Management of patients following implantable cardioverter-defibrillator therapy—The importance of a multifaceted approach

Karshana Selvarajah; Parisha Khan; Nishat Jahagirdar; Antonio Cannatà; Rahul Mukherjee; Daniel I. Bromage; Theresa McDonagh; Francis Murgatroyd; Paul A. Scott

doi:10.1002/joa3.13204

Management of patients following implantable cardioverter-defibrillator therapy—The importance of a multifaceted approach

Karshana Selvarajah, Parisha Khan^*, Nishat Jahagirdar, Antonio Cannatà, Rahul Mukherjee, Daniel I. Bromage, Theresa McDonagh, Francis Murgatroyd, Paul A. Scott

^*Corresponding author for this work

SCMMS Denmark Hill

Research output: Contribution to journal › Article › peer-review

Abstract

Background: The most effective way to treat patients following a first ICD therapy is unclear. We hypothesised that following first ICD therapy, combining different treatment strategies would be associated with a reduction in the risk of subsequent therapy compared to single strategies alone. Methods: Data was collected from consecutive patients undergoing ICD implantation at King's College Hospital between January 2009 and December 2019. We assessed the use of 7 specific treatment strategies, introduced after the 1st therapy—start/increase the dose of beta-blockers, prognostic heart failure medications, antiarrhythmic drugs as well as ICD reprogramming, ablation, ICD upgrade/revision and coronary revascularisation. We evaluated the association between these treatment strategies and the risk of a subsequent ICD therapy. Results: During a mean 50 months follow-up, 267 patients experienced 1st ICD therapy (212 appropriate and 55 inappropriate). Combining treatment strategies was associated with a significant reduction in the risk of subsequent therapy for appropriate therapy compared to 0/7 strategies (1st appropriate ICD therapy, 1/7 treatment strategy (n = 80), 43% lower risk and ≥2/7 treatment strategies (n = 73) 58% reduction, p = <.001). This was also true for inappropriate therapy (1st inappropriate therapy, 1 treatment strategy (n = 22) 86% lower risk and ≥2/7 treatment strategies (n = 25), 94% reduction, p < 0.001) compared to patients with 0/7 treatment strategies (n = 8). Conclusion: An approach combining treatment strategies may be more effective than using single strategies alone to prevent subsequent therapy in patients presenting following a 1st ICD therapy.

Original language	English
Article number	e13204
Journal	Journal of arrhythmia
Volume	41
Issue number	1
DOIs	https://doi.org/10.1002/joa3.13204
Publication status	Published - Feb 2025

Keywords

anti-tachycardia pacing
implantable cardioverter-defibrillator
supra
ventricular fibrillation
ventricular tachycardia

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1002/joa3.13204

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@article{089a431744d64e7e96dcedcd10d446c1,

title = "Management of patients following implantable cardioverter-defibrillator therapy—The importance of a multifaceted approach",

abstract = "Background: The most effective way to treat patients following a first ICD therapy is unclear. We hypothesised that following first ICD therapy, combining different treatment strategies would be associated with a reduction in the risk of subsequent therapy compared to single strategies alone. Methods: Data was collected from consecutive patients undergoing ICD implantation at King's College Hospital between January 2009 and December 2019. We assessed the use of 7 specific treatment strategies, introduced after the 1st therapy—start/increase the dose of beta-blockers, prognostic heart failure medications, antiarrhythmic drugs as well as ICD reprogramming, ablation, ICD upgrade/revision and coronary revascularisation. We evaluated the association between these treatment strategies and the risk of a subsequent ICD therapy. Results: During a mean 50 months follow-up, 267 patients experienced 1st ICD therapy (212 appropriate and 55 inappropriate). Combining treatment strategies was associated with a significant reduction in the risk of subsequent therapy for appropriate therapy compared to 0/7 strategies (1st appropriate ICD therapy, 1/7 treatment strategy (n = 80), 43% lower risk and ≥2/7 treatment strategies (n = 73) 58% reduction, p = <.001). This was also true for inappropriate therapy (1st inappropriate therapy, 1 treatment strategy (n = 22) 86% lower risk and ≥2/7 treatment strategies (n = 25), 94% reduction, p < 0.001) compared to patients with 0/7 treatment strategies (n = 8). Conclusion: An approach combining treatment strategies may be more effective than using single strategies alone to prevent subsequent therapy in patients presenting following a 1st ICD therapy.",

keywords = "anti-tachycardia pacing, implantable cardioverter-defibrillator, supra, ventricular fibrillation, ventricular tachycardia",

author = "Karshana Selvarajah and Parisha Khan and Nishat Jahagirdar and Antonio Cannat{\`a} and Rahul Mukherjee and Bromage, {Daniel I.} and Theresa McDonagh and Francis Murgatroyd and Scott, {Paul A.}",

note = "Publisher Copyright: {\textcopyright} 2024 The Author(s). Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of Japanese Heart Rhythm Society.",

year = "2025",

month = feb,

doi = "10.1002/joa3.13204",

language = "English",

volume = "41",

journal = "Journal of arrhythmia",

issn = "1880-4276",

publisher = "John Wiley & Sons Inc.",

number = "1",

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T1 - Management of patients following implantable cardioverter-defibrillator therapy—The importance of a multifaceted approach

