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Association of Implantable Cardioverter Defibrillator Therapy with All‐Cause Mortality—A Systematic Review and Meta‐Analysis
Author(s) -
QIAN ZHIYONG,
ZHANG ZHIYONG,
GUO JIANGHONG,
WANG YAO,
HOU XIAOFENG,
FENG GUANGZHI,
ZOU JIANGANG
Publication year - 2016
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.12766
Subject(s) - medicine , implantable cardioverter defibrillator , meta analysis , hazard ratio , cardiology , shock (circulatory) , sudden cardiac death , confidence interval , population , heart failure , subgroup analysis , environmental health
Background Implantable cardioverter defibrillators (ICDs) have become the standard approach for prevention of sudden cardiac death. Whether ICD therapy is an independent predictor of all‐cause mortality is controversial. We made the systematic review and meta‐analysis to estimate the impact of ICD therapy on mortality. Methods We searched the PubMed and Embase databases for studies evaluating the effect of ICD shocks or antitachycardia pacing (ATP) on mortality. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using random effects models. Results Thirteen cohort studies were identified. Mean ejection fraction of the population was 23–35%; 68.0% had ischemic etiology, and 74.5% received a primary prevention ICD implantation. Appropriate shocks were an independent predictor of increased mortality compared with no‐shock or no‐therapy patients (HR 2.07, 2.76, respectively). In contrast, inconsistent results were obtained during inappropriate‐shock analyses: when compared with no‐shock patients, inappropriate shocks were associated with an increased risk of death (HR 1.54, 95% CI: 1.25–1.89, P < 0.0001); however, when compared to no‐therapy patients, there was no relationship between inappropriate shocks and mortality (HR 1.20, 95% CI: 0.90–1.61, P = 0.22). Subgroup analysis in heart failure patients also did not find any difference in mortality between inappropriate‐shock and no‐therapy patients. No increased risk of mortality was found in the patients who experienced appropriate or inappropriate ATP only. Conclusion Appropriate shocks were associated with an increased mortality in ICD patients. However, whether inappropriate shocks worsened the clinical outcome was controversial, and larger prospective trials are needed to clarify the issue.