontario, Canada (P.D.); Northwestern Feinberg School of Medicine, Chicago, IL (A.H.K.); and University of Rochester, Rochester, NY (A.J.M.)
| | - Lurdes Y T Inoue
- From the Duke Clinical Research Institute, Durham, NC (P.L.H., S.M.A., R.E., K.L.L., D.B.M., G.S.); University of Washington, Seattle (J.Y.H., G.H.B., A.H., P.J.K., L.Y.T.I.); Columbia University, New York, NY (J.T.B., R.S.); Beth Israel Deaconess Medical Center, Boston, MA (A.B.); I.R.C.C.S. Policlinico San Donato, Milan, Italy (R.C.); University of Toronto, Ontario, Canada (P.D.); Northwestern Feinberg School of Medicine, Chicago, IL (A.H.K.); and University of Rochester, Rochester, NY (A.J.M.)
| | - Gillian Sanders
- From the Duke Clinical Research Institute, Durham, NC (P.L.H., S.M.A., R.E., K.L.L., D.B.M., G.S.); University of Washington, Seattle (J.Y.H., G.H.B., A.H., P.J.K., L.Y.T.I.); Columbia University, New York, NY (J.T.B., R.S.); Beth Israel Deaconess Medical Center, Boston, MA (A.B.); I.R.C.C.S. Policlinico San Donato, Milan, Italy (R.C.); University of Toronto, Ontario, Canada (P.D.); Northwestern Feinberg School of Medicine, Chicago, IL (A.H.K.); and University of Rochester, Rochester, NY (A.J.M.)
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