Management of patients following implantable cardioverter-defibrillator therapy-The importance of a multifaceted approach.

Background: The most effective way to treat patients following a first ICD therapy is unclear. We hypothesised that following first ICD therapy, combining different treatment strategies would be associated with a reduction in the risk of subsequent therapy compared to single strategies alone.

Methods: Data was collected from consecutive patients undergoing ICD implantation at King's College Hospital between January 2009 and December 2019. We assessed the use of 7 specific treatment strategies, introduced after the 1st therapy-start/increase the dose of beta-blockers, prognostic heart failure medications, antiarrhythmic drugs as well as ICD reprogramming, ablation, ICD upgrade/revision and coronary revascularisation. We evaluated the association between these treatment strategies and the risk of a subsequent ICD therapy.

Results: During a mean 50 months follow-up, 267 patients experienced 1st ICD therapy (212 appropriate and 55 inappropriate). Combining treatment strategies was associated with a significant reduction in the risk of subsequent therapy for appropriate therapy compared to 0/7 strategies (1st appropriate ICD therapy, 1/7 treatment strategy ( = 80), 43% lower risk and  ≥2/7 treatment strategies ( = 73) 58% reduction,  = <.001). This was also true for inappropriate therapy (1st inappropriate therapy, 1 treatment strategy ( = 22) 86% lower risk and  ≥2/7 treatment strategies ( = 25), 94% reduction,  < 0.001) compared to patients with 0/7 treatment strategies ( = 8).

Conclusion: An approach combining treatment strategies may be more effective than using single strategies alone to prevent subsequent therapy in patients presenting following a 1st ICD therapy.