Key result
Younger age linked to ~35% higher risk of inappropriate ICD therapy, driven by SVT.
Why the study?
Data on the association between age and triggers of inappropriate therapy among ICD recipients remain limited. This study evaluated the relationship between age and the risk of inappropriate ICD therapy and examined age-related differences according to specific therapy triggers.
Does younger age increase the risk of inappropriate ICD therapy in primary prevention ICD recipients?
Cohort (n=5,170)
Yes
Does younger age increase the risk of inappropriate ICD therapy in primary prevention ICD recipients?
Younger age in primary prevention ICD recipients is independently associated with a higher risk of inappropriate ICD therapy, primarily driven by supraventricular tachycardia, supporting the need for age-tailored device programming.
Background Data on the association between age and triggers of inappropriate therapy among implantable cardioverter-defibrillator (ICD) recipients remain limited. We evaluated the relationship between age and the risk of inappropriate ICD therapy and examined age-related differences according to specific therapy triggers. Methods The study population comprised 5,170 primary prevention ICD recipients enrolled in MADIT-II, MADIT-Risk, MADIT-CRT, MADIT-RIT, and RAID. Patients were categorized by age tertiles (≤60, 61–70, and >70 years). Multivariable Cox proportional-hazards models assessed associations between age and inappropriate therapy overall (primary endpoint) and by trigger type (secondary endpoints): atrial fibrillation (AF, including atrial flutter), supraventricular tachycardia (SVT, including sinus tachycardia), and other causes (primarily oversensing or lead malfunction). Results At 3 years, the cumulative incidence of any inappropriate ICD therapy was highest in patients ≤60 years and progressively lower across older tertiles (16%, 13%, and 11%, respectively; p=0.001; Figure, left panel). In multivariable analysis, patients aged ≤60 years and 61–70 years had a higher risk of inappropriate ICD therapy compared with those >70 years (HR 1.35 and 1.20, respectively; p for trend=0.008). Consistently, each 10-year decrease in age was independently associated with a 15% increase in the risk of inappropriate therapy (p<0.001). The excess risk was predominantly driven by SVT-triggered inappropriate therapy (Figure, right panel). Patients aged ≤60 years and 61–70 years had a higher SVT-related risk compared with those >70 years (HR 2.02 and 1.33, respectively; p for trend<0.001). Each 10-year decrease in age was associated with a 31% increase in SVT-related risk (p<0.001). Age was not significantly associated with AF-triggered or other causes of inappropriate therapy. Conclusions Among primary prevention ICD recipients, younger age is independently associated with a graded increase in inappropriate ICD therapy, predominantly driven by SVT-triggered events. These findings support age-tailored ICD programming strategies to reduce inappropriate therapies in younger patients.Inappropriate ICD Therapy by Age: Overall/SVT
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Barsheshet et al. (2026) conducted a cohort in Primary prevention implantable cardioverter-defibrillator (ICD) recipients (n=5,170). Younger age (≤60 years and 61–70 years; or per 10-year decrease in age) vs. Older age (>70 years) was evaluated on Inappropriate ICD therapy overall (HR 1.35 (≤60 vs >70 years); HR 1.20 (61–70 vs >70 years), p=0.008 for trend). Younger age (≤60 vs >70 years) independently increased the risk of inappropriate ICD therapy (16% vs 11% at 3 years; HR 1.35; p for trend=0.008), mainly driven by SVT.
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