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Weiss R, Knight BP, El-Chami M, Aasbo J, Hanon S, Sadhu A, Sidhu M, Brisben AJ, Carter N, Burke MC, Gold M. Impact of Age on Subcutaneous Implantable Cardioverter-Defibrillator in a Large Patient Cohort: Mid-Term Follow-Up. JACC Clin Electrophysiol 2023; 9:2132-2145. [PMID: 37676200 DOI: 10.1016/j.jacep.2023.06.013] [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] [Received: 10/18/2022] [Revised: 05/26/2023] [Accepted: 06/25/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND The subcutaneous implantable cardioverter-defibrillator (S-ICD) is an accepted alternative to transvenous (TV) ICD to provide defibrillation therapy to treat life-threatening ventricular tachyarrhythmias in high-risk patients. S-ICD outcomes by age group have not been reported. OBJECTIVES In this study, the authors sought to report S-ICD outcomes in different age groups in a multicenter S-ICD post-approval study (PAS) involving the largest cohort of patients ever reported. METHODS Patients were prospectively enrolled in the S-ICD PAS and stratified based on age: young, aged 15-34 years; adult, aged 35-69 years; and elderly, aged ≥70 years. Patient characteristics and clinical outcomes through 3 years of follow up after implantation were compared. RESULTS The S-ICD PAS enrolled 1,637 patients. Elderly patients were more likely to receive an S-ICD as a replacement of a TV-ICD (15.1% elderly vs 12.3% adult vs 7.4% young). Secondary prevention indication decreased with age (32.7% young vs 22.2% adult vs 20.5% elderly). Mortality rate was significantly higher in the elderly group (24.0% elderly vs 13.0% adult vs 7.4% young; P < 0.0001), whereas the complication rate did not differ significantly (12.3% young vs 11.3% adult vs 8.1% elderly). Rates of appropriate shock (12.7% young vs 13.0% adult vs 13.8% elderly) and inappropriate shock (7.8% young vs 9.1% adult vs 8.8% elderly) rates did not differ between groups (P = 0.96 and P = 0.98, respectively). CONCLUSIONS Implant complications and appropriate and inappropriate shock rates were similar among age groups. S-ICD for secondary prevention was more common in the young group. Replacing a TV-ICD for an S-ICD increases with age. (S-ICD System Post-Approval Study; NCT01736618).
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Affiliation(s)
- Raul Weiss
- Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
| | | | | | - Johan Aasbo
- Baptist Health Lexington, Lexington, Kentucky, USA
| | - Sam Hanon
- Mount Sinai-Beth Israel Medical Center, New York, New York, USA
| | - Ashish Sadhu
- Phoenix Cardiovascular Research Group, Phoenix, Arizona, USA
| | | | - Amy J Brisben
- Boston Scientific Corporation, Saint Paul, Minnesota, USA
| | - Nathan Carter
- Boston Scientific Corporation, Saint Paul, Minnesota, USA
| | | | - Michael Gold
- Medical University of South Carolina, Charleston, South Carolina, USA
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Perera D, Morgan HP, Ryan M, Dodd M, Clayton T, O’Kane PD, Greenwood JP, Walsh SJ, Weerackody R, McDiarmid A, Amin-Youssef G, Strange J, Modi B, Lockie T, Hogrefe K, Ahmed FZ, Behan M, Jenkins N, Abdelaal E, Anderson M, Watkins S, Evans R, Rinaldi CA, Petrie MC. Arrhythmia and Death Following Percutaneous Revascularization in Ischemic Left Ventricular Dysfunction: Prespecified Analyses From the REVIVED-BCIS2 Trial. Circulation 2023; 148:862-871. [PMID: 37555345 PMCID: PMC10487377 DOI: 10.1161/circulationaha.123.065300] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/05/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Ventricular arrhythmia is an important cause of mortality in patients with ischemic left ventricular dysfunction. Revascularization with coronary artery bypass graft or percutaneous coronary intervention is often recommended for these patients before implantation of a cardiac defibrillator because it is assumed that this may reduce the incidence of fatal and potentially fatal ventricular arrhythmias, although this premise has not been evaluated in a randomized trial to date. METHODS Patients with severe left ventricular dysfunction, extensive coronary disease, and viable myocardium were randomly assigned to receive either percutaneous coronary intervention (PCI) plus optimal medical and device therapy (OMT) or OMT alone. The composite primary