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 (n = 80), 43% lower risk and  ≥2/7 treatment strategies (n = 73) 58% reduction, p = <.001). This was also true for inappropriate therapy (1st inappropriate therapy, 1 treatment strategy (n = 22) 86% lower risk and  ≥2/7 treatment strategies (n = 25), 94% reduction, p < 0.001) compared to patients with 0/7 treatment strategies (n = 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.