Analysis and comparison of cohorts of patients with implantable cardioverter- defibrillator in primary and secondary prevention

Czech version

Authors: L. Křivan; M. Kozák; M. Sepši; J. Vlašínová; P. Lokaj; J. Špinar
Authors‘ workplace: Interní kardiologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MU Dr. Jindřich Špinar, CSc., FESC
Published in: Vnitř Lék 2010; 56(2): 99-105
Category: Original Contributions

Overview

Objective:
The aim of this study was an analysis of patients with ICD implanted in primary prevention (PP) in long term follow‑up and comparison with data obtained in secondary prevention patients (SP).

Patients and methods:
We assessed 73 patients with PP ICD and 138 patients with SP ICD. Males were in majority with 88% in PP group and 78% in SP group. The average age was 63 years. Majority of patients suffered from coronary artery disease. The mean ejection fraction (LV EF) was 28% in PP patients and 38% in SP patients. The number of affected coronary arteries and medication were similar in both groups. We compared the occurrence of intercurrent diseases, malignant arrhythmias, inappropriate therapies, hospital readmissions and patients’ survival.

Results:
PP patients had lower LV EF ejection fraction (p < 0.001), higher number of revascularized arteries (p < 0.001) and lower occurrence of inappropriate therapies and arrhythmic storms (p < 0.001). There was higher number of patients with diabetes (p = 0.009), dyslipidemia (p < 0.001) and cerebral artery disease (p = 0.017) among those in PP group. Renal insufficiency was related to a higher risk of death.

Conclusions:
Patients with PP ICD implantation have lower LVEF, and more intercurrent diseases then patients with ICD implanted form SP reasons. Their myocardium is more often revascularized and the occurrence of inappropriate therapy is low. Arrhythmic storm is a typical feature of patients with ICD implanted in secondary prevention.

Key words:
implantable cardioverter‑ defibrillator – primary prevention – secondary prevention – inappropriate therapy – sudden death

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