Document Detail


Inappropriate implantable cardioverter-defibrillator shocks in MADIT II: frequency, mechanisms, predictors, and survival impact.
MedLine Citation:
PMID:  18387436     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
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:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
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:
Created Date:  2008-04-04     Completed Date:  2008-05-02     Revised Date:  2008-10-27    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1357-65     Citation Subset:  AIM; IM    
Affiliation:
Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA. James_Daubert@URMC.Rochester.edu
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MeSH Terms
Descriptor/Qualifier:
Atrial Flutter / 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:
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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