outcome was all-cause death or aborted sudden death (defined as an appropriate implantable cardioverter defibrillator therapy or a resuscitated cardiac arrest) at a minimum of 24 months, analyzed as time to first event on an intention-to-treat basis. Secondary outcomes included cardiovascular death or aborted sudden death, appropriate implantable cardioverter defibrillator (ICD) therapy or sustained ventricular arrhythmia, and number of appropriate ICD therapies. RESULTS Between August 28, 2013, and March 19, 2020, 700 patients were enrolled across 40 centers in the United Kingdom. A total of 347 patients were assigned to the PCI+OMT group and 353 to the OMT alone group. The mean age of participants was 69 years; 88% were male; 56% had hypertension; 41% had diabetes; and 53% had a clinical history of myocardial infarction. The median left ventricular ejection fraction was 28%; 53.1% had an implantable defibrillator inserted before randomization or during follow-up. All-cause death or aborted sudden death occurred in 144 patients (41.6%) in the PCI group and 142 patients (40.2%) in the OMT group (hazard ratio, 1.03 [95% CI, 0.82-1.30]; P=0.80). There was no between-group difference in the occurrence of any of the secondary outcomes. CONCLUSIONS PCI was not associated with a reduction in all-cause mortality or aborted sudden death. In patients with ischemic cardiomyopathy, PCI is not beneficial solely for the purpose of reducing potentially fatal ventricular arrhythmias. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT01920048.
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MESH Headings
- Humans
- Male
- Aged
- Female
- Stroke Volume
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Ventricular Function, Left
- Arrhythmias, Cardiac/etiology
- Ventricular Dysfunction, Left/etiology
- Defibrillators, Implantable/adverse effects
- Treatment Outcome
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Affiliation(s)
- Divaka Perera
- National Institute for Health Research Biomedical Research Center and British Heart Foundation Center of Research Excellence at the School of Cardiovascular Medicine and Sciences, King’s College London, United Kingdom (D.P., H.P.M., M.R.)
- Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom (D.P., C.A.R.)
| | - Holly P. Morgan
- National Institute for Health Research Biomedical Research Center and British Heart Foundation Center of Research Excellence at the School of Cardiovascular Medicine and Sciences, King’s College London, United Kingdom (D.P., H.P.M., M.R.)
| | - Matthew Ryan
- National Institute for Health Research Biomedical Research Center and British Heart Foundation Center of Research Excellence at the School of Cardiovascular Medicine and Sciences, King’s College London, United Kingdom (D.P., H.P.M., M.R.)
| | - Matthew Dodd
- London School of Hygiene & Tropical Medicine, United Kingdom (M.D., T.C., R.E.)
| | - Tim Clayton
- London School of Hygiene & Tropical Medicine, United Kingdom (M.D., T.C., R.E.)
| | - Peter D. O’Kane
- Royal Bournemouth and Christchurch Hospital, Bournemouth, United Kingdom (P.D.O.)
| | - John P. Greenwood
- Leeds Teaching Hospitals NHS Trust and University of Leeds, United Kingdom (J.P.G., M.A.)
| | - Simon J. Walsh
- Belfast Health and Social Care NHS Trust, United Kingdom (S.J.W.)
| | | | - Adam McDiarmid
- Newcastle Hospitals NHS Foundation Trust, United Kingdom (A.M.)
| | - George Amin-Youssef
- King’s College Hospital NHS Foundation Trust, London, United Kingdom (G.A.-Y.)
| | - Julian Strange
- University Hospitals Bristol NHS Foundation Trust, United Kingdom (J.S.)
| | - Bhavik Modi
- University Hospitals of Leicester NHS Trust, United Kingdom (B.M.)
| | | | - Kai Hogrefe
- Kettering General Hospital, Northampton, United Kingdom (K.H.)
| | - Fozia Z. Ahmed
- Manchester Royal Infirmary, University NHS Foundation Trust, United Kingdom (F.Z.A.)
| | - Miles Behan
- Edinburgh Royal Infirmary, United Kingdom (M.B.)
| | | | | | - Michelle Anderson
- Leeds Teaching Hospitals NHS Trust and University of Leeds, United Kingdom (J.P.G., M.A.)
| | - Stuart Watkins
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (S.W., M.C.P.)
| | - Richard Evans
- London School of Hygiene & Tropical Medicine, United Kingdom (M.D., T.C., R.E.)
| | | | - Mark C. Petrie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (S.W., M.C.P.)
