Implantable cardioverter‐defibrillators: a long‐term view

Wilson, David G.; Shi, B.; Harding, Scott; Lever, Nigel; Larsen, Peter

doi:10.1111/j.1445-5994.2011.02710.x

Cited by 10 publications

(14 citation statements)

References 31 publications

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“…7 Also, previous primary prevention observational studies showed similar incidences of appropriate therapy after 5-7 years of follow-up. [11][12][13]20 Appropriate shocks were observed in 24% of the primary prevention patients and 47% of the secondary prevention patients over 12 years, which seems comparable with the 28% appropriate shocks reported by Ronn et al after 6 years in secondary prevention patients. 10 Furthermore, the large ALTITUDE registry reported 33%-38% appropriate shocks after 5 years.…”

Section: Appropriate Device Therapysupporting

confidence: 90%

“…Other observational studies reported similar mortality rates, although most follow-up periods did not exceed 5 years in these studies. [10][11][12][13][14][15] The incidence of all-cause mortality of ICD recipients was higher in the secondary prevention population; this has not been described before and was only apparent after stratifying for ICD and CRT-D treatments. However, closely reviewing the 3-year mortality rates observed in primary and secondary prevention trials demonstrates a comparable trend.…”

Section: Mortality In Icd and Crt-d Recipientsmentioning

confidence: 82%

“…9 Followup in observational studies does not exceed 5 years, while many patients live more than a decade after device implantation. [10][11][12][13][14][15] Therefore, the aim of the present study was to provide an overview of the long-term clinical outcome of ICD and CRT-D recipients in a large cohort outside the setting of a clinical trial. Clinical outcome includes all-cause mortality, device therapy, device replacements, and device-related complications.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The clinical course of patients with implantable cardioverter-defibrillators: Extended experience on clinical outcome, device replacements, and device-related complications

et al. 2015

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Section: Appropriate Device Therapysupporting

confidence: 90%

Section: Mortality In Icd and Crt-d Recipientsmentioning

confidence: 82%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The clinical course of patients with implantable cardioverter-defibrillators: Extended experience on clinical outcome, device replacements, and device-related complications

et al. 2015

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“…While this has increased from a proportion of 25% in the 2000-2005 period [14], the greatest proportion of unmet need is in the primary prevention population [4,8]. In the United States 82% of devices implanted are for primary prevention [8], although questions about the suitability of all of these implants have been raised [15].…”

Section: New Icd Implants In 2010 In New Zealand Show Marked Differenmentioning

confidence: 99%

Geographic, Ethnic and Socioeconomic Factors Influencing Access to Implantable Cardioverter Defibrillators (ICDs) in New Zealand

Wilson

Harding

Melton

et al. 2012

Heart, Lung and Circulation

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“…For primary prevention in patients with left ventricular ejection fraction (LVEF) below 35%, ICD is now recommended (2). However, only 30% to 50% of implanted patients received appropriate ICD firings, and up to 25% suffered from side effects in the first year after ICD insertion (3,4). In addition, because of steadily growing demand for ICD replacements (5), the financial burden of primary ICD insertion on our healthcare systems is increasing.…”

mentioning

confidence: 99%

Scaring Myocardial Scars

Mewton¹,

Chevalier²

2012

Journal of the American College of Cardiology

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Despite the impressive development of medical therapies for patients with myocardial dysfunction, sudden cardiac death (SCD) is still too frequent. In patients with severe cardiomyopathies the insertion of an implantable cardiac defibrillator (ICD) has been shown to reduce SCD risk (1). For primary prevention in patients with left ventricular ejection fraction (LVEF) below 35%, ICD is now recommended (2). However, only 30% to 50% of implanted patients received appropriate ICD firings, and up to 25% suffered from side effects in the first year after ICD insertion (3,4). In addition, because of steadily growing demand for ICD replacements (5), the financial burden of primary ICD insertion on our healthcare systems is increasing. Consequently, there is an urgent need to improve the benefit-risk ratio of ICD insertion. See page 408The assessment of myocardial scarring with delayed enhanced cardiac magnetic resonance (DE-CMR) has become an important and independent prognostic factor of cardiovascular outcomes in various cardiomyopathies (6). It is now established that myocardial scar and/or its correlates (scar pattern, relative size, heterogenous scar periphery size, transmurality) by DE-CMR are independent prognostic markers of cardiac death or ventricular tachycardia (VT) occurrence in patients with ischemic (7-12), nonischemic (13,14), and hypertrophic cardiomyopathies (15,16) as well as in patients referred for ICD insertion (8,17). Simple myocardial scar assessment by DE-CMR is an accurate, reproducible, and reliable tool when put in trained hands. Therefore it could be reasonably integrated in addition to the precise measurement of LVEF by cardiac magnetic resonance imaging (MRI) (another advantage of cardiac MRI) in the therapeutic management of candidates for ICD insertion. With this in mind, the original article by Klem et al. (18) in this issue of the Journal is a cornerstone for the constitution of clinical trials integrating myocardial scar assessment by DE-CMR in the decision for ICD insertion.In a prospective single-center cohort study on 137 patients referred for ICD insertion, Klem et al. (18) performed an expert and simple cardiac MRI study assessing myocardial scar and LVEF before implantation. The mean LVEF was 35 Ϯ 18%, and 75% (n ϭ 104) of the patients had an ICD placed, with an indication of primary prevention in 88%. Of the entire patient population, 78% (n ϭ 107) had scar by DE-CMR, while at the same time 76% (n ϭ 105) underwent an electrophysiology study with VT induction in 20% (n ϭ 21).At 24 months, the primary endpoint occurred in 28% (n ϭ 39) of the patients with an approximately equal distribution of events between death and ICD discharge. Importantly, there were no patients lost to follow-up. The striking finding in this study is that there was a 5-fold increase in the rate of adverse events for a scar size Ͼ5% of the left ventricular (LV) mass and that scar size dichotomized approximately 5% of the LV mass provided a significant increment in prognostic value in addition to that of LVE...

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Implantable cardioverter‐defibrillators: a long‐term view

Abstract: This is the first long-term follow-up study of ICD patients in New Zealand. We observed a low mortality rate when compared with other published registries, but a similar rate of both appropriate and inappropriate shock therapy.

Cited by 10 publications

References 31 publications

The clinical course of patients with implantable cardioverter-defibrillators: Extended experience on clinical outcome, device replacements, and device-related complications

The clinical course of patients with implantable cardioverter-defibrillators: Extended experience on clinical outcome, device replacements, and device-related complications

Geographic, Ethnic and Socioeconomic Factors Influencing Access to Implantable Cardioverter Defibrillators (ICDs) in New Zealand

Scaring Myocardial Scars

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