Key result
Implantable cardioverter-defibrillator implantation was associated with a non-significant reduction in sudden cardiac death mortality compared to unfunded controls (3.1% vs 9.8%; P=0.23).
Why the study?
Sudden cardiac death mortality remains very high despite guideline recommendations for ICD therapy, prompting the assessment of clinical profiles, complications, and quality of life in patients undergoing ICD implantation compared to controls in North India.
Does ICD implantation reduce mortality and improve quality of life in patients indicated for ICD compared to no implantation?
Cohort (n=115)
No
Does ICD implantation reduce mortality and improve quality of life in patients indicated for ICD compared to no implantation?
Absolute Event Rate: 3.1% vs 9.8%
p-value: p=0.23
In a real-world Indian cohort, ICD implantation was associated with a non-significant reduction in sudden cardiac death mortality and no deterioration in quality of life compared to patients who could not afford the device.
Background: Despite better understanding of various aspects of Sudden Cardiac Death (SCD), mortality from the disease still remains very high. Coronary artery disease (CAD) is the most common cause of SCD in all parts of India. The American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society (ACC/AHA/HRS) guidelines recommend the use of implantable cardioverter-defibrillator (ICD) therapy as a primary prevention. Aim: The aim of our study was to assess the clinical and demographic profile, complications and quality of life (QOL) of patients undergoing ICD implantation as compared to controls at a tertiary care center of north India. Method: A total of 64 patients with mean age 54.39± 11.54 years were implanted ICD during a period of one year. During the same period, 51 patients in which ICD could not be implanted due to financial reasons were included as controls. Of the 64 patients, 43 (67.19%) patients received ICD for primary prevention whereas 21 (32.81%) patients received it for secondary prevention. Result: At a follow up of 6 months, mortality was 4 (7.84%) in ICD group as compared to 8 (15.69%) in control group. Mortality from SCD in ICD and control group was 2 and 5 respectively (P = 0.23). ICD interrogation data was collected for 37 cases of which 19 (51.35%) patients had records of ventricular tachycardia (VT) and 3 (8.1%) patients had records of ventricular fibrillation (VF) respectively. Total VT/VF episodes recorded in primary prevention group were 10, whereas 12 in secondary prevention group. Success rate of ATP and ICD shocks were 30.23% and 95.92% respectively. All 47 VT/VF episodes were terminated by shocks. Conclusion: The QOL of patients undergoing ICD implant was better in the domains of social relationship and environment though the difference was not significant statistically. Overall, there was a significant reduction in SCD mortality and no deterioration in QOL.
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Khànal et al. (2019) conducted a cohort in Sudden Cardiac Death (SCD) prevention (n=115). Implantable cardioverter-defibrillator (ICD) implantation vs. No ICD implantation (due to financial reasons) was evaluated on Mortality from sudden cardiac death (p=0.23). Implantable cardioverter-defibrillator implantation was associated with a non-significant reduction in sudden cardiac death mortality compared to unfunded controls (3.1% vs 9.8%; P=0.23).
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