J Korean Med Sci.  2020 Mar;35(9):e49. 10.3346/jkms.2020.35.e49.

Clinical Impact of Implantable Cardioverter-Defibrillator Therapy and Mortality Prediction Model for Effective Primary Prevention in Korean Patients

Affiliations
  • 1Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.
  • 2Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea.
  • 3Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea.
  • 4Department of Internal Medicine, Daegu Fatima General Hospital, Daegu, Korea.
  • 5Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea. dgshin@med.yu.ac.kr
  • 6Department of Internal Medicine, Andong General Hospital, Andong, Korea.
  • 7Department of Internal Medicine, Dong-A University Hospital, Busan, Korea.
  • 8Department of Internal Medicine, Pusan National University Hospital, Busan, Korea.
  • 9Department of Internal Medicine, Inje University Busan Haeundae Paik Hospital, Busan, Korea.

Abstract

BACKGROUND
Studies on the efficacy of implantable cardioverter-defibrillator (ICD) therapy for primary prevention in Asian patients are relatively lacking compared to those for secondary prevention. Also, it is important to stratify which patients will benefit from ICD therapy for primary prevention.
METHODS
Of 483 consecutive patients who received new implantation of ICD in 9 centers in Korea, 305 patients with reduced left ventricular systolic function and/or documented ventricular fibrillation/tachycardia were enrolled and divided into primary (n = 167) and secondary prevention groups (n = 138).
RESULTS
During mean follow-up duration of 2.6 ± 1.6 years, appropriate ICD therapy occurred in 78 patients (25.6%), and appropriate ICD shock and anti-tachycardia pacing occurred in 15.1% and 15.1% of patients, respectively. Appropriate ICD shock rate was not different between the two groups (primary 12% vs. secondary 18.8%, P = 0.118). However, appropriate ICD therapy rate including shock and anti-tachycardia pacing was significantly higher (primary 18% vs. secondary 34.8%, P = 0.001) in the secondary prevention group. Type of prevention and etiology, appropriate and inappropriate ICD shock did not affect all-cause death. High levels of N-terminal pro-B-type natriuretic peptide, New York Heart Association functional class, low levels of estimated glomerular filtration ratio, and body mass index were associated with death before appropriate ICD shock in the primary prevention group. When patients were categorized in 5 risk score groups according to the sum of values defined by each cut-off level, significant differences in death rate before appropriate ICD shock were observed among risk 0 (0%), 1 (3.6%), 2 (3%), 3 (26.5%), and 4 (40%) (P < 0.001).
CONCLUSION
In this multicenter regional registry, the frequency of appropriate ICD therapy is not low in the primary prevention group. In addition, combination of poor prognostic factors of heart failure is useful in risk stratification of patients who are not benefiting from ICD therapy for primary prevention.

Keyword

Implantable Cardioverter-Defibrillator; Primary Prevention; Risk Assessment

MeSH Terms

Asian Continental Ancestry Group
Body Mass Index
Defibrillators, Implantable*
Filtration
Follow-Up Studies
Heart
Heart Failure
Humans
Korea
Mortality*
Primary Prevention*
Risk Assessment
Secondary Prevention
Shock
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