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Lloyd MS, Brisben AJ, Reddy VY, Blomström-Lundqvist C, Boersma LV, Bongiorni MG, Burke MC, Cantillon DJ, Doshi R, Friedman PA, Gras D, Kutalek SP, Neuzil P, Roberts PR, Wright DJ, Appl U, West J, Carter N, Stein KM, Mont L, Knops RE. Design and rationale of the MODULAR ATP global clinical trial: A novel intercommunicative leadless pacing system and the subcutaneous implantable cardioverter-defibrillator. Heart Rhythm O2 2023; 4:448-456. [PMID: 37520021 PMCID: PMC10373150 DOI: 10.1016/j.hroo.2023.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
Background The subcutaneous implantable cardioverter-defibrillator (S-ICD) has demonstrated safety and efficacy for the treatment of malignant ventricular arrhythmias. However, a limitation of the S-ICD lies in the inability to either pace-terminate ventricular tachycardia or provide prolonged bradycardia pacing support. Objective The rationale and design of a prospective, single-arm, multinational trial of an intercommunicative leadless pacing system integrated with the S-ICD will be presented. Methods A technical description of the modular cardiac rhythm management (mCRM) system (EMPOWER leadless pacemaker and EMBLEM S-ICD) and the implantation procedure is provided. MODULAR ATP (Effectiveness of the EMPOWER™ Modular Pacing System and EMBLEM™ Subcutaneous ICD to Communicate Antitachycardia Pacing) is a multicenter, international trial enrolling up to 300 patients at risk of sudden cardiac death at up to 60 centers trial design. The safety endpoint of freedom from major complications related to the mCRM system or implantation procedure at 6 months and 2 years are significantly higher than 86% and 81%, respectively, and all-cause survival is significantly >85% at 2 years. Results Efficacy endpoints are that at 6 months mCRM communication success is significantly higher than 88% and the percentage of subjects with low and stable thresholds is significantly higher than 80%. Substudies to evaluate rate-responsive features and performance of the pacing module are also described. Conclusion The MODULAR ATP global clinical trial will prospectively test the safety and efficacy of the first intercommunicating leadless pacing system with the S-ICD. This trial will allow for robust validation of device-device communication, pacing performance, rate responsiveness, and system safety.
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Affiliation(s)
| | | | - Vivek Y. Reddy
- Icahn School of Medicine, Mount Sinai, New York, New York
| | - Carina Blomström-Lundqvist
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Medical Sciences, Cardiology - Arrhythmia, Uppsala University, Uppsala, Sweden
| | - Lucas V.A. Boersma
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | | | | | | | - Rahul Doshi
- Heart and Vascular Health, HonorHealth Research Institute, Scottsdale, Arizona
- College of Medicine, University of Arizona, Phoenix, Arizona
| | - Paul A. Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Daniel Gras
- Departement de Cardiologie, Hôpital Privé du Confluent, Nantes, France
| | - Steven P. Kutalek
- Department of Cardiology, Saint Mary Medical Center, Langhorne, Pennsylvania
- Cardiac Electrophysiology, Drexel University, Philadelphia, Pennsylvania
| | - Petr Neuzil
- Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Paul R. Roberts
- Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - David J. Wright
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Ursula Appl
- Boston Scientific Corporation, St. Paul, Minnesota
| | - Julie West
- Boston Scientific Corporation, St. Paul, Minnesota
| | | | | | - Lluis Mont
- Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Institut de Recerca Biomèdica, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
| | - Reinoud E. Knops
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
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Panchangam S, Monahan KM, Helm RH. Anti-tachycardia Pacing: Mechanism, History and Contemporary Implementation. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2022. [DOI: 10.1007/s11936-022-00959-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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