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Long-term complication, reoperation high following ICD implantation

28 Aug 2017

Long-term complication and reoperation rates appear to be substantially high in implantable cardioverter-defibrillator (ICD) recipients, a study has found. Additionally, increasing age strongly predicts reduced long-term complications and decreased absolute and relative survival.

Researchers assessed the rate, cumulative incidence and predictors of long-term reoperation in 3,410 patients (mean 63.3 years; 81.7 percent male) with new primary (n=1,854) or secondary prevention (n=1,556) ICD implant. The median follow-up duration was 34 months. Of the patients, 1,069 had a single-chamber device, 1,905 had a dual chamber and 436 had biventricular.

The overall reoperation rate was 12.0 percent per patient-year, with diminishing rates for single vs dual vs biventricular ICDs (17.8 vs 12.5 vs 9.1 percent per patient-year). The respective Kaplan-Meier complication estimates (excluding generator end of life) at 1, 3 and 5 years were 10.2, 16.2 and 21.6 percent for single chamber ICD; 11.7, 19.1 and 27.4 percent for dual chamber ICD; and 15.9, 22.2 and 24.7 percent for biventricular ICD.

The rate of early lead complications was highest for cardiac resynchronization therapy, although it had a lower long-term need for upgrade. Cox regression models showed that device complexity, age and atrial fibrillation were independent predictors of complications. Overall mortality was 5.4 percent at 1 year, 17.4 percent at 3 years and 32.7 percent at 5 years.

In younger patients, the observed 5-year survival was nearly similar to the expected survival in the general population (relative survival ratio, 0.96; 95 percent CI, 0.90 to 0.98). Observed survival steadily declined with increasing age, relative to expected.

The present data indicate that complication and reoperation rates are high and warrant careful consideration for informed shared decision making, researchers said.

While reducing the risk of arrhythmic death and overall mortality in select populations, ICDs are associated with high short-term complication rates. Researchers highlighted the centrality of age to complications/reoperations and benefit, with age being the most powerful predictor of survival, followed by comorbidities. 

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Most Read Articles
Roshini Claire Anthony, 6 days ago

Treatment failure in osteoporosis remains a problem, even among patients who are treatment-adherent, according to a presentation at the recent meeting of the Asian Federation of Osteoporosis Societies (AFOS 2017), held in Kuala Lumpur, Malaysia. 

Elvira Manzano, 5 days ago
Bisphosphonates have proven antifracture efficacy and remain to be the cornerstone of osteoporosis treatment. However, a drug holiday is of particular importance with bisphosphonates due to some signals with long-term use of the drug, including rare incidence of atypical femoral fracture (AFF) and osteonecrosis of the jaw (ONJ), says a leading endocrinologist at AFOS 2017.
2 days ago
Breast cancer patients have notably different microbiomes in the local breast tissue and urinary tract, a recent study reveals. Particularly, species in the Methylobacterium genus are reduced in the local breast tissue while the urinary tract is enriched in gram-positive bacteria.
Pearl Toh, 13 Oct 2017
Women with higher plasma tryptophan concentrations were less likely to have poor sleep quality during pregnancy, especially among those with anxiety symptoms, according to the GUSTO* study.