title: The implantable cardioverter defibrillator in primary prevention: a revision of monocentric study group.
abstract: OBJECTIVE
  To evaluate the outcome of a population implanted with an implantable cardioverter defibrillator (ICD) for primary prevention in terms of mortality, morbidity and appropriate and inappropriate interventions. Secondly, to compare the performances of single-chamber vs. dual-chamber devices.
  
  
  METHODS
  We examined all patients with CAD or CMD who received an ICD in primary prevention with at least 6 months of follow-up. For each patient were evaluated, primarily, survival, complications related to the implantation and performance of the device (antitachycardia pacing/shock).
  
  
  RESULTS
  Of 193 patients, 163 were men (84.5). Mean age was 64.4 ± 10 years. One hundred and twenty patients (62%) were affected by CAD and 73 (38%) by CMD. The ejection fraction was 26 ± 6%. Fifty-three patients (27.5%) received a dual-chamber ICD, whereas 140 (72.5%) received a single-chamber ICD. There were periprocedural complications in 5.2% of the patients. At a mean follow-up of 49.9 months, 55 patients (28.5%) died. Appropriate interventions were documented in 40 patients (20.7%). In 36 patients (18%), inappropriate interventions occurred. Patients implanted with dual-chamber ICD had an overall mortality of 17% compared to 32.4% for those implanted with single-chamber ICD (P = 0.029). Mortality was higher in patients with CAD (33.9%) (P = 0.032). Among the fatalities, 69% occurred in patients who had an ejection fraction 25% or less at the time of implantation and 31% in patients with an ejection fraction greater than 25% (P = 0.013).
  
  
  CONCLUSIONS
  The 4-year survival was 72%. The overall mortality was higher in patients with CAD. More than two-thirds of the deceased had an ejection fraction less than 25%. The dual-chamber ICD patients had a significantly lower mortality rate.
authors.affiliation: aElectrophysiology, Department of General Internal Medicine, IRCCS San Martino University Hospital - IST National Institute for Cancer Research bMedi Service Management Unit World Trade Center cPrimary Hospital, Department of General Internal Medicine, IRCCS San Martino University Hospital - IST National Institute for Cancer Research, Genoa, Italy *D. Barabino deceased.
authors.forename: L
authors.initials: L
authors.lastname: Gigli
authors.forename: D
authors.initials: D
authors.lastname: Barabino
authors.forename: P
authors.initials: P
authors.lastname: Sartori
authors.forename: P
authors.initials: P
authors.lastname: Rossi
authors.forename: G
authors.initials: G
authors.lastname: Reggiardo
authors.forename: F
authors.initials: F
authors.lastname: Chiarella
authors.forename: G M
authors.initials: GM
authors.lastname: Rosa
authors.forename: G
authors.initials: G
authors.lastname: Bertero
mesh_terms: D000368:Aged; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000009:adverse effects; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011322:Primary Prevention / Q000295:instrumentation / Q000379:methods; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis