Appropriate Evaluation and Treatment of Heart Failure Patients After Implantable Cardioverter-Defibrillator Discharge. Time to Go Beyond the Initial Shock

Joseph D. Mishkin, Sherry J. Saxonhouse, Gregory W. Woo, Thomas A. Burkart, William M. Miles, Jamie B. Conti, Richard S. Schofield, Samuel F. Sears, Juan M. Aranda

Research output: Contribution to journalReview article

51 Scopus citations

Abstract

Multiple clinical trials support the use of implantable cardioverter-defibrillators (ICDs) for prevention of sudden cardiac death in patients with heart failure (HF). Unfortunately, several complicating issues have arisen from the universal use of ICDs in HF patients. An estimated 20% to 35% of HF patients who receive an ICD for primary prevention will experience an appropriate shock within 1 to 3 years of implant, and one-third of patients will experience an inappropriate shock. An ICD shock is associated with a 2- to 5-fold increase in mortality, with the most common cause being progressive HF. The median time from initial ICD shock to death ranges from 168 to 294 days depending on HF etiology and the appropriateness of the ICD therapy. Despite this prognosis, current guidelines do not provide a clear stepwise approach to managing these high-risk patients. An ICD shock increases HF event risk and should trigger a thorough evaluation to determine the etiology of the shock and guide subsequent therapeutic interventions. Several combinations of pharmacologic and device-based interventions such as adding amiodarone to baseline beta-blocker therapy, adjusting ICD sensitivity, and employing antitachycardia pacing may reduce future appropriate and inappropriate shocks. Aggressive HF surveillance and management is required after an ICD shock, as the risk of sudden cardiac death is transformed to an increased HF event risk.

Original languageEnglish (US)
Pages (from-to)1993-2000
Number of pages8
JournalJournal of the American College of Cardiology
Volume54
Issue number22
DOIs
StatePublished - Nov 24 2009

Keywords

  • appropriate shock
  • heart failure
  • implantable cardioverter-defibrillator therapy
  • inappropriate shock

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Mishkin, J. D., Saxonhouse, S. J., Woo, G. W., Burkart, T. A., Miles, W. M., Conti, J. B., Schofield, R. S., Sears, S. F., & Aranda, J. M. (2009). Appropriate Evaluation and Treatment of Heart Failure Patients After Implantable Cardioverter-Defibrillator Discharge. Time to Go Beyond the Initial Shock. Journal of the American College of Cardiology, 54(22), 1993-2000. https://doi.org/10.1016/j.jacc.2009.07.039