title: Long-term outcome of implantable cardioverter-defibrillator implantation in secondary prevention of sudden cardiac death.
abstract: BACKGROUND
  Little is known about the long-term outcomes of patients who receive an implantable cardioverter-defibrillator (ICD) for purely secondary prevention indications.
  
  
  OBJECTIVE
  To assess the rates and predictors of appropriate therapies over a very long-term follow-up period in this population.
  
  
  METHODS
  Between June 2003 and August 2006, 239 consecutive patients with structural left ventricular disease and a secondary prophylaxis indication for ICD therapy (survivors of life-threatening ventricular tachyarrhythmias) were prospectively enrolled. An extended follow-up of these patients was carried out. The primary endpoint was the occurrence of appropriate device therapy. Secondary endpoints were all-cause death, electrical storm and inappropriate therapy.
  
  
  RESULTS
  The study population consisted of 239 patients (90% men; mean age 64±12 years; 72% ischaemic cardiomyopathy; left ventricular ejection fraction 37±12%). During a median follow-up of 7.8 (3.5-9.3) years, appropriate device therapy occurred in 139 (58.2%) patients. Death occurred in 141 patients (59%), electrical storm in 73 (30.5%) and inappropriate therapy in 42 (17.6%). Multivariable analysis identified patients whose presenting arrhythmia was ventricular fibrillation as being less likely to require appropriate device therapy than those whose presenting arrhythmia was ventricular tachycardia (sub-hazard ratio 0.62, 95% confidence interval 0.40-0.97; P=0.04). Independent predictors of all-cause death were age at implantation (P<0.0001), wide QRS complexes (P=0.024), creatinine concentration (P=0.0002) and B-type natriuretic peptide at implantation (P=0.0001).
  
  
  CONCLUSIONS
  Secondary prevention ICD recipients exhibit a high risk of appropriate device therapy and death over prolonged follow-up. Patients who presented initially with ventricular fibrillation were less likely to require the delivery of appropriate device therapy.
authors.affiliation: Department of Cardiovascular Medicine, Lille University Hospital, 59370 Lille, France; Faculty of Medicine, University of Lille 2, 59000 Lille, France. Electronic address: stephane.boule@chru-lille.fr.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Boulé
authors.affiliation: Department of Cardiovascular Medicine, Lille University Hospital, 59370 Lille, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Sémichon
authors.affiliation: Department of Cardiovascular Medicine, Lille University Hospital, 59370 Lille, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Guédon-Moreau
authors.affiliation: Unité de biostatistique, université de Lille, CHU de Lille, EA 2694 - santé publique : épidémiologie et qualité des soins, 59000 Lille, France.
authors.forename: Élodie
authors.initials: É
authors.lastname: Drumez
authors.affiliation: Department of Cardiovascular Medicine, Lille University Hospital, 59370 Lille, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Kouakam
authors.affiliation: Department of Cardiovascular Medicine, Lille University Hospital, 59370 Lille, France.
authors.forename: Christelle
authors.initials: C
authors.lastname: Marquié
authors.affiliation: Department of Cardiovascular Medicine, Lille University Hospital, 59370 Lille, France.
authors.forename: François
authors.initials: F
authors.lastname: Brigadeau
authors.affiliation: Department of Cardiovascular Medicine, Lille University Hospital, 59370 Lille, France; Faculty of Medicine, University of Lille 2, 59000 Lille, France.
authors.forename: Salem
authors.initials: S
authors.lastname: Kacet
authors.affiliation: Department of Cardiovascular Medicine, Lille University Hospital, 59370 Lille, France; Faculty of Medicine, University of Lille 2, 59000 Lille, France.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Potelle
authors.affiliation: Department of Cardiovascular Medicine, Lille University Hospital, 59370 Lille, France; Faculty of Medicine, University of Lille 2, 59000 Lille, France.
authors.forename: William
authors.initials: W
authors.lastname: Escande
authors.affiliation: Faculty of Medicine, University of Lille 2, 59000 Lille, France.
authors.forename: Zouheir
authors.initials: Z
authors.lastname: Souissi
authors.affiliation: Department of Cardiovascular Medicine, Lille University Hospital, 59370 Lille, France; Faculty of Medicine, University of Lille 2, 59000 Lille, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Lacroix
authors.affiliation: Unité de biostatistique, université de Lille, CHU de Lille, EA 2694 - santé publique : épidémiologie et qualité des soins, 59000 Lille, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Duhamel
authors.affiliation: Department of Cardiovascular Medicine, Lille University Hospital, 59370 Lille, France; Faculty of Medicine, University of Lille 2, 59000 Lille, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Klug
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D017180:Tachycardia, Ventricular / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D055815:Young Adult
keywords: Défibrillateur automatique implantable; Fibrillation ventriculaire; Implantable cardioverter–defibrillator; Mort subite; Prévention secondaire; Secondary prevention; Sudden cardiac death; Tachycardie ventriculaire; Ventricular fibrillation; Ventricular tachycardia