title: Implantable cardioverter defibrillators in octogenarians: clinical outcomes from a single center.
abstract: OBJECTIVE
  Limited data exist on outcomes in very elderly ICD recipients. We describe outcomes in new ICD and Cardiac Resynchronisation Therapy with Defibrillator (CRT-D) implants in octogenarians at our institution.
  
  
  METHODS
  Patients aged 80 years and above who underwent de novo ICD or CRT-D implantation from January 2006 to July 2012 were identified. Clinical data were collected from the procedural record, medical and ICD notes. Baseline characteristics were compared using independent sample t test for continuous variables and Fisher's exact test for categorical variables. Kaplan-Meier curves were constructed.
  
  
  RESULTS
  Ten per cent of all new ICD/CRT-D implants were aged 80 years and over. Median age was 83.0 years. Median follow-up was 29 months. Death occurred in 17 (34%). Median time to death was 23 months. Three deaths (6%) occurred within 12 months of ICD implantation. Appropriate therapy (ATP or shock) occurred in 19 (38%). Inappropriate therapy occurred in 6 (12%). Rates of appropriate shocks and inappropriate therapy (shocks and ATP) and significant valvular incompetence were higher amongst deceased patients (P=0.03 OR 5.9 95% CI 1.3-27) and (P=0.02 OR 12 95% CI 1.3-112). Univariate analysis identified diuretic use (P=0.008 95% C.I. 0.05 to 0.63) and appropriate shock (P= 0.025 95% C.I. 1.25 to 26.3) as predictors of mortality.
  
  
  CONCLUSIONS
  Octogenarians make up a small but increasing number of ICD recipients. This study highlights high survival rates at one year with acceptable rates of appropriate and inappropriate device therapy. Ongoing debate regarding the appropriateness of ICD in very elderly patients is warranted.
authors: University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD.
authors: D G
authors: DG
authors: Wilson
authors: Bristol Heart Institute, University Bristol Hospitals NHS Foundation Trust, Malborough street, Bristol BS6 8HW.
authors: N
authors: N
authors: Ahmed
authors: Bristol Heart Institute, University Bristol Hospitals NHS Foundation Trust, Malborough street, Bristol BS6 8HW.
authors: R
authors: R
authors: Nolan
authors: Bristol Heart Institute, University Bristol Hospitals NHS Foundation Trust, Malborough street, Bristol BS6 8HW.
authors: A
authors: A
authors: Frontera
authors: Bristol Heart Institute, University Bristol Hospitals NHS Foundation Trust, Malborough street, Bristol BS6 8HW.
authors: G
authors: G
authors: Thomas
authors: Bristol Heart Institute, University Bristol Hospitals NHS Foundation Trust, Malborough street, Bristol BS6 8HW.
authors: E R
authors: ER
authors: Duncan
keywords: implantable defibrillators; octogenarians; sudden cardiac death