Key result
ICDs in young South African patients deliver appropriate shocks to ~42% of recipients.
Why the study?
Important regional variations exist in sudden cardiac death etiology in young patients without atherosclerotic coronary artery disease, but data from South Africa are limited.
What are the clinical profiles and outcomes of young patients (≤35 years) treated with implantable cardioverter defibrillators in South Africa?
Observational (n=38)
No
What are the clinical profiles and outcomes of young patients (≤35 years) treated with implantable cardioverter defibrillators in South Africa?
In young South African patients receiving ICDs, ARVC and idiopathic dilated cardiomyopathy are major indications, with high rates of appropriate therapies but also notable inappropriate shocks.
High appropriate shock rates support ICD benefit in young South Africans with ARVC/DCM; observational data leaves optimal selection and shock minimization open.
AIM: In young patients without atherosclerotic coronary artery disease, the aetiology of sudden cardiac death (SCD) has been described in Europe and North America. However, there are important regional variations and there are limited data on the aetiology and outcome of SCD in South Africa. The objective of this study was to determine the profile and outcomes of young patients treated with implantable cardioverter defibrillators (ICDs) at a South African tertiary hospital. METHODS: This study was designed as a retrospective review of patients aged 35 years or younger implanted with ICDs at Groote Schuur Hospital. RESULTS: During the study period, 38 patients younger than 35 years were implanted with ICDs. The mean (standard deviation) age at ICD implantation was 25.1 (7.6) years and 63.2% were male. A secondary-prevention ICD was implanted in 57.9% of the patient population, and primary prevention in the remaining 42.1%. Patients with secondary-prevention ICDs presented with ventricular tachycardia (59.1%), ventricular fibrillation (31.8%) and receipt of cardiopulmonary resuscitation but no recorded electrocardiograms (9.1%). Arrhythmogenic right ventricular cardiomyopathy (ARVC) was the leading cause of SCD in the secondary-prevention patient population (36.4%). Idiopathic dilated cardiomyopathy accounted for 50% of the primary-prevention patient population. After a median (interquartile range) follow up 32 (14-90) months, 7.9% died and 5.2% received a heart transplant; 42.1% of the study population received appropriate ICD shock therapies and 18.4% received inappropriate shock therapies. CONCLUSIONS: In this single-centre study from South Africa, ARVC and repaired congenital heart disease were the leading causes of SCD in patients younger than 35 years treated with secondary-prevention ICDs. Primary-prevention ICDs were frequently implanted for idiopathic dilated cardiomyopathy.
No takes yet. Share an insight, caveat, or question.
Mkoko et al. (2023) conducted an observational in Sudden cardiac death (n=38). Implantable cardioverter defibrillators (ICDs) was evaluated on Clinical profile and outcomes (mortality, heart transplant, shock therapies). Among young South African patients (≤35 years) with ICDs, 42.1% received appropriate shocks, 18.4% inappropriate shocks, and 7.9% died over a median 32-month follow-up.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: