Association of Implantable Cardioverter Defibrillators With Survival in Patients With and Without Improved Ejection Fraction

Adabag, Selçuk; Patton, Kristen K.; Buxton, Alfred E.; Rector, Thomas S.; Ensrud, Kristine E.; Vakil, Kairav; Levy, Wayne C.; Poole, Jeanne E.

doi:10.1001/jamacardio.2017.1413

Cited by 65 publications

(56 citation statements)

References 44 publications

(87 reference statements)

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“…Compared with placebo, the adjusted HR for the effect of ICD on mortality was 0.64 (95% CI 0.48 to 0.85) in patients with a repeated EF of ≤35% and 0.62 (95% CI 0.29 to 1.30) in those with a repeated EF >35%. These data suggest that patients who had an improvement in EF >35% during follow-up accrued a similar mortality benefit with ICD as those whose EF remained ≤35% 18. Similar findings were reported in other smaller studies where improvement in EF >35% was associated with lower risk of ICD therapies; however, the residual arrhythmic risk was significant enough to warrant ongoing ICD therapy 9 11 12.…”

supporting

confidence: 81%

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Primary prevention ICD generator at end of life: to replace or to not?

Pillai

Ellenbogen

2019

Heart Asia

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supporting

confidence: 81%

“…In the Sudden Cardiac Death in Heart Failure Trial substudy, 1273 patients with reduced EF ≤35% assigned to ICD versus placebo were analysed 18. During a median follow-up of 30 months, EF improved to >35% in about 30% of patients in each group.…”

mentioning

confidence: 99%

Primary prevention ICD generator at end of life: to replace or to not?

Pillai

Ellenbogen

2019

Heart Asia

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“…13,14 In a study of 195 patients, 50 (25.6%) had 10% improvement in LVEF reaching a median LVEF during follow-up of 41% (25th, 75th percentiles 37%, 49%). 15 Studies have shown that LVEF improvement is associated with a significant long-term reduction in heart failure hospitalizations, ICD shocks, and death.…”

Section: Data On Icdsmentioning

confidence: 99%

When Is It Safe Not to Reimplant an Implantable Cardioverter Defibrillator at the Time of Battery Depletion?

Al‐Khatib

Friedman

Sanders

2018

Cardiac Electrophysiology Clinics

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The implantable cardioverter defibrillator (ICD) is a life-saving therapy in various patient populations. Although data on the outcomes of initial ICD implants are abundant, data on ICD replacements, especially in patients with improved left ventricular (LV) function, are scarce. Therefore, it is not known when it is safe to not replace an ICD that has reached the end of battery life. This article reviews data on patients with primary prevention ICDs who have improvement in left ventricular ejection fraction during follow-up and provides some guidance, based on the available evidence, related to circumstances when replacement of an ICD may be forgone.

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“…The mean LVEF at the most recent follow‐up was >35% (Table 1), most likely because of (1) inclusion of cases where LVEF does not need to be low at the time of ICD implantation (arrhythmogenic right ventricular cardiomyopathy [ARVC], cardiac sarcoidosis, inherited arrhythmia syndromes, etc. ), and (2) improvement in LVEF that occurs in 25%–50% of patients after ICD implantation 22–28 …”

Section: Discussionmentioning

confidence: 99%

Mechanism of spontaneous initiation of ventricular fibrillation in patients with implantable defibrillators

Xie

Mayer

Capps

et al. 2020

Cardiovasc electrophysiol

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Introduction To improve the mechanistic understanding of spontaneous initiation of ventricular fibrillation (VF), we characterized the patterns of premature ventricular complex (PVC) preceding spontaneous VF in primary and secondary implantable cardioverter‐defibrillator (ICD) recipients. Methods and Results A single‐center, cross‐sectional analysis of 1209 patients with primary and secondary prevention ICD identified 190 patients who received ICD therapy (firing or antitachycardia pacing) for VF or monomorphic ventricular tachycardia (MMVT). Initiation was quantified by the coupling interval (CI), the cycle length immediately preceding the CI (CL(−1)), the CI corrected by CL(−1) using Fridericia's formula (CIc), and the prematurity index (PI). In both VF (n = 44; 23%) and MMVT (n = 134; 71%), the most common pattern of initiation was late‐coupled PVC, followed by the short‐long‐short pattern. The parameters such as pre‐initiation median CL, CL(−1), CI, and PI were not significantly different between VF and MMVT for any patterns. At least some events (45% of VF and 63% of MMVT) had extremely long CIs beyond the QTc cut‐off estimated from the CL(−1), suggestive of initiation by a train of multiple PVCs or nonsustained VT instead of a single PVC. Conclusion Some spontaneous VF events in ICD recipients appear to be initiated by a train of multiple PVC or nonsustained VT rather than a single PVC. This finding indicates that patterns of a single PVC are not an important determinant of VF initiation and thus account for conflicting results in previous studies.

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Association of Implantable Cardioverter Defibrillators With Survival in Patients With and Without Improved Ejection Fraction

Abstract: clinicaltrials.gov Identifier: NCT01114269.

Cited by 65 publications

References 44 publications

Primary prevention ICD generator at end of life: to replace or to not?

Primary prevention ICD generator at end of life: to replace or to not?

When Is It Safe Not to Reimplant an Implantable Cardioverter Defibrillator at the Time of Battery Depletion?

Mechanism of spontaneous initiation of ventricular fibrillation in patients with implantable defibrillators

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