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Predictors of an inadequate defibrillation safety margin at ICD implantation: insights from the National Cardiovascular Data Registry.

Publication ,  Journal Article
Hsu, JC; Marcus, GM; Al-Khatib, SM; Wang, Y; Curtis, JP; Sood, N; Parker, MW; Kluger, J; Lampert, R; Russo, AM
Published in: J Am Coll Cardiol
July 22, 2014

BACKGROUND: Defibrillation testing is often performed to establish effective arrhythmia termination, but predictors and consequences of an inadequate defibrillation safety margin (DSM) remain largely unknown. OBJECTIVES: The aims of this study were to develop a simple risk score predictive of an inadequate DSM at implantable cardioverter-defibrillator (ICD) implantation and to examine the association of an inadequate DSM with adverse events. METHODS: A total of 132,477 ICD Registry implantations between 2010 and 2012 were analyzed. Using logistic regression models, factors most predictive of an inadequate DSM (defined as the lowest successful energy tested <10 J from maximal device output) were identified, and the association of an inadequate DSM with adverse events was evaluated. RESULTS: Inadequate DSMs occurred in 12,397 patients (9.4%). A simple risk score composed of 8 easily identifiable variables characterized patients at high and low risk for an inadequate DSM, including (with assigned points) age <70 years (1 point); male sex (1 point); race: black (4 points), Hispanic (2 points), or other (1 point); New York Heart Association functional class III (1 point) or IV (3 points); no ischemic heart disease (2 points); renal dialysis (3 points); secondary prevention indication (1 point); and ICD type: single-chamber (2 points) or biventricular (1 point) device. An inadequate DSM was associated with greater odds of complications (odds ratio: 1.22; 95% confidence interval: 1.09 to 1.37; p = 0.0006), hospital stay >3 days (odds ratio: 1.24; 95% confidence interval: 1.19 to 1.30; p < 0.0001), and in-hospital mortality (odds ratio: 1.96; 95% confidence interval: 1.63 to 2.36; p < 0.0001). CONCLUSIONS: A simple risk score identified ICD recipients at risk for an inadequate DSM. An inadequate DSM was associated with an increased risk for in-hospital adverse events.

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

July 22, 2014

Volume

64

Issue

3

Start / End Page

256 / 264

Location

United States

Related Subject Headings

  • Risk Factors
  • Registries
  • Predictive Value of Tests
  • Middle Aged
  • Male
  • Length of Stay
  • Humans
  • Female
  • Electric Countershock
  • Defibrillators, Implantable
 

Citation

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Chicago
ICMJE
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Hsu, J. C., Marcus, G. M., Al-Khatib, S. M., Wang, Y., Curtis, J. P., Sood, N., … Russo, A. M. (2014). Predictors of an inadequate defibrillation safety margin at ICD implantation: insights from the National Cardiovascular Data Registry. J Am Coll Cardiol, 64(3), 256–264. https://doi.org/10.1016/j.jacc.2014.01.085
Hsu, Jonathan C., Gregory M. Marcus, Sana M. Al-Khatib, Yongfei Wang, Jeptha P. Curtis, Nitesh Sood, Matthew W. Parker, Jeffrey Kluger, Rachel Lampert, and Andrea M. Russo. “Predictors of an inadequate defibrillation safety margin at ICD implantation: insights from the National Cardiovascular Data Registry.J Am Coll Cardiol 64, no. 3 (July 22, 2014): 256–64. https://doi.org/10.1016/j.jacc.2014.01.085.
Hsu JC, Marcus GM, Al-Khatib SM, Wang Y, Curtis JP, Sood N, et al. Predictors of an inadequate defibrillation safety margin at ICD implantation: insights from the National Cardiovascular Data Registry. J Am Coll Cardiol. 2014 Jul 22;64(3):256–64.
Hsu, Jonathan C., et al. “Predictors of an inadequate defibrillation safety margin at ICD implantation: insights from the National Cardiovascular Data Registry.J Am Coll Cardiol, vol. 64, no. 3, July 2014, pp. 256–64. Pubmed, doi:10.1016/j.jacc.2014.01.085.
Hsu JC, Marcus GM, Al-Khatib SM, Wang Y, Curtis JP, Sood N, Parker MW, Kluger J, Lampert R, Russo AM. Predictors of an inadequate defibrillation safety margin at ICD implantation: insights from the National Cardiovascular Data Registry. J Am Coll Cardiol. 2014 Jul 22;64(3):256–264.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

July 22, 2014

Volume

64

Issue

3

Start / End Page

256 / 264

Location

United States

Related Subject Headings

  • Risk Factors
  • Registries
  • Predictive Value of Tests
  • Middle Aged
  • Male
  • Length of Stay
  • Humans
  • Female
  • Electric Countershock
  • Defibrillators, Implantable