Among patients with heart failure (HF) who had an ICD or CRT-D for primary prevention, the risk for ventricular tachyarrhythmia (VTA) and ICD shocks was significantly lower among patients ≥75 years old, compared with younger patients, according to a study published July 9 in JACC: Clinical Electrophysiology.

In light of the remaining controversy of the benefit of ICDs in elderly patients, Mehmet K. Aktas, MD, MBA, et al., examined outcomes in 5,170 patients enrolled in five landmark ICD clinical trials according to three predefined age groups: <65 years (n=2,502; 48%); 65 to <75 years (n=1,792; 35%); and ≥75 years (876; 17%). They also assessed the competing risks for VTA and death by age group. Fast VTA was defined as ≥200 beats/min or ventricular fibrillation.

Results showed that at three years the cumulative incidence of fast VTA was lowest among patients ≥75 years at 10% compared with 17% for patients <65 years and 15% for patients 65 to <75 years (p<0.001), translating to a 40% lower risk based on the multivariate Fine and Gray analysis. Of note, in patients ≥75 years, the risk for death without prior fast VTA was higher than the risk for developing fast VTA.

Predictors of a fast VTA in patients ≥75 years identified by the researchers include a history of nonsustained ventricular tachycardia, male sex and the presence of nonischemic cardiomyopathy.

The authors state that aging is associated with a higher risk of death than the risk for fast VTA which is the reverse of what is seen in younger patients. They write, “These results provide evidence that more stringent selection criteria should be considered in the identification of older patients for the insertion of primary prevention ICDs.”

Gilson C. Fernandes, MD, and E. Kevin Heist, MD, PhD, FACC, write in accompanying editorial comment that age is only one of the variables of a complex decision-making conversation. Furthermore, that the identification of risk factors and application of multivariate risk models may be helpful tools to identify patients for whom an ICD could be useful. “A frank discussion about how each patient values quantity and quality of life, coupled with the best available data on the expected impact of ICD placement on these variables, is critical to a truly informed decision by the patient on this important question.”

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Tachycardia, Ventricular, Ventricular Fibrillation, Arrhythmias, Cardiac, Risk Factors, Cardiomyopathies, Aging, Electrophysiology

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