Efficacy and safety of ICD therapy in a population of elderly patients treated with optimal background medication.

Introduction: Implantable cardioverter-defibrillator (ICD) therapy has been shown to improve survival in patients with structural heart disease and at high risk for life threatening ventricular arrhythmias. Whether elderly patients benefit from device therapy in a similar way as younger patients is largely unknown.

Methods: We retrospectively analyzed data from 375 consecutive ICD recipients with structural heart disease. Patients were divided into two groups, younger than 70 years at time of ICD implantation (group 1) or 70 years or older (group 2). Main outcome measures were time to death from any cause and time from first appropriate ICD therapy to death.

Results: Group 1 and 2 patients were comparable with respect to clinical presentation and average follow-up duration. In the elderly patient group, 78% received an ICD for secondary prevention versus 63% in group 1 (p = 0.007). During a mean follow-up period of 26.5 +/- 18.1 months, there was no significant difference in overall mortality among the two groups: 47 patients died, 34 (12.5%) of group 1 versus 13 (12.7%) of group 2. The average time to death was 28.4 +/- 16.7 vs 30.4 +/- 22.1 months after device implantation, respectively (p = ns). There was no difference in time from device implantation to first adequate ICD therapy and time from first appropriate ICD therapy to death among the two groups (p = ns). Device associated complications were comparable in both groups.

Conclusions: Elderly ICD recipients had comparable survival rates and appropriate use of the ICD compared to younger individuals.