Do All Patients with Implantable Cardioverter Defibrillator Need a Generator Change? A Health Service Evaluation of Patients Who Underwent Generator Changes from a Single Tertiary Center

Overview

Journal Indian Pacing Electrophysiol J

Date 2020 Sep 1

PMID 32866597

Authors

Chun Shing Kwok

Joseph Mayer

Sayed Irfan Kazi

Lec Makiela

Alexandra Anna Rachel Keay

Sadie Bennett

Fozia Zahir Ahmed

Ashish Patwala

Thanh T Phan

Affiliations

Soon will be listed here.

Abstract

Background: The patient characteristics, therapy received and outcomes after one or more implantable cardioverter defibrillator (ICD) generator changes from contemporary practice is not well known.

Methods: We conducted a health service evaluation of patients who underwent ICD implantation and generator change. Patients who had generator changes from February 2016 to October 2019 were identified from our database and electronic records were reviewed for patient characteristics, number of generator changes, receipt of therapy and death.

Results: Our database included 88 patients with a generator change. A total of 22 patients (25.0%) received dual chamber ICD, 10 patients (11.4%) received single chamber ICD, 54 patients (61.3%) received cardiac resynchronization therapy defibrillator and 2 patients (2.3%) received subcutaneous ICD. A second generator change occurred in 18 patients and a third generator changes was performed in 6 patients. There were 29 deaths and a follow up period of 9.4 ± 2.9 years. From implant to initial generator change 39 patients had appropriate antitachycardia pacing (ATP), 6 patient had inappropriate ATP, 29 patients had appropriate shocks and 5 patients had an inappropriate shock. Between the 1st and 2nd generator change and the 2nd and 3rd there were no cases of inappropriate ATP or shock. Overall, 42 patients out of the 88 had appropriate therapy (47.7%) and 7 patients had inappropriate therapy (8.0%).

Conclusions: Most patients with ICDs do not receive therapy and a minority have inappropriate therapy which typically occur before the first generator change as we observed no inappropriate therapy beyond the first generator change.

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