title: Cardioverter-defibrillator implantation and generator replacement in the octogenarian.
abstract: OBJECTIVE
  Increase in life expectancy has led to increased rate of implantable cardioverter-defibrillator (ICD) implantation in patients in their 80s, but there are no current formal recommendations to guide physicians when elderly patients with ICDs require elective unit replacement (EUR). This study aims at assessing survival and rates of ICD therapies in patients who have had ICD implantation or EUR above the age of 80, focusing on the latter.
  
  
  RESULTS
  Retrospective analysis of a prospectively kept database of all ICD-related procedures carried out in a single tertiary centre. Patients 80 years of age or older submitted to ICD implantation (n = 42) or EUR (n = 34) between November 1991 and May 2012 were included. Using collected baseline and outcome data from this cohort, we assessed survival of these patients and the rates of ICD therapies. Median additional years of life after ICD implantation and ICD EUR in patients who died before data retrieval was 2.5 and 1.2, respectively, and while 65% of deceased patients after ICD implantation died in the first 3 years after the procedure, 50% of deceased post-ICD EUR patients died within the first year. Mortality rates at 1 and 2 years post-EUR were 23.1 and 38.1%, respectively. Furthermore, ventricular tachycardia occurred in a small minority of patients after EUR (16.7%) and no ventricular fibrillation-triggered ICD therapies were reported in both groups.
  
  
  CONCLUSIONS
  In octogenarians who are due for an ICD EUR, careful thought should be given to the current clinical status, comorbidities, and general frailty prior to considering them for the procedure. A survival benefit from ICD EUR in this age stratum is not likely.
authors.affiliation: Cardiology Department, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge CB23 3RE, UK.
authors.forename: Manoj
authors.initials: M
authors.lastname: Goonewardene
authors.affiliation: Cardiology Department, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge CB23 3RE, UK sergioncbarra@gmail.com.
authors.forename: Sérgio
authors.initials: S
authors.lastname: Barra
authors.affiliation: Cardiology Department, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge CB23 3RE, UK.
authors.forename: Patrick
authors.initials: P
authors.lastname: Heck
authors.affiliation: Cardiology Department, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge CB23 3RE, UK.
authors.forename: David
authors.initials: D
authors.lastname: Begley
authors.affiliation: Cardiology Department, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge CB23 3RE, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Fynn
authors.affiliation: Cardiology Department, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge CB23 3RE, UK.
authors.forename: Munmohan
authors.initials: M
authors.lastname: Virdee
authors.affiliation: Cardiology Department, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge CB23 3RE, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Grace
authors.affiliation: Cardiology Department, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge CB23 3RE, UK.
authors.forename: Sharad
authors.initials: S
authors.lastname: Agarwal
mesh_terms: D000369:Aged, 80 and over; D015331:Cohort Studies; D016208:Databases, Factual; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D020878:Device Removal; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D019919:Prosthesis Implantation; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000453:epidemiology; D014693:Ventricular Fibrillation / Q000453:epidemiology
keywords: Elderly people; Generator replacement; Implantable cardioverter-defibrillator; Mortality; Ventricular arrhythmias