Key result
Primary prophylactic ICD implantation in the 2010s was associated with a lower 8-year rate of appropriate therapy compared to the 2000s (42% vs 51%, HR 0.63), while complication rates remained high.
Why the study?
ICD therapy became routine over 20 years ago, but the benefit-harm profile of contemporary primary prophylactic ICD therapy needed evaluation.
Does the benefit-harm profile of primary prophylactic ICD therapy differ between patients implanted in 2010-2017 compared to 2000-2009?
Cohort (n=1,222)
No
Does the benefit-harm profile of primary prophylactic ICD therapy differ between patients implanted in 2010-2017 compared to 2000-2009?
Hazard Ratio: 0.63 (95% CI 0.5–0.81)
Absolute Event Rate: 42% vs 51%
p-value: p=<0.001
The benefit of primary prophylactic ICD therapy has decreased over the last two decades while complication rates remain high, suggesting a need for better risk stratification, especially in nonischemic cardiomyopathy.
BACKGROUND: Implantable cardioverter defibrillator (ICD) was implemented into clinical routine more than 20 years ago. Since then, ICD therapy became standard therapy for primary and secondary prevention of sudden cardiac death in clinical practice. OBJECTIVES: Aim of the study was to evaluate the benefit-harm profile of contemporary primary prophylactic ICD therapy. METHODS: A total of 1222 consecutive patients of a prospective single-center ICD-registry were analyzed who underwent primary prophylactic ICD implantation between 2000 and 2017. Patients were divided into two groups according to the implantation year: 2010-2017 (group 1, n = 579) and 2000-2009 (group 2, n = 643). RESULTS: The rate of estimated appropriate ICD therapy after 8 years was 51% in the 2000s and 42% in the 2010s (P < .001). The complication rate changed slightly from 53% to 47% (P = .005). This decline was mainly driven by the reduction of inappropriate ICD shocks (30% vs 14%, P < .001) whereas the rate of ICD shock lead malfunction and device/ lead infection remained unchanged over time. Nonischemic cardiomyopathy was an independent predictor for ICD complications without benefit of ICD therapy (HR 1.37, 95% CI 1.07-1.77). CONCLUSION: The ICD therapy rate for ventricular arrhythmias in patients with primary prophylactic ICD implantation is decreasing over the last two decades. Complication rate remains high due to an unchanged rate of ICD shock malfunctions and device infections. Nonischemic cardiomyopathy is an independent predictor for ICD complications without benefit of ICD therapy in primary prophylactic ICD-therapy.
No takes yet. Share an insight, caveat, or question.
Kleemann et al. (2019) conducted a cohort in Heart failure with primary prophylactic ICD indication (n=1,222). ICD implantation in 2010-2017 vs. ICD implantation in 2000-2009 was evaluated on Appropriate ICD therapy at 8 years (HR 0.63, 95% CI 0.50-0.81, p=<0.001). Primary prophylactic ICD implantation in the 2010s was associated with a lower 8-year rate of appropriate therapy compared to the 2000s (42% vs 51%, HR 0.63), while complication rates remained high.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: