| Inappropriate implantable cardioverter-defibrillator shocks in MADIT II: frequency, mechanisms, predictors, and survival impact. | |
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MedLine Citation:
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PMID: 18387436 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: This study sought to identify the incidence and outcome related to inappropriate implantable cardioverter-defibrillator (ICD) shocks, that is, those for nonventricular arrhythmias. BACKGROUND: The MADIT (Multicenter Automatic Defibrillator Implantation Trial) II showed that prophylactic ICD implantation improves survival in post-myocardial infarction patients with reduced ejection fraction. Inappropriate ICD shocks are common adverse consequences that may impair quality of life. METHODS: Stored ICD electrograms from all shock episodes were adjudicated centrally. An inappropriate shock episode was defined as an episode during which 1 or more inappropriate shocks occurred; another inappropriate ICD episode occurring within 5 min was not counted. Programmed parameters for patients with and without inappropriate shocks were compared. RESULTS: One or more inappropriate shocks occurred in 83 (11.5%) of the 719 MADIT II ICD patients. Inappropriate shock episodes constituted 184 of the 590 total shock episodes (31.2%). Smoking, prior atrial fibrillation, diastolic hypertension, and antecedent appropriate shock predicted inappropriate shock occurrence. Atrial fibrillation was the most common trigger for inappropriate shock (44%), followed by supraventricular tachycardia (36%), and then abnormal sensing (20%). The stability detection algorithm was programmed less frequently in patients receiving inappropriate shocks (17% vs. 36%, p = 0.030), whereas other programming parameters did not differ significantly from those without inappropriate shocks. Importantly, patients with inappropriate shocks had a greater likelihood of all-cause mortality in follow-up (hazard ratio 2.29, p = 0.025). CONCLUSIONS: Inappropriate ICD shocks occurred commonly in the MADIT II study, and were associated with increased risk of all-cause mortality. |
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Authors:
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James P Daubert; Wojciech Zareba; David S Cannom; Scott McNitt; Spencer Z Rosero; Paul Wang; Claudio Schuger; Jonathan S Steinberg; Steven L Higgins; David J Wilber; Helmut Klein; Mark L Andrews; W Jackson Hall; Arthur J Moss; |
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Publication Detail:
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Type: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 51 ISSN: 1558-3597 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 2008 Apr |
Date Detail:
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Created Date: 2008-04-04 Completed Date: 2008-05-02 Revised Date: 2008-10-27 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 1357-65 Citation Subset: AIM; IM |
Affiliation:
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Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA. James_Daubert@URMC.Rochester.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Atrial Flutter
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mortality,
therapy* Clinical Trials as Topic Defibrillators, Implantable / adverse effects* Electric Countershock* / adverse effects, mortality, statistics & numerical data Equipment Failure Female Humans Incidence Male Middle Aged Myocardial Infarction / complications, physiopathology Odds Ratio Prospective Studies Retrospective Studies Risk Factors Stroke Volume Tachycardia, Supraventricular / mortality, therapy* |
| Comments/Corrections | |
Comment In:
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J Am Coll Cardiol. 2008 Sep 16;52(12):1037-8; author reply 1038
[PMID:
18786489
]
J Am Coll Cardiol. 2008 Apr 8;51(14):1366-8 [PMID: 18387437 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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