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Long-term incidence of inappropriate shocks in patients with implantable cardioverter defibrillators in clinical practice—an underestimated complication?

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Abstract

Background

Implantable cardioverter defibrillators (ICD) are life-saving device therapy, and patients often carry devices for decades with interim pulse generator exchanges. Inappropriate shocks are associated with impaired quality of life and increased mortality, but available data on their incidence and etiology outside of clinical trials is limited and usually restricted to the lifespan of a singular device. We hypothesized that the incidence in clinical practice is underestimated and aimed this study to retrospectively assess the long-term incidence and etiology of inappropriate shocks in a real-world cohort of patients with multiple ICDs over a long follow-up period.

Methods

Patients with ICDs implanted between 1998 and 2012 in two Swiss cardiology departments and at least one device exchange in the same department thereafter were included in this cohort. Retrospective analysis with follow-up until 2016 was conducted to assess incidence and etiology of inappropriate ICD shocks.

Results

Two hundred forty-nine ICDs were implanted in 100 patients (mean age: 60.1 ± 11.7; 80% male). Over a mean follow-up time of 11.2 (± 3.6) years, 555 shocks occurred in 55 patients. One hundred twenty-three (22%) shocks in 23 (23%) patients were inappropriate. Supraventricular arrhythmia and oversensing were the most frequent causes of inappropriate shock. Patients with younger age or previous supraventricular arrhythmias were at increased risk of inappropriate shocks. Patients with inappropriate shocks during the lifespan of their first ICD were at increased risk for inappropriate shocks in subsequent devices.

Conclusions

Inappropriate shocks are an underestimated and frequent problem in clinical practice with an incidence that may exceed numbers of previously reported clinical trials with shorter follow-up periods. Patients at increased risk for inappropriate shocks need careful evaluation of potential therapeutic optimization strategies including pharmacological treatment, device programming, electrophysiological ablation, device downgrading, and telemonitoring.

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Abbreviations

ICD:

Implantable cardioverter-defibrillator

IAS:

Inappropriate shock

SD:

Standard deviation

SVT:

Supraventricular arrhythmia

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Authors and Affiliations

  1. Division of Cardiology, Zurich Regional Health Center Wetzikon, Spitalstrasse 66, 8620, Wetzikon, Switzerland

    Daniel Hofer, Firat Duru, Urs Eriksson & Nazmi Krasniqi

  2. Heart Center Zurich, Division of Cardiology and Electrophysiology, University Hospital Zurich, Rämistrasse 100, 8006, Zürich, Switzerland

    Daniel Hofer, Jan Steffel, Laurent Haegeli, Thomas F. Lüscher, Firat Duru, Urs Eriksson & Nazmi Krasniqi

  3. HerzKlinik Hirslanden, Klinik Hirslanden, Witellikerstrasse 40, 8032, Zurich, Switzerland

    David Hürlimann

  4. Zurich Center for Integrative Human Physiology, Zurich, Switzerland

    Firat Duru & Urs Eriksson

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  1. Daniel Hofer
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Corresponding author

Correspondence to Daniel Hofer.

Ethics declarations

The study was conducted according to the principles expressed in the Declaration of Helsinki of 1964, as revised in 2013, and was in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national). Patient consent was not required, since data was collected and analyzed retrospectively as well as anonymously, and there were no new procedural studies undertaken due to the retrospective study design. This article does not contain any new studies with human subjects performed by any of the authors. The local ethical committee (Kantonale Ethikkomission Zürich) approved the study in advance.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published.

Disclosures

Dr. Hofer reports educational and travel funds from St. Jude Medical and Biosense Webster. Dr. Krasniqi and Prof. Eriksson report research grants and educational funds from Boston Scientific, St. Jude Medical, Medtronik, and Biotronik. Dr. Hürlimann reports speaker honoraria and consulting fees from Biotronik, Boston Scientific, LivaNova, Medtronic, and St. Jude Medical. Dr. Haegeli reports speaker honoraria and consulting fees from St. Jude Medical. Dr. Steffel has received consultant and/or speaker fees from Amgen, Astra-Zeneca, Atricure, Bayer, Biosense Webster, Biotronik, Boehringer-Ingelheim, Boston Scientific, Bristol-Myers Squibb, Cook Medical, Daiichi Sankyo, Medtronic, Novartis, Pfizer, Sanofi-Aventis, Sorin, St. Jude Medical, and Zoll. Dr. Steffel is co-director of CorXL. He has received grant support through his institution from Bayer Healthcare, Biosense Webster, Biotronik, Boston Scientific, Daiichi Sankyo, Medtronic, and St. Jude Medical. Prof. Duru reports institutional funds from Boston Scientific, Biotronik, St. Jude Medical, Biosense Webster, and Medtronic. All other authors report no relationships to disclose.

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Hofer, D., Steffel, J., Hürlimann, D. et al. Long-term incidence of inappropriate shocks in patients with implantable cardioverter defibrillators in clinical practice—an underestimated complication?. J Interv Card Electrophysiol 50, 219–226 (2017). https://doi.org/10.1007/s10840-017-0297-8

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  • DOI: https://doi.org/10.1007/s10840-017-0297-8

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