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Predictors and clinical impact of inappropriate implantable cardioverter-defibrillator shocks in Korean patients.

Yang JH, Byeon K, Yim HR, Park JW, Park SJ, Huh J, Kim JS, On YK - J. Korean Med. Sci. (2012)

Bottom Line: This retrospective, single-center study included 148 patients treated between October 1999 and June 2011.The primary outcome was a composite event of all-cause mortality or hospitalization for any cardiac reason.The median follow-up duration was 29 months (interquartile range: 8 to 53).

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT
Limited data are available on inappropriate shocks in Korean patients implanted with an implantable cardioverter-defibrillator (ICD). We investigated the impact of inappropriate shocks on clinical outcomes. This retrospective, single-center study included 148 patients treated between October 1999 and June 2011. The primary outcome was a composite event of all-cause mortality or hospitalization for any cardiac reason. The median follow-up duration was 29 months (interquartile range: 8 to 53). One or more inappropriate shocks occurred in 34 (23.0%) patients. A history of atrial fibrillation was the only independent predictor of inappropriate shock (hazard ratio [HR]: 4.16, 95% confidence interval [CI]: 1.89-9.15, P < 0.001). Atrial fibrillation was the most common cause of inappropriate shock (67.7%), followed by supraventricular tachycardia (23.5%), and abnormal sensing (8.8%). A composite event of all-cause mortality or hospitalizations for any cardiac reason during follow-up was not significantly different between patients with or without inappropriate shock (inappropriate shock vs no inappropriate shock: 35.3% vs 35.4%, adjusted HR: 1.06, 95% CI: 0.49-2.29, P = 0.877). Inappropriate shocks do not affect clinical outcomes in patients implanted with an ICD, although the incidence of inappropriate shocks is high.

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Kaplan-Meier curves of inappropriate shock versus no inappropriate shock. (A) All-cause mortality in inappropriate shock (solid) versus no inappropriate shock (dashed). (B) A composite event of all-cause mortality or hospitalization for any cardiac reason in inappropriate shock versus no inappropriate shock. (C) All-cause mortality in inappropriate shock versus no inappropriate shock in patients for second prevention of sudden cardiac death. (D) A composite event of all-cause mortality or hospitalization for any cardiac reason in inappropriate shock versus no inappropriate shock in patients for second prevention of sudden cardiac death.
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Figure 1: Kaplan-Meier curves of inappropriate shock versus no inappropriate shock. (A) All-cause mortality in inappropriate shock (solid) versus no inappropriate shock (dashed). (B) A composite event of all-cause mortality or hospitalization for any cardiac reason in inappropriate shock versus no inappropriate shock. (C) All-cause mortality in inappropriate shock versus no inappropriate shock in patients for second prevention of sudden cardiac death. (D) A composite event of all-cause mortality or hospitalization for any cardiac reason in inappropriate shock versus no inappropriate shock in patients for second prevention of sudden cardiac death.

Mentions: The median follow-up duration was 29 months (interquartile range: 8 to 53). Table 4 and Fig. 1 show the cumulative clinical outcomes of the study population during the follow-up period. The composite event of all-cause mortality or hospitalization for any cardiac cause was high in the inappropriate shock group, but the difference between groups was not statistically significant (25.4% for no inappropriate shock vs 35.3% for inappropriate shock, adjusted hazard ratio [HR]: 1.06, 95% confidence interval [CI]: 0.49-2.29, P = 0.877). During the follow-up period, there were no significant differences between groups for all-cause mortality (7.9% vs 11.8%, adjusted HR: 0.59, 95% CI: 0.14-2.45, P = 0.468), death due to cardiac causes (5.3% vs 8.8%, adjusted HR: 0.89, 95% CI: 0.13-6.20, P = 0.889), and hospitalization due to cardiac causes (19.3% vs 32.4%, adjusted HR: 1.51, 95% CI: 0.62-3.67, P = 0.360). In patients implanted for secondary prevention, the incidences of combined all-cause mortality and hospitalization due to a cardiac cause, as well as all-cause mortality only between the two groups did not differ significantly (P = 0.412 for combined all-cause mortality or hospitalization due to a cardiac cause, P = 0.539 for all-cause mortality only).


