Key result
Primary prevention patients without prior therapy face ~14% appropriate ICD therapy risk three years post-replacement.
Why the study?
Does elective ICD generator replacement provide appropriate therapy in primary prevention patients without prior appropriate ICD therapy?
Cohort (n=275)
Yes
Does elective ICD generator replacement provide appropriate therapy in primary prevention patients without prior appropriate ICD therapy?
Primary prevention ICD patients without prior appropriate therapy still have a 13.7% 3-year incidence of appropriate therapy after generator replacement, supporting routine replacement.
May inform replacement decisions; leaves open net benefit of routine generator exchange in primary prevention without prior therapy.
OBJECTIVE: It is not clear whether patients who received an implantable cardioverter-defibrillator (ICD) for primary prevention should undergo device replacement if they never experienced an appropriate ICD therapy during the first generator longevity. This study evaluated the incidence and predictors of appropriate ICD therapy after device replacement in this specific population. METHODS: From two large prospective ICD registries, we identified all primary prevention patients who had a first ICD replacement without previous appropriate ICD therapy. Cox regression analysis was used to identify predictors of appropriate ICD therapy. RESULTS: Of 403 primary prevention patients needing first ICD replacement, 275 patients (68%) had not received previous appropriate ICD therapy. Patients without previous appropriate ICD therapy before first ICD replacement (mean age at replacement 62 ± 12 years, 75% male) had a mean follow-up of 86 ± 24 months after the initial implantation and 30 ± 24 months after device replacement. Following replacement, 3-year cumulative incidence of appropriate ICD therapy was 13.7% (95% CI 8.6 to 18.8%). No predictive factors associated with appropriate ICD therapy after replacement could be identified in spite of including seven clinically relevant factors. CONCLUSIONS: A considerable number of primary prevention patients without previous appropriate ICD therapy before first ICD replacement received appropriate ICD therapy after replacement. As there were no predictors of appropriate ICD therapy after replacement, replacing an ICD is still recommended in all primary prevention patients despite the lack of appropriate ICD therapy during first battery service life.
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Yap et al. (2014) conducted a cohort in Primary prevention patients needing first ICD replacement without prior appropriate therapy (n=275). ICD generator replacement was evaluated on appropriate ICD therapy (95% CI 8.6 to 18.8). Following first ICD replacement in primary prevention patients without prior appropriate therapy, the 3-year cumulative incidence of appropriate ICD therapy was 13.7% (95% CI 8.6-18.8%).
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