| Content Provider |
World Health Organization (WHO)-Global Index Medicus |
| Author |
Proietti, Riccardo Labos, Christopher Davis, Mark Thanassoulis, George Santangeli, Pasquale Russo, Vincenzo Di Biase, Luigi Roux, Jean-Francois Verma, Atul Natale, Andrea Essebag, Vidal |
| Description |
Author Affiliation: Proietti R ( McGill University Health Center, Montréal, Québec, Canada); Labos C ( McGill University Health Center, Montréal, Québec, Canada.); Davis M ( McGill University Health Center, Montréal, Québec, Canada.); Thanassoulis G ( McGill University Health Center, Montréal, Québec, Canada.); Santangeli P ( Cardiology Department, University of Pennsylvania, Philadelphia, Pennsylvania, USA.); Russo V ( Second Chair of Cardiology, Monaldi Hospital, Naples, Italy.); Di Biase L ( Texas Cardiac Arrhythmias Institute, St. Davids Medical Center, Austin, Texas, USA); Roux JF ( McGill University Health Center, Montréal, Québec, Canada); Verma A ( McGill University Health Center, Montréal, Québec, Canada); Natale A ( Texas Cardiac Arrhythmias Institute, St. Davids Medical Center, Austin, Texas, USA); Essebag V ( McGill University Health Center, Montréal, Québec, Canada) |
| Abstract |
BACKGROUND: It is unknown whether implantable cardioverter-defibrillator (ICD) discharges actively contribute to a worse prognosis independent of the underlying arrhythmia. There is considerable variability in the reported risk of mortality after appropriate and inappropriate ICD shocks. The aim of our systematic review was to provide a reliable effect size of the association between ICD shock and mortality for both types of therapies. METHODS: On the basis of a systematic literature search, 10 studies were considered eligible for inclusion in the analysis, and data on the hazard ratio (HR) of mortality after ICD shock were extracted from each study. RESULTS: On pooled analysis, a substantial difference was detected in the risk for subsequent mortality between appropriate and inappropriate shocks. Among patients receiving an appropriate ICD shock, the HR for cardiac death was 2.95 (95% confidence interval [CI], 2.12-4.11; P < 0.001) compared with an HR of 1.71 (95% CI, 1.45-2.02) for those receiving an inappropriate shock. Clinical variables like ejection fraction, New York Heart Association class, and length of follow-up did not affect the HRs in our meta-regression models. CONCLUSIONS: Our analysis showed a significant association between appropriate and inappropriate ICD shocks and mortality, with a stronger association for appropriate shocks. Previous trials of ICD therapy reduction programming have shown a significant reduction of inappropriate shocks. The management of appropriate shocks is more challenging and may be optimized by the assessment and treatment of the underlying ventricular arrhythmias. The role of therapies aimed at modifying the arrhythmic substrate and the potential impact on ICD shocks and mortality requires further investigation. |
| File Format |
HTM / HTML |
| ISSN |
0828282X |
| Issue Number |
3 |
| Volume Number |
31 |
| e-ISSN |
19167075 |
| Journal |
Canadian Journal of Cardiology |
| Language |
English |
| Publisher |
Elsevier |
| Publisher Date |
2015-03-01 |
| Publisher Place |
Great Britain (UK) |
| Access Restriction |
One Nation One Subscription (ONOS) |
| Subject Keyword |
Discipline Cardiology Arrhythmias, Cardiac Mortality Therapy Defibrillators, Implantable Adverse Effects Heart Failure Humans Randomized Controlled Trials As Topic Risk Factors Survival Analysis Journal Article Meta-analysis Review |
| Content Type |
Text |
| Resource Type |
Article |
| Subject |
Cardiology and Cardiovascular Medicine |
