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01. History of Cardiology
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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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Long-term follow-up in primary and secondary prevention ICD patients in a modern cohort
Session:
Painel 5 - Arritmologia 6
Speaker:
Mafalda Carrington
Congress:
CPC 2020
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.2 Implantable Cardioverter / Defibrillator
Session Type:
Posters
FP Number:
---
Authors:
Mafalda Carrington; Afonso Nunes Ferreira; Pedro Silvério António; Inês Aguiar Ricardo; Tiago Graça Rodrigues; Joana Rigueira; Nelson P. Cunha; Rafael Santos; Pedro Morais; Nzinga André; Igor Santos; Ana Bernardes; Fausto José Pinto; João Rodrigues De Sousa; Pedro Nuno Carlos Marques
Abstract
<p><u>Introduction</u>:</p> <p>Implantable Cardioverter Defibrillators (ICD) may be indicated for secondary prevention of sudden cardiac death (SCD) and for primary prevention in patients with ischaemic (i-CMP) and non-ischaemic dilated CMP with low ejection fraction (EF). Device primary prevention of SCD may also be indicated in selected patients with other CMP and channelopathies. In early secondary prevention cohorts, ICDs seemed to produce an equal reduction of all-cause mortality comparing to primary prevention cohorts. However, evidence on the mortality of primary versus secondary indication is limited in the light of current medicine and devices technology.</p> <p> </p> <p><u>Purpose</u>:<br /> In a modern cohort, to compare all-cause mortality between patients who implanted an ICD for primary versus secondary prevention of SCD.</p> <p> </p> <p><u>Methods</u>:</p> <p>Prospective single-center study of patients who implanted ICD between 2015 and 2019. Clinical characteristics were evaluated at baseline and mortality was assessed using the national registry of citizens. We performed univariate and multivariate analysis by using logistic regressions to compare clinical characteristics of patients who were implanted with an ICD for primary versus secondary prevention. Mortality was assessed by using cox regression, as well as Kaplan-Meier methods.</p> <p> </p> <p><u>Results</u>:</p> <p>From 2015-2019, 414 ICDs were implanted (81% male, 62±12 years-old), 271(66%) had an indication of primary prevention of SCD and 50 (13%) died after a median follow-up of 23 [11-41] months. Patients who underwent ICD implantation for primary prevention were younger (61±12 vs 63±13, p=0.002) and were more frequently in NYHA class≥II (50% vs 25%, p<0.001). They also had more i-CMP (63% vs 51%, p=0.018) and a LVEF≤40% (91% vs 49%, p<0.001). Patients with a secondary prevention indication experienced more frequently an ICD re-implantation after complication or pacemaker upgrade (6% vs 1%, p=0.009), and during follow-up they also underwent more ventricular tachycardia (VT) ablation (16% vs 1%, p<0.001). Despite these differences between groups, the multivariate analysis showed that the NYHA class and etiology of CMP were not independently associated with primary prevention. After adjusting for age, EF≤40%, re-implantation/upgrade and AF or VT ablation, we found that ICD indication was not an independent predictor of all-cause mortality (HR 0.579; 95%CI 0.30-1.00, p=0.095).</p> <p> </p> <p><u>Conclusion</u>:</p> <p>In our cohort of patients who underwent ICD implantation, the majority (66%) had a primary indication for prevention of SCD. During a median follow-up period of almost 2 years, primary and secondary prevention ICD patients exhibited comparable all-cause mortality rates (13%).</p>
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