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Implantable cardioverter‐defibrillator in the elderly: Predictors of appropriate interventions and mortality at 12‐month follow‐up
Author(s) -
Ferretto Sonia,
Zorzi Alessandro,
Dalla Valle Chiara,
Migliore Federico,
Leoni Loira,
Lazzari Manuel,
Corrado Domenico,
Iliceto Sabino,
Bertaglia Emanuele
Publication year - 2017
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.13215
Subject(s) - medicine , implantable cardioverter defibrillator , ejection fraction , multivariate analysis , incidence (geometry) , univariate analysis , pediatrics , heart failure , physics , optics
Background The effectiveness of implantable cardioverter‐defibrillator (ICD) in the elderly is uncertain, given their competing risk of nonarrhythmic death. Guidelines state that an ICD should be implanted if the expectation of survival is at least 1 year. However, survival is not easy to predict in elderly patients with severe cardiac disease. Aim To assess 12‐month survival after ICD implantation in patients aged ≥75 years, to identify predictors of 12‐month mortality, and to evaluate the incidence of ICD therapy during follow‐up. Methods We retrospectively analyzed all clinical, instrumental, and survival data of patients ≥75 years old who received an ICD in our center from 2000 to 2013. Results We included 127 patients (mean age 78 years). ICD was implanted for primary prevention in 61%. The 12‐month survival rate was 87.4%. At both univariate and multivariate analyses, left ventricular ejection fraction (EF) ≤ 25%, and moderate to severe impaired renal function (IRF) independently predicted 12‐month mortality that was as high as 45.5% in patients with both risk factors. During a median follow‐up of 38 months, 30 patients (23.6%) received ≥1 appropriate ICD interventions, but only 3.1% of shocks occurred during the first year, and none in the subgroup of patients with EF ≤ 25% and IRF. Conclusion Twelve‐month survival in elderly patients after ICD implantation is good and the indication for ICD should not be based on age alone. However, the subgroup with EF ≤ 25% and IRF showed a high 12‐month nonarrhythmic mortality and did not benefit from ICD implantation.