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Journal Articles EP-Europace Year : 2019

Prophylactic implantable cardioverter-defibrillator in the very elderly

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

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.
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Dates and versions

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

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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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