Heart 1997;78:364-370 ( October )

Age dependent efficacy of implantable cardioverter-defibrillator treatment: observations in 450 patients over an 11 year period

Hans-Joachim Trappe,^a Petra Pfitzner,^a Michael Achtelik,^a Hans-Gerd Fieguth^b

^a Department of Cardiology and Angiology, University Hospital Herne, Ruhr University Bochum, Germany, ^b Department of Cardiovascular Surgery, University Hospital Hannover, Germany

Correspondence to: Dr Trappe, Department of Cardiology and Angiology, University Hospital Herne, Ruhr-University Bochum, Hoelkeskampring 40, 44625 Herne, Germany.

Accepted for publication 10 June 1997

ObjectiveTo determine whether implantable cardioverter-defibrillator (ICD) treatment is beneficial in elderly patients with life threatening ventricular tachyarrhythmias.
DesignSince January 1984, ICDs were implanted in 450 patients to evaluate surgical risk, complications and mean survival in relation to patient age; 81 patients (18%) were  50 years at the time of ICD implant, 254 patients (56%) were between 51 and 64 years, and the remaining 115 (26%) were  65 years. Epicardial lead systems were implanted in 209 patients (46%), while transvenous lead systems were implanted in 241 (54%).
Results13 patients (3%) died perioperatively, more often after epicardial (11 of 209 patients, 5%) than after transvenous ICD implantation (one of 241 patients, < 1%) (p < 0.05). During a mean (SD) follow up of 28 (24) months (range < 1 to 114 months), 90 patients (20%) died. Of these, nine (2%) died from sudden arrhythmic death; five (1%) died suddenly, probably as a result of non-arrhythmic causes; 55 (12%) died from other cardiac causes (congestive heart failure, myocardial infarction); and 21 (5%) died from non-cardiac causes. The three, five, and seven year survival for arrhythmic mortality was 95% in patients  50 years compared with a three year survival of 93% and a five and seven year survival of 91% in patients of 51 to 64 years, and a three, five, and seven year survival of 99% in patients  65 years. 362 patients (80%) received ICD discharges (21 (43) shocks per patient), with a similar incidence among all three patient groups ( 50 years, 80%; 51 to 64 years, 81%; 65 years, 79%). The time interval between ICD implant and the first ICD treatment was shorter in patients  65 years (8 (8) months) than in patients between 51 and 64 years (11 (14) months) or  50 years (11 (11) months) (p < 0.05). Survival time following first appropriate shock was 30 (24) months in patients  50 years, 30 (26) months in patients of 51 to 64 years, and 19 (20) months in patients  65 years.
ConclusionsElderly patients benefit from ICD treatment, and survive for a considerable time after the first treatment. Therefore, elderly patients should be considered candidates for ICD implantation if life threatening ventricular tachyarrhythmias are present.

Keywords: cardioverter-defibrillator;  heart failure;  sudden death;  ICD discharges;  elderly patients

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© 1997 by Heart
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