Malekrah Alireza, Shafiee Akbar, Heidari Amirhossein, Vasheghani-Farahani Ali, Bozorgi Ali, Sadeghian Saeed, Yaminisharif Ahmad
Department of Electrophysiology, Tehran Heart Center, Cardiovascular Diseases Research Institute Tehran University of Medical Sciences Tehran Iran.
Cardiovascular Research Center Mazandaran University of Medical Science Sari Iran.
Health Sci Rep. 2023 Jul 22;6(7):e1432. doi: 10.1002/hsr2.1432. eCollection 2023 Jul.
Implantable cardioverter-defibrillators (ICDs) are frequently used to prevent sudden cardiac death in patients with high-risk arrhythmias. However, the use of ICD therapy in elderly patients beyond the predicted age of life expectancy is still controversial. We aimed to evaluate the predictors of mortality and clinical outcomes following ICD implantation in elderly patients.
We conducted a retrospective analysis of 145 elderly patients aged 72 years and older who received ICD implantation between January 2010 and August 2015. We collected and analyzed baseline data, including clinical, demographic, and medical history, the reason for ICD therapy, procedural data, and echocardiography results. Follow-up data included the development of complications and mortality. The predictors of mortality were identified using the univariate and multivariable Cox regression models.
During the median follow-up duration of 30.5 [18.0-48.0] months, 141 cases completed follow-up (mean age = 76.0 ± 3.7 years). Forty-four patients experienced at least one episode of ICD therapy. Inappropriate shock, recurrent shock, and device-related infection were the most frequent complications observed in our study. Of the 145 patients, 42 died during the follow-up period, with an average survival time of 22.4 months after ICD implantation. Among these patients, 11 received ICD for primary prevention, and 31 received it for secondary prevention. Cardiovascular problems were the leading cause of death. We found that a low baseline ejection fraction (EF) was an independent predictor of mortality (hazard ratio = 0.93, 95% confidence interval: 0.90-0.98; = 0.008).
Our study suggests that ICD therapy is a valuable treatment option for elderly patients beyond their predicted age of life expectancy. The study highlights the importance of baseline EF as a significant predictor of mortality in these patients.
植入式心脏复律除颤器（ICD）常用于预防高危心律失常患者的心源性猝死。然而，在预期寿命以上的老年患者中使用ICD治疗仍存在争议。我们旨在评估老年患者植入ICD后的死亡率预测因素和临床结局。
我们对2010年1月至2015年8月期间接受ICD植入的145例72岁及以上老年患者进行了回顾性分析。我们收集并分析了基线数据，包括临床、人口统计学和病史、ICD治疗的原因、手术数据和超声心动图结果。随访数据包括并发症的发生情况和死亡率。使用单变量和多变量Cox回归模型确定死亡率的预测因素。
在中位随访期30.5 [18.0 - 48.0]个月期间，141例完成随访（平均年龄 = 76.0 ± 3.7岁）。44例患者经历了至少一次ICD治疗。不适当电击、反复电击和与设备相关的感染是我们研究中观察到的最常见并发症。在145例患者中，42例在随访期间死亡，ICD植入后平均生存时间为22.4个月。在这些患者中，11例接受ICD进行一级预防，31例接受ICD进行二级预防。心血管问题是主要死因。我们发现低基线射血分数（EF）是死亡率的独立预测因素（风险比 = 0.93，95%置信区间：0.90 - 0.98；P = 0.008）。
我们的研究表明，ICD治疗对于预期寿命以上的老年患者是一种有价值的治疗选择。该研究强调了基线EF作为这些患者死亡率重要预测因素的重要性。
