Predictors of implantable cardioverter defibrillator shocks during the first year.
Predictors of implantable cardioverter defibrillator shocks during the first year.
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DOI：
10.1097/01.jcn.0000317473.42801.a8
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发表时间：
2009-01
期刊：
影响因子：
--
通讯作者：
Hunziker J
中科院分区：
文献类型：
--
作者：
Dougherty CM;Hunziker J
The purpose of this study was to predict implantable cardioverter defibrillator (ICD) shocks using demographic and clinical characteristics in the first year after implantation for secondary prevention of cardiac arrest. A prospective design was used to follow 168 first time ICD recipients over 12 months. Demographic and clinical data were obtained from medical records at the time of ICD insertion. ICD shock data were obtained from ICD interrogation reports at hospital discharge, 3, 6, and 12 months. Logistic regression was used to predict ever receiving an ICD shock using background characteristics. Subjects received an ICD for secondary prevention of sudden cardiac arrest, were 64.1 years old, 89% Caucasian, 77% male, with a mean ejection fraction (EF)% = 33.7+14.1%. The cumulative % of ever receiving an ICD shock was 33.3% over 1 year. Three variables predicted shocks in the first year: history of COPD (OR 4.42, 95% CI 1.2-16.4, p = 0.03), history of CHF (OR 3.55, 95% CI 1.4-9.3, p = 0.01), and documented ventricular tachycardia (VT) at the time of ICD implant (OR 10.05, 95% CI 1.8-55.4, p = 0.01). High levels of anxiety approached significance (OR = 2.82, p = 0.09). The presence of COPD, CHF, or VT at ICD implant were significant predictors of receiving an ICD shock in the first year post-ICD. Because ICD shocks are distressing, painful, and associated with greater mortality, health care providers should focus attention on prevention of shocks by controlling VT, careful management of HF symptoms, reducing the use of short acting beta agonist medications in COPD, and perhaps recognizing and treating high levels of anxiety.