AU - Selvarajah, Karshana

AU - Khan, Parisha

AU - Jahagirdar, Nishat

AU - Cannatà, Antonio

AU - Mukherjee, Rahul

AU - Bromage, Daniel I.

AU - McDonagh, Theresa

AU - Murgatroyd, Francis

AU - Scott, Paul A.

PY - 2025/2

Y1 - 2025/2

N2 - Background: The most effective way to treat patients following a first ICD therapy is unclear. We hypothesised that following first ICD therapy, combining different treatment strategies would be associated with a reduction in the risk of subsequent therapy compared to single strategies alone. Methods: Data was collected from consecutive patients undergoing ICD implantation at King's College Hospital between January 2009 and December 2019. We assessed the use of 7 specific treatment strategies, introduced after the 1st therapy—start/increase the dose of beta-blockers, prognostic heart failure medications, antiarrhythmic drugs as well as ICD reprogramming, ablation, ICD upgrade/revision and coronary revascularisation. We evaluated the association between these treatment strategies and the risk of a subsequent ICD therapy. Results: During a mean 50 months follow-up, 267 patients experienced 1st ICD therapy (212 appropriate and 55 inappropriate). Combining treatment strategies was associated with a significant reduction in the risk of subsequent therapy for appropriate therapy compared to 0/7 strategies (1st appropriate ICD therapy, 1/7 treatment strategy (n = 80), 43% lower risk and ≥2/7 treatment strategies (n = 73) 58% reduction, p = <.001). This was also true for inappropriate therapy (1st inappropriate therapy, 1 treatment strategy (n = 22) 86% lower risk and ≥2/7 treatment strategies (n = 25), 94% reduction, p < 0.001) compared to patients with 0/7 treatment strategies (n = 8). Conclusion: An approach combining treatment strategies may be more effective than using single strategies alone to prevent subsequent therapy in patients presenting following a 1st ICD therapy.

AB - Background: The most effective way to treat patients following a first ICD therapy is unclear. We hypothesised that following first ICD therapy, combining different treatment strategies would be associated with a reduction in the risk of subsequent therapy compared to single strategies alone. Methods: Data was collected from consecutive patients undergoing ICD implantation at King's College Hospital between January 2009 and December 2019. We assessed the use of 7 specific treatment strategies, introduced after the 1st therapy—start/increase the dose of beta-blockers, prognostic heart failure medications, antiarrhythmic drugs as well as ICD reprogramming, ablation, ICD upgrade/revision and coronary revascularisation. We evaluated the association between these treatment strategies and the risk of a subsequent ICD therapy. Results: During a mean 50 months follow-up, 267 patients experienced 1st ICD therapy (212 appropriate and 55 inappropriate). Combining treatment strategies was associated with a significant reduction in the risk of subsequent therapy for appropriate therapy compared to 0/7 strategies (1st appropriate ICD therapy, 1/7 treatment strategy (n = 80), 43% lower risk and ≥2/7 treatment strategies (n = 73) 58% reduction, p = <.001). This was also true for inappropriate therapy (1st inappropriate therapy, 1 treatment strategy (n = 22) 86% lower risk and ≥2/7 treatment strategies (n = 25), 94% reduction, p < 0.001) compared to patients with 0/7 treatment strategies (n = 8). Conclusion: An approach combining treatment strategies may be more effective than using single strategies alone to prevent subsequent therapy in patients presenting following a 1st ICD therapy.

KW - anti-tachycardia pacing

KW - implantable cardioverter-defibrillator

KW - supra

KW - ventricular fibrillation

KW - ventricular tachycardia

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U2 - 10.1002/joa3.13204

DO - 10.1002/joa3.13204

M3 - Article

AN - SCOPUS:85212793884

SN - 1880-4276

VL - 41

JO - Journal of arrhythmia

JF - Journal of arrhythmia

IS - 1

M1 - e13204

ER -

Management of patients following implantable cardioverter-defibrillator therapy—The importance of a multifaceted approach

Abstract

Keywords

UN SDGs

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