Prophylactic implantable cardioverter-defibrillator in the very elderly

Author:

Zakine Cyril1,Garcia Rodrigue2,Narayanan Kumar13,Gandjbakhch Estelle4,Algalarrondo Vincent5,Lellouche Nicolas6,Perier Marie-Cécile17,Fauchier Laurent8,Gras Daniel9,Bordachar Pierre10,Piot Olivier11,Babuty Dominique8,Sadoul Nicolas12,Defaye Pascal13,Deharo Jean-Claude14,Klug Didier15,Leclercq Christophe16,Extramiana Fabrice17,Boveda Serge18,Marijon Eloi1719

Affiliation:

1. Paris Cardiovascular Research Center, Paris, France

2. University Hospital of Poitiers, Poitiers, France

3. Maxcure Hospitals, Hyderabad, India

4. La Pitié Salpêtrière Hospital, Paris, France

5. Antoine-Béclère Hospital, Paris, France

6. Henri Mondor Hospital, Paris, France

7. European Georges Pompidou Hospital, Cardiology Department, Paris, France

8. Tours University Hospital, Tours, France

9. Hopital privé du Confluent, Nantes, France

10. University Hospital od Bordeaux, Bordeaux, France

11. Centre Cardiologique du Nord, Saint Denis, France

12. Nancy University Hospital, Nancy, France

13. University Hospital of Grenoble, Grenoble, France

14. La Timone University Hospital, Marseille, France

15. Lille University Hospital, Lille, France

16. Rennes University Hospital, Université de Rennes, CIC-IT, Rennes, France

17. Bichat-Claude-Bernard Hospital, Paris, France

18. Clinique Pasteur, Toulouse, France

19. Paris Descartes University, Paris, France

Abstract

Aims Current guidelines do not propose any age cut-off for the primary prevention implantable cardioverter-defibrillator (ICD). However, the risk/benefit balance in the very elderly population has not been well studied. Methods and results In a multicentre French study assessing patients implanted with an ICD for primary prevention, outcomes among patients aged ≥80 years were compared with <80 years old controls matched for sex and underlying heart disease (ischaemic and dilated cardiomyopathy). A total of 300 ICD recipients were enrolled in this specific analysis, including 150 patients ≥80 years (mean age 81.9 ± 2.0 years; 86.7% males) and 150 controls (mean age 61.8 ± 10.8 years). Among older patients, 92 (75.6%) had no more than one associated comorbidity. Most subjects in the elderly group got an ICD as part of a cardiac resynchronization therapy procedure (74% vs. 46%, P < 0.0001). After a mean follow-up of 3.0 ± 2 years, 53 patients (35%) in the elderly group died, including 38.2% from non cardiovascular causes of death. Similar proportion of patients received ≥1 appropriate therapy (19.4% vs. 21.6%; P = 0.65) in the elderly group and controls, respectively. There was a trend towards more early perioperative events (P = 0.10) in the elderly, with no significant increase in late complications (P = 0.73). Conclusion Primary prevention ICD recipients ≥80 years in the real world had relatively low associated comorbidity. Rates of appropriate therapies and device-related complications were similar, compared with younger subjects. Nevertheless, the inherent limitations in interpreting observational data on this particular competing risk situation call for randomized controlled trials to provide definitive answers. Meanwhile, a careful multidisciplinary evaluation is needed to guide patient selection for ICD implantation in the elderly population.

Funder

French Institute of Health and Medical Research

Toulouse Association for the Study of Rhythm Disturbances

French Society of Cardiology

Publisher

Oxford University Press (OUP)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

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