Key result
Worsening renal function (HR 2.79; 95% CI 1.50-5.18) and consistently LVEF ≤35% (HR 2.15; 95% CI 1.10-4.19) at elective ICD replacement were independent predictors of mortality.
Why the study?
Do changes in LVEF and renal function predict mortality and appropriate ICD therapy in patients undergoing elective ICD replacement?
Cohort (n=238)
No
Do changes in LVEF and renal function predict mortality and appropriate ICD therapy in patients undergoing elective ICD replacement?
Clinical reassessment of LVEF and renal function at the time of elective ICD replacement predicts mortality but does not help identify patients who will receive their first appropriate therapy, which occurs in about 25% of patients post-replacement.
BACKGROUND: A proportion of patients with an implantable cardioverter-defibrillator (ICD) in prevention of sudden cardiac death will only receive their first appropriate ICD therapy (AT) after device replacement. Clinical reassessment at the time of replacement could be helpful to guide the decision to replace or not in the future. METHODS: All patients with an ICD for primary or secondary prevention in ischemic (ICM) or nonischemic cardiomyopathy were included in a single-center retrospective registry. The association of changes in left ventricular ejection fraction (LVEF; cut-off at 35%), worsening renal function (decrease in estimated glomerular filtration rate > 15 mL/min), and worsening New York Heart Association class at elective device replacement with mortality and AT was analyzed using adjusted Cox regression analysis. RESULTS: A total of 238 (33%) out of 727 patients received elective device replacement (86.1% male, 74.4% ICM, 42.9% primary prevention). During this replacement 20.2% received a device upgrade. The mean time to replacement was 6.4 ± 2.0 years and mean follow-up after replacement was 3.4 ± 3.0 years. Of patients who did not receive AT before replacement 23.1% received their first AT after replacement. Worsening renal function (hazard ratio [HR] 2.79, 95% confidence interval [CI] 1.50-5.18) and a consistently LVEF ≤35% compared to a consistently LVEF >35% (HR 2.15, 95% CI 1.10-4.19) at the time of replacement were independent predictors of mortality. Independent predictors of first AT after replacement could not be identified. CONCLUSION: Although reassessment of LVEF and renal function at replacement can be helpful in predicting total mortality, the clinical utility to guide reimplantation seemed limited. Our experience indicates that approximately 25% of patients received their first AT only after replacement.
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Vandenberk et al. (2017) conducted a cohort in Implantable cardioverter-defibrillator (ICD) patients undergoing elective device replacement (n=238). Worsening renal function vs. No worsening renal function was evaluated on Mortality (HR 2.79, 95% CI 1.50-5.18). Worsening renal function (HR 2.79; 95% CI 1.50-5.18) and consistently LVEF ≤35% (HR 2.15; 95% CI 1.10-4.19) at elective ICD replacement were independent predictors of mortality.
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