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Article Dans Une Revue EP-Europace Année : 2019

Prophylactic implantable cardioverter-defibrillator in the very elderly

Cyril Zakine
  • Fonction : Auteur
Rodrigue Garcia
  • Fonction : Auteur
Kumar Narayanan
  • Fonction : Auteur
Estelle Gandjbakhch
Vincent Algalarrondo
  • Fonction : Auteur
Marie-Cécile Perier
  • Fonction : Auteur
Laurent Fauchier
Daniel Gras
  • Fonction : Auteur
Pierre Bordachar
  • Fonction : Auteur
Olivier Piot
  • Fonction : Auteur
Dominique Babuty
  • Fonction : Auteur
Nicolas Sadoul
  • Fonction : Auteur
Pascal Defaye
  • Fonction : Auteur
Jean-Claude Deharo
  • Fonction : Auteur
Didier Klug
  • Fonction : Auteur
Christophe Leclercq
  • Fonction : Auteur
Fabrice Extramiana
  • Fonction : Auteur
Serge Boveda
  • Fonction : Auteur
Eloi Marijon
  • Fonction : Auteur

Résumé

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.
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Dates et versions

hal-04395763 , version 1 (15-01-2024)

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Citer

Cyril Zakine, Rodrigue Garcia, Kumar Narayanan, Estelle Gandjbakhch, Vincent Algalarrondo, et al.. Prophylactic implantable cardioverter-defibrillator in the very elderly. EP-Europace, 2019, 21 (7), pp.1063-1069. ⟨10.1093/europace/euz041⟩. ⟨hal-04395763⟩

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