Analyses of inappropriate shocks in a Spanish ICD primary prevention population: Predictors and prognoses

BackgroundICDs have been demonstrated to be highly effective in the primary prevention of sudden death, but inappropriate shocks (IS) occur frequently and represent one of the most important adverse effects of ICDs. The aim of this study was to analyze IS and identify the clinical predictors and prognostic implications of ISs in a real-world primary prevention ICD population.MethodsThis multicenter retrospective study was performed in 13 centers with experience in the field of ICD implantation (at least 30 per year) and ICD follow-up in Spain. All consecutive patients who underwent ICD implantation for primary prevention between January 2008 and May 2014 were included.ResultsOne-thousand-sixteen patients were included, and 4 (0.39%) were lost to follow-up. Two-hundred-seventeen (21.4%) patients suffered from shock; 69 (6.8%) of these patients experienced IS, and 154 (15.4%) experienced appropriate shocks (AS). Age (< 65 years, hazard ratio (HR) 2.588 [95% CI 1.282-5.225]; p = 0.008), history of atrial fibrillation (HR 2.252 [95% CI 1.230-4.115]; p = 0.009), non-ischemic myocardiopathy (HR 2.258 [95% CI 1.090-4.479]; p = 0.028), and cardiac resynchronization therapy (HR 0.385 [95% CI 0.200-0.740]; p = 0.004) were identified as IS predictors in a multivariate analysis. IS was not associated with rehospitalization due to heart failure, myocardial infarction, cardiovascular mortality or all-cause mortality.ConclusionsThis analysis of our national registry identified the independent IS predictors of age, atrial fibrillation history and cardiac resynchronization therapy and suggests that ISs are not linked to poorer clinical endpoints.