title: Implantable Cardioverter-Defibrillators at End of Battery Life: Opportunities for Risk (Re)-Stratification in ICD Recipients.
abstract: Although implantable cardioverter-defibrillators (ICDs) are frequently viewed as a lifelong commitment in that patients are routinely scheduled for generator exchange (GE) at end of battery life, several considerations should prompt a reevaluation of risks and benefits before GE. Compared with initial ICD implant, patients receiving replacement devices are older, and have more comorbidities and shorter life expectancy, all of which may limit the benefit of ICD therapy following GE. Additionally, GE is associated with significant complications, including infection, which may increase the risk of mortality. In this paper, we review recent data regarding opportunities for risk stratification before GE, with a particular focus on those with improved left ventricular function and those who have not experienced ICD therapies during the first battery life. We also provide a broader perspective on ICD therapy, focusing on how decisions regarding GE may affect goals of care at the end of life.
authors.affiliation: Cardiology Division, Section of Cardiac Electrophysiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia. Electronic address: faisal.merchant@emoryhealthcare.org.
authors.forename: Faisal M
authors.initials: FM
authors.lastname: Merchant
authors.affiliation: Atlanta Veterans Administration Medical Center, Department of Veterans Affairs, Atlanta, Georgia; Emory Cardiovascular Clinical Research Institute, Emory University, Atlanta, Georgia.
authors.forename: Tammie
authors.initials: T
authors.lastname: Quest
authors.affiliation: Cardiology Division, Section of Cardiac Electrophysiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Angel R
authors.initials: AR
authors.lastname: Leon
authors.affiliation: Cardiology Division, Section of Cardiac Electrophysiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Mikhael F
authors.initials: MF
authors.lastname: El-Chami
mesh_terms: D002423:Cause of Death / Q000639:trends; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology*; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D004868:Equipment Failure; D014943:Global Health; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends
keywords: cardiac arrhythmias; generator exchange; heart failure; risk assessment; sudden cardiac death; ventricular function