Implantable Cardioverter-Defibrillators in Patients With COPD

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Abstract

Background:

COPD is a common comorbidity in heart failure. The efficacy of implantable cardioverter-defibrillator (ICD) therapy has not been determined in patients with heart failure and COPD.

Methods:

We examined the incidence of ICD shocks and mortality in 628 consecutive patients who underwent defibrillator implantation at the Minneapolis Veterans Affairs Medical Center from 2006 to 2010.

Results:

The mean age of the patients was 67 ± 10 years, and 99% were men. Patients with COPD (n = 246 [39%]) were functionally more limited (P< .0001) and more likely to have an ICD for primary prevention of sudden death (P= .04) than those without COPD. Over a median 4.1 years (interquartile range [IQR] 2.2-5.7) of follow-up, patients with COPD had a higher incidence of appropriate shocks than those without COPD (29% vs 17%;P< .0001), whereas the incidence of inappropriate shocks was similar (9% vs 10%,P= .61). In multivariable analysis, COPD was associated with a twofold increase in the odds of an appropriate ICD shock (95% CI, 1.3-2.9;P= .001). Incidence of ICD shocks did not vary with severity of COPD. Although all-cause mortality was higher in patients with COPD than in those without COPD (29% vs 21%,P= .029), 1-year mortality (5.3% vs 2.6%,P= .08) and the average time from first appropriate ICD shock to death was comparable (median, 2.3 [IQR, 1.2-4.4] vs 2.8 [IQR, 1.4-5.3] years;P= .29).

Conclusions:

Patients with COPD have a higher incidence of ICD shocks than those without COPD and appear to benefit from ICD therapy.

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