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Teerawongsakul P, Ananwattanasuk T, Chokesuwattanaskul R, Shah M, Lathkar-Pradhan S, Barham W, Oral H, Thakur RK, Jongnarangsin K, Tanawuttiwat T. Programming of implantable cardioverter defibrillators for primary prevention: outcomes at centers with high vs. low concordance with guidelines. J Interv Card Electrophysiol 2023; 66:1359-1366. [PMID: 36422768 DOI: 10.1007/s10840-022-01431-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/15/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND While ICD therapy reduction programming strategies are recommended in current multi-society guidelines, concerns remain about a possible trade-off between the benefits of ICD therapy reduction and failure to treat episodes of ventricular arrhythmias. The study is to evaluate the outcomes of primary prevention patients followed in centers with high and low concordance with the 2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement and 2019 focused update on optimal ICD programming and testing guidelines. METHODS Consecutive patients with primary prevention ICD implantation from two centers between 2014 and 2016 were included. One center was classified as high guideline concordance center (HGC) with 47% (146/310) of patients with initial ICD concordant with the guidelines, and the other center was classified as low guideline concordance center (LGC) with only 1% (2/178) of patients with guideline-concordant initial ICD programming. Cox proportional hazard models were used to assess risk of first ICD therapy (ATP or shock), first ICD shock, and mortality. RESULTS A total of 488 patients were included (mean age, 66 ± 13 years). During a mean follow-up of 1.9 ± 0.9 years, patients followed at HGC were 63% less likely to receive any ICD therapy (adjusted HR [aHR] 0.37, 95% CI 0.42-0.99). There were no significant differences in the rate of first ICD shock (aHR 0.72, 95% CI 0.34-1.52) or mortality (aHR 1.19, 95% CI, 0.47-3.05). CONCLUSIONS Compared to primary prevention patients followed at LGC, primary prevention ICD patients followed at HGC received a significantly lower rate of ICD therapy, mainly from ATP reduction, without a difference in mortality during follow-up.
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Affiliation(s)
- Padoemwut Teerawongsakul
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
- Division of Cardiac Electrophysiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Teetouch Ananwattanasuk
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
- Division of Cardiac Electrophysiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Ronpichai Chokesuwattanaskul
- Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Cardiac Center, Bangkok, Thailand
| | - Muazzum Shah
- Division of Cardiac Electrophysiology, University of Michigan Health System, Ann Arbor, MI, USA
| | | | - Waseem Barham
- Division of Cardiac Electrophysiology, Michigan State University, and Sparrow Thoracic and Cardiovascular Institute, Lansing, MI, USA
| | - Hakan Oral
- Division of Cardiac Electrophysiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Ranjan K Thakur
- Division of Cardiac Electrophysiology, Michigan State University, and Sparrow Thoracic and Cardiovascular Institute, Lansing, MI, USA
| | - Krit Jongnarangsin
- Division of Cardiac Electrophysiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Tanyanan Tanawuttiwat
- Division of Cardiovascular Medicine, Indiana University School of Medicine, 1800 N Capitol Ave, Room E300B, Indianapolis, IN, 46202, USA.
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Cheskes L, Krywenky A, Sadek MM. Just the facts: management of electrical storm and recurrent ICD shocks in the emergency department. CAN J EMERG MED 2021; 23:147-149. [PMID: 33709365 DOI: 10.1007/s43678-020-00049-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/16/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Lindsay Cheskes
- Department of Emergency Medicine, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, K1Y4E9, Canada
| | - Ashley Krywenky
- Department of Emergency Medicine, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, K1Y4E9, Canada.
| | - Mouhannad M Sadek
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
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Cardiac Implantable Electric Devices: Indications and Complications. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2017. [DOI: 10.1007/s40138-017-0128-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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