Key result
Over a median 10.6-year follow-up, 33% of ARVC patients with an ICD experienced an inappropriate shock or surgical complication, while 41% received appropriate shock therapy.
Why the study?
ICD treatment is a cornerstone to prevent sudden cardiac death in ARVC, but complications associated with long-term ICD treatment needed characterization in a multinational cohort.
Cohort (n=299)
Yes
In patients with ARVC, ICDs deliver potentially life-saving therapy in over 40% of patients over a decade, but are associated with a high rate (33%) of significant complications, predominantly lead-related.
High complication burden alongside frequent appropriate shocks in ARVC supports individualized ICD decisions; leaves open optimal lead strategies and risk stratification.
AIMS: Treatment with implantable cardioverter-defibrillators (ICD) is a cornerstone for prevention of sudden cardiac death in arrhythmogenic right ventricular cardiomyopathy (ARVC). We aimed at describing the complications associated with ICD treatment in a multinational cohort with long-term follow-up. METHODS AND RESULTS: The Nordic ARVC registry was established in 2010 and encompasses a large multinational cohort of ARVC patients, including their clinical characteristics, treatment, and events during follow-up. We included 299 patients (66% males, median age 41 years). During a median follow-up of 10.6 years, 124 (41%) patients experienced appropriate ICD shock therapy, 28 (9%) experienced inappropriate shocks, 82 (27%) had a complication requiring surgery (mainly lead-related, n = 75), and 99 (33%) patients experienced the combined endpoint of either an inappropriate shock or a surgical complication. The crude rate of first inappropriate shock was 3.4% during the first year after implantation but decreased after the first year and plateaued over time. Contrary, the risk of a complication requiring surgery was 5.5% the first year and remained high throughout the study period. The combined risk of any complication was 7.9% the first year. In multivariate cox regression, presence of atrial fibrillation/flutter was a risk factor for inappropriate shock (P < 0.05), whereas sex, age at implant, and device type were not (all P > 0.05). CONCLUSION: Forty-one percent of ARVC patients treated with ICD experienced potentially life-saving ICD therapy during long-term follow-up. A third of the patients experienced a complication during follow-up with lead-related complications constituting the vast majority.
No takes yet. Share an insight, caveat, or question.
Christensen et al. (2021) conducted a cohort in Arrhythmogenic right ventricular cardiomyopathy (ARVC) (n=299). Implantable cardioverter-defibrillator (ICD) was evaluated on Combined endpoint of either an inappropriate shock or a surgical complication. Over a median 10.6-year follow-up, 33% of ARVC patients with an ICD experienced an inappropriate shock or surgical complication, while 41% received appropriate shock therapy.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: