Factors associated with the survival of patients with implanted cardiac defibrillators in a cohort from Medellin, Colombia
Sotelo-Narváez, Jorge Enrique; Ruiz-Velásquez, Luis Miguel; Aristizábal-Aristizábal, Julián Miguel; Marín-Velásquez, Jorge Eduardo; Díaz-Martínez, Juan Carlos
ABSTRACT
Introduction: sudden cardiac death accounts for 50% of cardiovascular deaths worldwide and 20% of mortality. The use of an implantable cardioverter defibrillator (ICD) is associated with the optimal management of cardiovascular diseases and positively impacts mortality.
Material and methods: a retrospective cohort of 730 patients required an ICD and attended electrophysiology consultation in eight hospitals in Medellín, Colombia, between 2013 and 2020 and had a follow-up for at least six months with two controls. Adjusted and survival analyzes were performed.
Results: 72% of patients were male. The most prevalent pathologies were arterial hypertension (71%) and dyslipidemia (46%). 56.7% of patients had ischemic heart disease. At the beginning of the follow-up, 72.9% had an ejection fraction (LVEF) of less than 35%, and echocardiographic follow-up found improvement in LVEF, less than 35% in 19.9%. 62.7% had an ICD for primary prevention, 20.3% received appropriate therapy due to ventricular tachycardia, and 11.2% and 14.7% had inappropriate therapy, usually caused by atrial fibrillation (8.5%). Survival analysis found that functional class NYHA III (HR 2.96, 95% CI 1.85-5.15), arterial hypertension (HR 2.182, 95% CI 1.23-3.86), inappropriate therapies, and age (HR 1.02, 95% CI 1.01-1.03) were associated with a significant decrease in survival in patients with an ICD.
Conclusion: in this study, it was found that most of the patients were men, and the main indication of ICD was primary prevention. Age, NYHA III functional class, arterial hypertension, and inappropriate therapies were associated with a significant decrease in survival in patients with an ICD.
