Key result
Secondary prevention ICDs in patients ≥80 yield 71% two-year survival free from deactivation or death.
Why the study?
No randomised evidence guides secondary prevention ICD use in patients aged ≥80 years, despite the increasing importance of competing modes of death when assessing benefit.
Does secondary prevention implantable cardioverter-defibrillator therapy provide acceptable survival and appropriate therapy in patients aged ≥80 years?
Cohort (n=38)
No
Does secondary prevention implantable cardioverter-defibrillator therapy provide acceptable survival and appropriate therapy in patients aged ≥80 years?
Answers are grounded in this paper and cite their sources.
In octogenarians, secondary prevention ICDs provide acceptable survival and frequent appropriate therapy, but are associated with a high rate of complications and shock storms, highlighting the need for careful shared decision-making.
Introduction and aimsGuidelines recommend secondary prevention implantable cardioverter defibrillator (SP-ICD) therapy after significant ventricular arrhythmia. However, landmark SP-ICD trials enrolled patients with mean ages of 58-65 years. No randomised evidence guides SP-ICD use in patients aged ≥80 years, despite the increasing importance of competing modes of death when assessing benefit. We aimed to describe the patient journey and clinical outcomes of individuals aged ≥80 years receiving an SP-ICD at a single high-volume centre over 7 years.Methods and resultsWe retrospectively reviewed all consecutive device implants at a regional Scottish centre from 2014 to 2021 to identify SP-ICD implantation in patients aged ≥80 years. Clinical data were then obtained from electronic health records. Thirty-eight patients received an SP-ICD. Survival free from ICD deactivation or death at 6 months, 1 year and 2 years was 95%, 84% and 71%, respectively. During follow-up, 21 patients (55%) received appropriate therapy. There was an overall complication rate of 13%. One patient received inappropriate ICD therapy, and five patients (13%) experienced ICD shock storm.ConclusionOctogenarians receiving SP-ICDs experienced frequent appropriate defibrillator therapy and acceptable survival, but complications were common. These findings emphasise patient-centred decision-making and counselling about risks, future therapies and potential device deactivation.
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McCoubrey et al. (2026) conducted a cohort in Significant ventricular arrhythmia requiring secondary prevention (n=38). Secondary prevention implantable cardioverter-defibrillator (SP-ICD) was evaluated on Survival free from ICD deactivation or death at 2 years. Secondary prevention implantable cardioverter-defibrillators in patients aged ≥80 years resulted in 71% survival free from deactivation or death at 2 years, with 55% receiving appropriate therapy.
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