Predictors and clinical impact of inappropriate implantable cardioverter-defibrillator shocks in Korean patients.

Yang JH, Byeon K, Yim HR, Park JW, Park SJ, Huh J, Kim JS, On YK - J. Korean Med. Sci. (2012)

Kaplan-Meier curves of inappropriate shock versus no inappropriate shock. (A) All-cause mortality in inappropriate shock (solid) versus no inappropriate shock (dashed). (B) A composite event of all-cause mortality or hospitalization for any cardiac reason in inappropriate shock versus no inappropriate shock. (C) All-cause mortality in inappropriate shock versus no inappropriate shock in patients for second prevention of sudden cardiac death. (D) A composite event of all-cause mortality or hospitalization for any cardiac reason in inappropriate shock versus no inappropriate shock in patients for second prevention of sudden cardiac death.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3369447&req=5

Figure 1: Kaplan-Meier curves of inappropriate shock versus no inappropriate shock. (A) All-cause mortality in inappropriate shock (solid) versus no inappropriate shock (dashed). (B) A composite event of all-cause mortality or hospitalization for any cardiac reason in inappropriate shock versus no inappropriate shock. (C) All-cause mortality in inappropriate shock versus no inappropriate shock in patients for second prevention of sudden cardiac death. (D) A composite event of all-cause mortality or hospitalization for any cardiac reason in inappropriate shock versus no inappropriate shock in patients for second prevention of sudden cardiac death.
Mentions: The median follow-up duration was 29 months (interquartile range: 8 to 53). Table 4 and Fig. 1 show the cumulative clinical outcomes of the study population during the follow-up period. The composite event of all-cause mortality or hospitalization for any cardiac cause was high in the inappropriate shock group, but the difference between groups was not statistically significant (25.4% for no inappropriate shock vs 35.3% for inappropriate shock, adjusted hazard ratio [HR]: 1.06, 95% confidence interval [CI]: 0.49-2.29, P = 0.877). During the follow-up period, there were no significant differences between groups for all-cause mortality (7.9% vs 11.8%, adjusted HR: 0.59, 95% CI: 0.14-2.45, P = 0.468), death due to cardiac causes (5.3% vs 8.8%, adjusted HR: 0.89, 95% CI: 0.13-6.20, P = 0.889), and hospitalization due to cardiac causes (19.3% vs 32.4%, adjusted HR: 1.51, 95% CI: 0.62-3.67, P = 0.360). In patients implanted for secondary prevention, the incidences of combined all-cause mortality and hospitalization due to a cardiac cause, as well as all-cause mortality only between the two groups did not differ significantly (P = 0.412 for combined all-cause mortality or hospitalization due to a cardiac cause, P = 0.539 for all-cause mortality only).

Bottom Line: This retrospective, single-center study included 148 patients treated between October 1999 and June 2011.The primary outcome was a composite event of all-cause mortality or hospitalization for any cardiac reason.The median follow-up duration was 29 months (interquartile range: 8 to 53).

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT
Limited data are available on inappropriate shocks in Korean patients implanted with an implantable cardioverter-defibrillator (ICD). We investigated the impact of inappropriate shocks on clinical outcomes. This retrospective, single-center study included 148 patients treated between October 1999 and June 2011. The primary outcome was a composite event of all-cause mortality or hospitalization for any cardiac reason. The median follow-up duration was 29 months (interquartile range: 8 to 53). One or more inappropriate shocks occurred in 34 (23.0%) patients. A history of atrial fibrillation was the only independent predictor of inappropriate shock (hazard ratio [HR]: 4.16, 95% confidence interval [CI]: 1.89-9.15, P < 0.001). Atrial fibrillation was the most common cause of inappropriate shock (67.7%), followed by supraventricular tachycardia (23.5%), and abnormal sensing (8.8%). A composite event of all-cause mortality or hospitalizations for any cardiac reason during follow-up was not significantly different between patients with or without inappropriate shock (inappropriate shock vs no inappropriate shock: 35.3% vs 35.4%, adjusted HR: 1.06, 95% CI: 0.49-2.29, P = 0.877). Inappropriate shocks do not affect clinical outcomes in patients implanted with an ICD, although the incidence of inappropriate shocks is high.

Show MeSH
Related in: MedlinePlus