title: Prognostic impact of inappropriate defibrillator shocks in a population cohort.
abstract: BACKGROUND
  There is a relative paucity of data linking inappropriate implantable cardioverter-defibrillator (ICD) shocks to adverse clinical outcomes.
  
  
  OBJECTIVE
  To examine the association between inappropriate ICD shocks and mortality or heart transplantation in a large population cohort.
  
  
  METHODS
  A cohort study which included all subjects who underwent ICD implantation between 1998 and 2008 and were followed up at our institution.
  
  
  METHODS
  Multivariable Cox regression analyses were conducted to investigate the effect of inappropriate shocks on the risk of death and heart transplantation. Appropriate and inappropriate ICD therapies were modelled as time-dependent covariates.
  
  
  RESULTS
  A total of 1698 patients were included. During a median follow-up of 30 months, there were 246 (14.5%) deaths and 42 (2.5%) heart transplants. The incidence of inappropriate shocks was 10% at 1 year and 14% at 2 years. In the adjusted model, inappropriate shocks were not associated with death or transplantation (HR=0.97, 95% CI 0.70 to 1.36, p value=0.873). In contrast, appropriate shocks were associated with adverse outcomes (HR=3.11, 95% CI 2.41 to 4.02, p value<0.001). The lack of association between inappropriate shocks and outcomes persisted for those with severely impaired left ventricular function (ejection fraction <30%) and for those receiving multiple inappropriate treatments.
  
  
  CONCLUSIONS
  In this study, we observed no association between inappropriate ICD shocks and increased mortality or heart transplantation, even among those with severely impaired cardiac function. These findings question whether inappropriate ICD shocks lead to adverse outcomes.
authors.affiliation: Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada. mdeyell@providencehealth.bc.ca
authors.forename: Marc William
authors.initials: MW
authors.lastname: Deyell
authors.forename: Anzhen
authors.initials: A
authors.lastname: Qi
authors.forename: Santabhanu
authors.initials: S
authors.lastname: Chakrabarti
authors.forename: John Ah-Fan
authors.initials: JA
authors.lastname: Yeung-Lai-Wah
authors.forename: Stanley
authors.initials: S
authors.lastname: Tung
authors.forename: Clarence
authors.initials: C
authors.lastname: Khoo
authors.forename: Mathew T
authors.initials: MT
authors.lastname: Bennett
authors.forename: Hong
authors.initials: H
authors.lastname: Qian
authors.forename: Charles R
authors.initials: CR
authors.lastname: Kerr
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000401:mortality / Q000628:therapy*; D001955:British Columbia; D015331:Cohort Studies; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D005260:Female; D016027:Heart Transplantation / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology
keywords: Arrhythmias