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Outcomes following implantable cardioverter-defibrillator generator replacement in patients with recovered left ventricular systolic function: The National Cardiovascular Data Registry

Published:November 07, 2018DOI:https://doi.org/10.1016/j.hrthm.2018.11.005

      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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      Linked Article

      • The benefit of implantable cardioverter–defibrillators beyond the first generator
        Heart RhythmVol. 16Issue 5
        • Preview
          Implantable 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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