In octogenarians undergoing ICD elective unit replacement, 1- and 2-year mortality rates were 23.1% and 38.1%, respectively, with a median additional life of 1.2 years in deceased patients.
Cohort (n=76)
No
What are the survival and rates of ICD therapies in patients 80 years of age or older undergoing ICD implantation or elective unit replacement?
In octogenarians, elective unit replacement of ICDs is associated with high early mortality and low rates of appropriate therapies, suggesting limited survival benefit and highlighting the need for careful patient selection.
AIMS: Increase in life expectancy has led to increased rate of implantable cardioverter-defibrillator (ICD) implantation in patients in their 80s, but there are no current formal recommendations to guide physicians when elderly patients with ICDs require elective unit replacement (EUR). This study aims at assessing survival and rates of ICD therapies in patients who have had ICD implantation or EUR above the age of 80, focusing on the latter. METHODS AND RESULTS: Retrospective analysis of a prospectively kept database of all ICD-related procedures carried out in a single tertiary centre. Patients 80 years of age or older submitted to ICD implantation (n = 42) or EUR (n = 34) between November 1991 and May 2012 were included. Using collected baseline and outcome data from this cohort, we assessed survival of these patients and the rates of ICD therapies. Median additional years of life after ICD implantation and ICD EUR in patients who died before data retrieval was 2.5 and 1.2, respectively, and while 65% of deceased patients after ICD implantation died in the first 3 years after the procedure, 50% of deceased post-ICD EUR patients died within the first year. Mortality rates at 1 and 2 years post-EUR were 23.1 and 38.1%, respectively. Furthermore, ventricular tachycardia occurred in a small minority of patients after EUR (16.7%) and no ventricular fibrillation-triggered ICD therapies were reported in both groups. CONCLUSION: In octogenarians who are due for an ICD EUR, careful thought should be given to the current clinical status, comorbidities, and general frailty prior to considering them for the procedure. A survival benefit from ICD EUR in this age stratum is not likely.
Goonewardene et al. (Thu,) conducted a cohort in ICD implantation or elective unit replacement (n=76). Elective unit replacement (EUR) vs. Initial ICD implantation was evaluated on Survival and rates of ICD therapies. In octogenarians undergoing ICD elective unit replacement, 1- and 2-year mortality rates were 23.1% and 38.1%, respectively, with a median additional life of 1.2 years in deceased patients.
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