ISSN 1671-5411 CN 11-5329/R
Volume 20 Issue 1
Jan.  2023
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Please cite this article as: Pauwelyn M, Ingelaere S, Hoffmann R, Vijgen J, Mairesse GH, Blankoff I, Vandekerckhove Y, Waroux JBLPD, Vandenberk B, Willems R. Implantable cardiac defibrillators in octogenarians. J Geriatr Cardiol 2023; 20(1): 23−31. DOI: 10.26599/1671-5411.2023.01.007
Citation: Please cite this article as: Pauwelyn M, Ingelaere S, Hoffmann R, Vijgen J, Mairesse GH, Blankoff I, Vandekerckhove Y, Waroux JBLPD, Vandenberk B, Willems R. Implantable cardiac defibrillators in octogenarians. J Geriatr Cardiol 2023; 20(1): 23−31. DOI: 10.26599/1671-5411.2023.01.007

Implantable cardiac defibrillators in octogenarians

doi: 10.26599/1671-5411.2023.01.007
RW is supported as postdoctoral clinical researcher by the Fund for Scientific Research-Flanders (FWO-Vlaanderen). RW reports research funding from Abbott, Biotronik, Boston Scientific, Medtronic; speakers and consultancy fees from Medtronic, Boston Scientific, Biotronik, Abbott.
*The authors contributed equally to this manuscript
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  •  OBJECTIVE  Implantable cardiac defibrillators (ICD) implantation in the very elderly remains controversial. We aimed to describe the experience and outcome of patients over 80 years old implanted with an ICD in Belgium.  METHODS  Data were extracted from the national QERMID-ICD registry. All implantations performed in octogenarians between February 2010 and March 2019 were analysed. Data on baseline patient characteristics, type of prevention, device configuration and all-cause mortality were available. To determine predictors of mortality, multivariable Cox proportional hazard regression modelling was performed.  RESULTS  Nationwide, 704 primo ICD implantations were performed in octogenarians (median age 82, IQR 81-83 years; 83% male and 45% secondary prevention). During a mean follow-up of 3.1 ± 2.3 years, 249 (35%) patients died, of which 76 (11%) within the first year after implantation. In multivariable Cox regression analysis age (HR = 1.15, P = 0.004), oncological history (HR = 2.43, P = 0.027) and secondary prevention (HR = 2.23, P = 0.001) were independently associated with 1-year mortality. A better preserved left ventricular ejection fraction (LVEF) was associated with a better outcome (HR = 0.97, P = 0.002). Regarding overall mortality multivariable analysis withheld age, history of atrial fibrillation, centre volume and oncological history as significant predictors. Higher LVEF was again protective (HR = 0.99, P = 0.008).  CONCLUSIONS  Primary ICD implantation in octogenarians is not often performed in Belgium. Among this population, 11% died within the first year after ICD implantation. Advanced age, oncological history, secondary prevention and a lower LVEF were associated with an increased one-year mortality. Age, low LVEF, atrial fibrillation, centre volume and oncological history were indicative of higher overall mortality.
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