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Implantable cardioverter‐defibrillators: a long‐term view
Author(s) -
Wilson D.,
Shi B.,
Harding S.,
Lever N.,
Larsen P.
Publication year - 2012
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/j.1445-5994.2011.02710.x
Subject(s) - medicine , hazard ratio , confidence interval , proportional hazards model , implantable cardioverter defibrillator , atrial fibrillation , population , surgery , pediatrics , environmental health
Background: No long‐term data on implantable cardioverter‐defibrillators (ICDs) exist in Australasia. Aims: We examined all patients receiving a new ICD implant at Wellington Hospital between January 2001 and December 2005 to determine long‐term outcomes in this patient population. Methods: Follow‐up data were collected and Kaplan–Meier curves were constructed for survival and long‐term outcomes, and Cox proportional hazard model was used for calculation of hazard ratio. Results: In the study period, 138 new ICDs were implanted, and the mean follow‐up time was 84 ± 16 months. Patients were predominantly male (76%), 75% were European, 20% were Maori. Median age was 59 years (range 16–80 years). In 47% of patients, there was an ischaemic substrate. A secondary‐prevention indication was present in 77%. The 7‐year survival rate was 72%. No difference in mortality was observed between primary‐ and secondary‐prevention groups. The 7‐year appropriate therapy rate was 55%. The appropriate shock rate was greater in secondary prevention than in primary‐prevention patients was observed (hazard ratio = 2.11, 95% confidence interval 1.16–3.85, P = 0.01). Over the study period, inappropriate therapy rate was 25%. This was more common in patients with prior atrial fibrillation (hazard ratio = 3.57, 95% confidence interval 1.80–7.09, P < 0.001). The median device longevity was 6.8 years. Conclusions: This is the first long‐term follow‐up study of ICD patients in New Zealand. We observed a low mortality rate when compared with other published registries, but a similar rate of both appropriate and inappropriate shock therapy.