Background
Some patients with heart failure (HF) experience recovery of left ventricular (LV)
systolic function by the end of their implantable cardioverter-defibrillator (ICD)
generator battery life. Outcomes following generator replacement in this setting are
poorly understood.
Objective
We sought to describe outcomes following ICD generator replacement associated with
recovery of LV systolic function.
Methods
We evaluated 26,197 Medicare beneficiaries enrolled in the American College of Cardiology’s
National Cardiovascular Data Registry ICD Registry who underwent primary prevention
ICD generator replacement between 2006 and 2009, stratified by LV ejection fraction
(LVEF): reduced (LVEF ≤35%), partially recovered (LVEF >35% and ≤50%), and recovered
(LVEF >50%).
Results
At the time of generator replacement, 1915 (7.3%) patients had recovered LVEF and
4576 (17.5%) had partially recovered LVEF. Periprocedural events were rare (<1%) in
all patients. In patients with reduced LVEF, the incidence of HF readmission and mortality
at 3 years was 27.5% and 32.7%, respectively. In comparison, the rates of HF readmission
and mortality were lower for patients with partially recovered LVEF (readmission:
15.9%; hazard ratio [HR] 0.66; 95% confidence interval [CI] 0.61–0.72; mortality:
23.0%; HR 0.82; 95% CI 0.76–0.87) and those with recovered LVEF (readmission: 12.2%;
HR 0.55; 95% CI 0.48–0.63; mortality: 18.2%; HR 0.72; 95% CI 0.64–0.80).
Conclusion
Patients with partially recovered and recovered LVEF have lower risks of mid-term
adverse outcomes than do those with reduced LVEF following ICD generator replacement.
Approximately 3 in 4 patients continue to have reduced LVEF at the time of generator
replacement and are at high risk of HF readmission and mortality. These data highlight
the prognostic associations of LVEF in patients undergoing generator replacement as
well as the clinical encounter for generator replacement as an opportunity to identify
those at increased risk of adverse outcomes.
Keywords
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Article info
Publication history
Published online: November 07, 2018
Footnotes
This research was supported by the American College of Cardiology Foundation’s National Cardiovascular Data Registry (NCDR). The views expressed in this article represent those of the authors and do not necessarily represent the official views of the NCDR or its associated professional societies identified at www.ncdr.com.
Dr Hsu has received honoraria from St. Jude Medical, Medtronic, Boston Scientific, and Biotronik and research grants from Biotronik and Biosense Webster. Dr Minges receives a portion of his salary providing analytical services to the National Cardiovascular Data Registry (NCDR). Dr Curtis receives a portion of his salary providing analytical services to the NCDR and has equity interest in Medtronic. The rest of the authors report no conflicts of interest.
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ScienceDirect
Access this article on ScienceDirectLinked Article
- The benefit of implantable cardioverter–defibrillators beyond the first generatorHeart RhythmVol. 16Issue 5
- PreviewImplantable cardioverter–defibrillators (ICDs) are lifesaving and are placed based on guideline recommendations for primary or secondary prevention of fatal arrhythmic death due to underlying cardiomyopathic processes.1 Although the benefits of ICD therapy are clear, potential drawbacks such as inappropriate shocks can lead to significant morbidity and may be associated with increased mortality.2 Indwelling leads and devices are prone to bloodstream infections.3 Psychosocial aspects, such as posttraumatic stress disorder from shocks,4 and disqualification or restrictions in certain vocations, driving, and competitive sports can be devastating to the psyche of patients.
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