Comparison of ventricular arrhythmia burden, therapeutic interventions, and survival, in patients &lt; 75 and patients &gt;= 75 years of age treated with implantable cardioverter defibrillators

Ermis, Cengiz; Zhu, Alan X.; VanHeel, Laura; Sakaguchi, Ryuhei; Lurie, Keith G.; Lü, Fei; Benditt, David G.

doi:10.1093/europace/eum015

Cited by 17 publications

(16 citation statements)

References 14 publications

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“…The burden of pVC in the current study did not differ between younger (< 70 years) and older (≥ 70 years) adults. similar results were reported in a study by Ermis et al 11 In the current study only 18 subjects had no detectable pVCs during the Holter registration while over three quarter of the subjects had less than 500 pVCs/24 hour irrespective of the age group (Fig 1), though pVC-related symptoms were significantly more common in younger subjects in our study.…”

Section: Pac Pvcsupporting

confidence: 93%

Relationship between 24- hour Holter variables, chest discomfort and syncope: Does age matter?

Saha¹

2015

ICFJ

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One hundred and forty four ambulatory, non-emergent human subjects from 20-88 years of age were investigated following routine 24 hour Holter monitoring referred by primary and tertiary care centers primarily for evaluation of palpitations and syncope. The patients were grouped into 3 different age categories: A) 20-59 years of age (16%), B) 60-69 years of age (26.4%) and C) > 70 years of age (57.6%). Heart rate profile, RR intervals, symptoms, frequency of premature supra ventricular and ventricular complexes were registered. The data show that though the occurrence and frequency of premature atrial and ventricular contractions over a period of 24 hours did not differ between the groups, the younger subjects documented more subjective discomforts during the Holter monitoring. Extra-systoles in excess of 1000 beats / 24 hour occured incessantly throughout the registration. Patients with syncope and those without did not differ as regards the Holter variables. However, subjects with atrial fibrillation had acceptable rate control and had significantly lower incidence of syncope than those with sinus rhythm. The findings suggest that in a county setting, Holter monitoring for evaluation of syncope may not be the first hand mode of investigation in a non emergent setting. On the contrary, the modality appears to be valuable for monitoring patients with atrial fibrillation. Even mild symptoms in the elderly population may warrant closer clinical follow up to prevent cardiac events and/or syncope leading to serious physical injury.

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Section: Pac Pvcsupporting

confidence: 93%

Relationship between 24- hour Holter variables, chest discomfort and syncope: Does age matter?

Saha¹

2015

ICFJ

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“…We used regression methods described by Harrell,12 in which potentially clinically important predictors of outcome with P<0. 25 were considered for entry into a Fine and Gray competing risk timeto-event model. Covariates were retained in the final nonparsimonious multivariable model if the P value was <0.20 for competing risk of either death or appropriate ICD shock.…”

Section: Discussionmentioning

confidence: 99%

“…Prior observational studies have also evaluated small samples at single centers and lacked sufficient clinical data to control for confounders. 24,25 The current report is novel because the data were collected in a prospective fashion with detailed longitudinal follow-up. Outcomes were determined bimodally with the use of a combination of both clinical assessments and passive follow-up through well-established administrative databases.…”

Section: 19 a Meta-analysis Of Secondary Prevention Trials (Cardiamentioning

confidence: 99%

Survival After Implantable Cardioverter-Defibrillator Implantation in the Elderly

Yung

Birnie²,

Dorian³

et al. 2013

Circulation

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I mplantable cardioverter-defibrillators (ICDs) used in appropriately selected patients at high risk of sudden cardiac death are associated with reduction in arrhythmic death. 1 Recommendations for ICDs are based on large randomized, controlled trials, which often enroll highly selected patients who are often young with few comorbidities. In contrast, the average patient with heart failure and severe left ventricular systolic dysfunction is aged >65 years with multiple comorbidities. With the aging population, the number of elderly patients being considered for ICD implantation is increasing, and an estimated 28% of those deemed potentially eligible by conventional criteria are octogenarians.2 However, with advancing age and comorbidity burden, the relative contribution of nonarrhythmic causes of death may increase, 3,4 potentially attenuating the benefits of ICD therapy. Current guidelines do not specifically address the appropriateness or prognosis of ICD implantation with advanced age. 1,5,6 Clinical Perspective on p 2392Randomized trials can underrepresent elderly patients, while population-based registries may illuminate the impact and outcomes of ICDs implanted in this group. The Ontario ICD Database is a large, population-based, prospective registry of ICD recipients referred for primary or secondary prevention defibrillator implantation. Using this registry, we examined all-cause mortality, appropriate and inappropriate defibrillator shocks, hospitalization, and early complications in elderly ICD Background-The benefit of implantable cardioverter-defibrillators (ICDs) among elderly patients is controversial and may be attenuated by nonarrhythmic death. We examined the impact of age on device-delivered therapies and outcomes after primary or secondary prevention ICD. Methods and Results-In a prospective, inclusive registry of 5399 ICD recipients in Ontario, Canada (February 2007 to September 2010), device-delivered therapies and complications were determined at routine clinic visits. Among primary prevention ICD recipients aged 18 to 49 (n=317), 50 to 59 (n=769), 60 to 69 (n=1336), 70 to 79 (n=1242), and ≥80 (n=275) years, mortality increased with age, as follows: 2.1, 3.0, 5.4, 6.9, and 10.2 deaths per 100 person-years, respectively (P<0.001). Secondary prevention ICD recipients aged 18 to 49 (n=114), 50 to 59 (n=244), 60 to 69 (n=481), 70 to 79 (n=462), and ≥80 (n=159) years also exhibited increasing mortality, as follows: 2.2, 3.8, 6.1, 8.7, and 15.5 deaths per 100 person-years, respectively (P<0.001). However, rates of appropriate shock were similar across age groups: from 6.7 (18-49 years) to 4.2 (≥80 years) per 100 person-years after primary prevention ICDs (P=0.139) and from 11.4 (18-49 years) to 11.9 (≥80 years) per 100 person-years after secondary prevention ICDs (P=0.993). Covariate-adjusted competing risk analysis demonstrated higher risk of death (P trend <0.001 for both primary and secondary prevention) but no significant decline in appropriate shocks with older age after primary (P=0.130) ...

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“…Ermiz and colleagues [22] reported a cohort study including 202 ICD recipients using an age cut-off of 75 years. Similar to the results our study [18] and to the results of Panotopulos et al [20], elderly ICD N 75 years recipients were found to have a similar low sudden death rate and a similar incidence of appropriate ICD shocks, but a higher total mortality during follow-up compared to younger ICD recipients.…”

Section: Cohort Studies Of Elderly Icd Recipientsmentioning

confidence: 99%

Outcomes of elderly heart failure recipients of ICD and CRT

Grimm

2008

International Journal of Cardiology

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Comparison of ventricular arrhythmia burden, therapeutic interventions, and survival, in patients < 75 and patients >= 75 years of age treated with implantable cardioverter defibrillators

Abstract: In terms of reversing potentially life-threatening arrhythmias, the rationale for ICD therapy is comparable in older and younger individuals.

Cited by 17 publications

References 14 publications

Relationship between 24- hour Holter variables, chest discomfort and syncope: Does age matter?

Relationship between 24- hour Holter variables, chest discomfort and syncope: Does age matter?

Survival After Implantable Cardioverter-Defibrillator Implantation in the Elderly

Outcomes of elderly heart failure recipients of ICD and CRT

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