Abstract 20851: Incidence of Appropriate ICD Therapies After Elective Generator Replacement in Patient With Heart Failure Initially Implanted for Primary Prevention

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Implantable cardioverter-defibrillator (ICD) is an effective therapy to reduce overall mortality in heart failure. When the ICD generator approaches the end of life, the majority of the patients undergo an elective generator replacement (GR) even if they no longer meet implantation criteria. Whether arrhythmic risk should be re-assessed at the time of GR is still an open question. The aim of our study was to assess, via a meta-analysis of current literature, the occurrence of appropriate ICD therapies after GR in patients stratified based on the presence/absence of ICD indication at the time of GR. We performed a systematic literature search for all English studies published between January 2000 and March 2017. We included all primary prevention studies who analyzed the rate of ICD therapies after GR. Of a total of 1829 initial studies, we included 5 retrospective studies. Pts were categorized into two groups: 1) "with persistent ICD indication " in case of LVEF≤35% or previous appropriate therapies; 0) " without persistent ICD indication" in case of a LVEF> 35% and no previous appropriate ICD therapies; For each group incidences were computed from each article as number of events per hundred person-year. A random effect meta-analysis was performed. We included in our analysis 623 patients; 407 (65%) in group 1 and 216 (35%) in group 0. The incidence of patient with appropriate ICD therapies after GR was 12.2/100-person-year (95% Confidence Interval 9.9-14.5) in group 1 vs. 4.3/100-person-year (95% CI 1.2-7.4) in group 0. Patients with persistent ICD indication were found to have a 2.45 (95%CI 1.1-5.5) fold higher risk of appropriate ICD therapies after GR (figure 1) Patients who no longer meet ICD implantation criteria at the time of generator replacement show a significantly lower risk of appropriate ICD therapies during the ICD’s “second life”. Although more data are required our results suggest the need for arrhythmic risk re-stratification at the time of generator replacement.

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