TY - JOUR
T1 - Survival after shock therapy in implantable cardioverter-defibrillator and cardiac resynchronization therapy-defibrillator recipients according to rhythm shocked
T2 - The altitude survival by rhythm study
AU - Powell, Brian D.
AU - Saxon, Leslie A.
AU - Boehmer, John P.
AU - Day, John D.
AU - Gilliam, F. Roosevelt
AU - Heidenreich, Paul A.
AU - Jones, Paul W.
AU - Rousseau, Matthew J.
AU - Hayes, David L.
N1 - Funding Information:
The ALTITUDE Study Group activities are financially supported by Boston Scientific (St. Paul, Minnesota).
Funding Information:
Dr. Powell has received consulting fees from Boston Scientific. Dr. Saxon has received consulting fees from Boston Scientific and St. Jude Medical; and institutional grant support from Boston Scientific , Medtronic, Inc. , and St. Jude Medical . Dr. Boehmer has received consulting fees and institutional grant support from Boston Scientific . Dr. Gilliam has received consulting fees from Boston Scientific, Medtronic, Inc., Philips Medical, and St. Jude Medical. Mr. Jones and Mr. Rousseau are employees of Boston Scientific. Dr. Hayes is an advisory board member for Boston Scientific and Medtronic, Inc.; is a steering committee member for St. Jude Medical; has received royalties from Wiley Publishing; and has received honoraria from Boston Scientific, Medtronic, Inc., St. Jude Medical, Biotronik, Inc., and Sorin Medical. All other authors have reported that they have no relationships relevant to the content of this paper to disclose.
PY - 2013/10/29
Y1 - 2013/10/29
N2 - Objectives This study sought to determine if the risk of mortality associated with inappropriate implantable cardioverter-defibrillator (ICD) shocks is due to the underlying arrhythmia or the shock itself. Background Shocks delivered from ICDs are associated with an increased risk of mortality. It is unknown if all patients who experience inappropriate ICD shocks have an increased risk of death. Methods We evaluated survival outcomes in patients with an ICD and a cardiac resynchronization therapy defibrillator enrolled in the LATITUDE remote monitoring system (Boston Scientific Corp., Natick, Massachusetts) through January 1, 2010. First shock episode rhythms from 3,809 patients who acutely survived the initial shock were adjudicated by 7 electrophysiologists. Patients with a shock were matched to patients without a shock (n = 3,630) by age at implant, implant year, sex, and device type. Results The mean age of the study group was 64 ± 13 years, and 78% were male. Compared with no shock, there was an increased rate of mortality in those who received their first shock for monomorphic ventricular tachycardia (hazard ratio [HR]: 1.65, p < 0.0001), ventricular fibrillation/polymorphic ventricular tachycardia (HR: 2.10, p < 0.0001), and atrial fibrillation/flutter (HR: 1.61, p = 0.003). In contrast, mortality after first shocks due to sinus tachycardia and supraventricular tachycardia (HR: 0.97, p = 0.86) and noise/artifact/oversensing (HR: 0.91, p = 0.76) was comparable to that in patients without a shock. Conclusions Compared with no shock, those who received their first shock for ventricular rhythms and atrial fibrillation had an increased risk of death. There was no significant difference in survival after inappropriate shocks for sinus tachycardia or noise/artifact/oversensing. In this study, the adverse prognosis after first shock appears to be more related to the underlying arrhythmia than to an adverse effect from the shock itself.
AB - Objectives This study sought to determine if the risk of mortality associated with inappropriate implantable cardioverter-defibrillator (ICD) shocks is due to the underlying arrhythmia or the shock itself. Background Shocks delivered from ICDs are associated with an increased risk of mortality. It is unknown if all patients who experience inappropriate ICD shocks have an increased risk of death. Methods We evaluated survival outcomes in patients with an ICD and a cardiac resynchronization therapy defibrillator enrolled in the LATITUDE remote monitoring system (Boston Scientific Corp., Natick, Massachusetts) through January 1, 2010. First shock episode rhythms from 3,809 patients who acutely survived the initial shock were adjudicated by 7 electrophysiologists. Patients with a shock were matched to patients without a shock (n = 3,630) by age at implant, implant year, sex, and device type. Results The mean age of the study group was 64 ± 13 years, and 78% were male. Compared with no shock, there was an increased rate of mortality in those who received their first shock for monomorphic ventricular tachycardia (hazard ratio [HR]: 1.65, p < 0.0001), ventricular fibrillation/polymorphic ventricular tachycardia (HR: 2.10, p < 0.0001), and atrial fibrillation/flutter (HR: 1.61, p = 0.003). In contrast, mortality after first shocks due to sinus tachycardia and supraventricular tachycardia (HR: 0.97, p = 0.86) and noise/artifact/oversensing (HR: 0.91, p = 0.76) was comparable to that in patients without a shock. Conclusions Compared with no shock, those who received their first shock for ventricular rhythms and atrial fibrillation had an increased risk of death. There was no significant difference in survival after inappropriate shocks for sinus tachycardia or noise/artifact/oversensing. In this study, the adverse prognosis after first shock appears to be more related to the underlying arrhythmia than to an adverse effect from the shock itself.
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U2 - 10.1016/j.jacc.2013.04.083
DO - 10.1016/j.jacc.2013.04.083
M3 - Article
C2 - 23810882
AN - SCOPUS:84886409725
SN - 0735-1097
VL - 62
SP - 1674
EP - 1679
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 18
ER -