Inappropriate Shocks in Patients with Implantable Cardioverter Defibrillator: Demographics and Predictors

Abstract

Introduction: Inappropriate ICD shocks may negatively affect the quality of life and lead to arrhythmias and psychiatric problems. In this study, we investigated demographic and clinical characteristics of patients with ICD shocks and the predictors leading to inappropriate ICD shocks presented to our emergency department.

Patients and Methods: A total of 64 patients with ICD shocks presented to the emergency department were included in the study. Clinical data of the patients were retrospectively obtained. The clinical features, left ventricular ejection fraction (LVEF), drugs used, and electrocardiographic (ECG) data at the time of implantation of the patients were obtained.

Results: Of the patients presented, 82% were male and the mean age was found as 56.6 ± 15.8 years. Fourty-nine (76%) and 15 (34%) patients experienced appropriate and inappropriate ICD shocks, respectively. The most common findings in the patients presented with inappropriate ICD shocks included atrial fibrillation in 8 (53%), supraventricular tachycardia in 6 (40%), and lead sensing problem in 1 (7%) patients. Compared with the patients presented with appropriate shocks, patients with inappropriate ICD shocks were younger, had less coronary artery disease, had more history of atrial fibrillation before implantation, and shorter time from implantation to first inappropriate shock. In multivariate logistic regression analysis, age and a history of atrial fibrillation were found as independent predictors for inappropriate ICD shocks.

Conclusion: Presence of atrial fibrillation is the most common rhythm problem that causes inappropriate ICD shocks. History of previous atrial fibrillation and a younger age are predicting clinical parameters for inappropriate ICD shocks.

Keywords

• Inappropriate ICD shock,atrial fibrillation

İmplante Kardiyoverter Defibrilatör Yapılan Hastalarda Uygunsuz-Şoklama: Demografik Özellikler ve Öngördürücüler

Abstract

Giriş: Uygunsuz implante edilen kardiyoverter defibrilatör (ICD) şokları yaşam kalitesini olumsuz etkileyebilir, aritmiye ve psikiyatrik sorunlara yol açabilir. Biz çalışmamızda acil servisimize ICD şoklamasıyla başvuran hastaların demografik, klinik özeliklerini ve uygunsuz ICD şoklamasına yol açan öngördürücüleri araştırdık.

Hastalar ve Yöntem: Acil servise ICD şoklamasıyla başvuran 64 hasta çalışmaya alındı. Hastalara ait klinik veriler retrospektif olarak elde edildi. Çalışmaya dahil edilen hastaların klinik özelikleri, sol ventrikül ejeksiyon fraksiyonu (LVEF), kullandıkları ilaçlar, implantasyon anındaki elektrokardiyogramlarına (EKG) ait veriler elde edildi.

Bulgular: Başvuran hastaların %82’si erkek ve ortalama yaş (56.6 ± 15.8) tespit edildi. Kırk dokuz (%76) hastada  uygun şoklama tespit edilirken 15 (%34) hastada uygunsuz ICD şoklaması tespit edildi. Uygunsuz ICD şoklama ile başvuran  hastalarda sırasıyla en sık atriyal fibrilasyon (AF) 8 (%53), supraventriküler taşikardi 6 (%40) ve lead algılama sorunu 1 (%7) hastada  saptandı. Uygunsuz ICD şoklaması olan hastalar uygun şoklamayla başvuran hastalarla kıyaslandığında daha genç yaşa, daha az koroner arter hastalığına, implantasyon öncesi  daha fazla AF öyküsüne ve implantasyondan sonra ilk şoklamaya kadar  daha kısa süreye sahip olan hastalardı. Multivariate logistik regresyon analizi sonrası yaş, AF öyküsü varlığı uygunsuz ICD şoklaması için bağımsız öngördürücü olduğu bulundu.

Sonuç: AF varlığı uygunsuz ICD şoklamasına neden olan  en sık ritm sorunudur. Daha önce AF öyküsünün olması ve genç yaşta olmak, uygunsuz ICD şoklaması için öngördürücü klinik parametrelerdir.

Keywords

• Uygunsuz ICD şoklama,atriyal fibrilasyon

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