Medizinische Universität Graz - Research portal
Selected Publication:
Nöbauer, S.
Adäquate und inadäquate Therapien sowie Komplikationsrate bei Patienten mit primärprophylaktischer ICD-Implantation
[ Diplomarbeit/Master Thesis ] Graz Medical University; 2009. pp.93.
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- Authors Med Uni Graz:
- Advisor:
- Lercher Peter
- Pieske Burkert Mathias
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- Abstract:
- Introduction: The use of implantable cardioverter defibrillators (ICD) for primary prevention of sudden cardiac death has become a common strategy. Studies that evaluated the association of follow-up (FU) duration, patient age, underlying heart disease (ischemic cardiomyopathy, ICM, or dilatative cardiomyopathy, DCM) and the presence or absence of atrial fibrillation (AF) with the rate of device-related events are still limited. Methods: A retrospective analysis focused on appropriate and inappropriate therapies as well as on complications was performed including 161 patients who received an ICD for primary prevention. The incidence of device therapies and complications was determined as rate of event-positive FUs per patient and year. Patients were stratified according to FU-duration (> 48 months), age (> 70 years), underlying heart disease (ICM vs. DCM) and the presence of AF during FU. Results: There were no significant differences in the rate of inappropriate therapies in subgroups FU-duration and age. However, the rate of appropriate therapies was significantly higher in patients with a FU-duration > 48 months (0.5 0.61 vs. 0.43 0.91; meanSD; p<0.001) and in patients < 70 years of age (0.5 0.84 vs. 0.3 0,94; p<0.05). The rate of device-related complications was similar in patients < and > 70 years of age and significantly higher in patients with a FU-duration < 48 months (0,67 1,19 vs. 0,14 0,18; p<0,01). Rates of appropriate and inappropriate therapy as well as complication rate were similar in patients with ICM and DCM. In patients with AF there were a significant higher rate of FUs with inappropriate therapies (0.35 0.95 vs. 0.12 0.44; p<0,01) and postoperative pocket-hematomas (0.16 0.55 vs. 0.07 0.36; p<0,05) per patient and year and a higher overall mortality (12.7% vs. 3.9%; p<0.05). Conclusions: The observations during long-term-FU approve the continuing high incidence of arrhythmias in the examined population with no differences between ICM and DCM. Patients over 70 years of age were not at a higher risk of complications. AF was associated with a higher risk for inappropriate therapies and postoperative pocket-hematomas as well as a higher mortality. The findings of our monocentric study need to be confirmed through investigations within a larger patient population.