Yonsei Med J.  2017 May;58(3):514-520. 10.3349/ymj.2017.58.3.514.

Long-Term Prognosis of Patients with an Implantable Cardioverter-Defibrillator in Korea

• Uhm JS
• Kim TH
• Kim IC
• Park YA
• Shin DG
• Lim YM
• Yu HT
• Yang PS
• Pak HN
• Kang SM
• Lee MH
• Joung B

• KMID: 2419107
• DOI: http://doi.org/10.3349/ymj.2017.58.3.514

Abstract

PURPOSE
The objective of this study was to elucidate the long-term prognosis of patients with implantable cardioverter-defibrillators (ICDs) in Korea.
MATERIALS AND METHODS
We enrolled 405 patients (age, 57.7±16.7 years; 311 men) who had undergone ICD implantation. The patients were divided into three groups: heart failure (HF) and ICD for primary (group 1, n=118) and secondary prevention (group 2, n=93) and non-HF (group 3, n=194). We compared appropriate and inappropriate ICD therapy delivery among the groups and between high- (heart rate ≥200 /min) and low-rate (<200 /min) ICD therapy zones.
RESULTS
During the follow-up period (58.9±49.8 months), the annual appropriate ICD therapy rate was higher in group 2 (10.4%) than in groups 1 and 3 (6.1% and 5.9%, respectively, p<0.001). There were no significant differences in annual inappropriate ICD therapy rate among the three groups. In group 1, the annual appropriate ICD therapy rate was significantly lower in patients with a high-rate versus a low-rate therapy zone (4.5% and 9.6%, respectively, p=0.026). In group 3, the annual inappropriate ICD therapy rate was significantly lower in patients with a high-rate versus a low-rate therapy zone (3.1% and 4.0%, respectively, p=0.048).
CONCLUSION
Appropriate ICD therapy rates are not low in Korean patients with ICD, relative to prior large-scale studies in Western countries. Appropriate and inappropriate ICD therapy could be reduced by a high-rate therapy zone in patients with HF and ICD for primary prevention, as well as non-HF patients, respectively.

Keyword

Heart failure; implantable cardioverter-defibrillator; primary prevention; sudden cardiac death

MeSH Terms

Aged
Death, Sudden, Cardiac/*ethnology
*Defibrillators, Implantable
Female
Follow-Up Studies
Heart Failure/*therapy
Humans
Inappropriate Prescribing
Male
Medical Errors/*prevention & control
Middle Aged
Primary Prevention/*methods
Prognosis
Republic of Korea
Secondary Prevention

Figure

• 

  Fig. 1 Appropriate (A) and inappropriate (B) implantable cardioverter-defibrillator (ICD) therapy, and all-cause mortality (C) in patients in three groups. Group 1, heart failure (HF) and ICD for primary prevention; group 2, HF and ICD for secondary prevention; group 3, non-HF and ICD.

• 

  Fig. 2 Appropriate implantable cardioverter-defibrillator (ICD) therapy according to ICD therapy zones (high-rate ICD therapy zone vs. low-rate ICD therapy zone) in group 1 (A), 2 (B), and 3 (C). Group 1, heart failure (HF) and ICD for primary prevention; group 2, HF and ICD for secondary prevention; group 3, non-HF and ICD.

• 

  Fig. 3 Inappropriate implantable cardioverter-defibrillator (ICD) therapy according to ICD therapy zones (high-rate ICD therapy zone vs. low-rate ICD therapy zone) in group 1 (A), 2 (B), and 3 (C). Group 1, heart failure (HF) and ICD for primary prevention; group 2, HF and ICD for secondary prevention; group 3, non-HF and ICD.

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