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Implantable Cardioverter-Defibrillator Implantation, Continuation, and Deactivation in Elderly Patients

  • Cardiovascular Disease in the Elderly (M Chen, Section Editor)
  • Published:
Current Geriatrics Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

We review the major randomized trials and recent literature which address the impact of age on the decisions to implant, replace, and deactivate implantable cardioverter-defibrillators (ICDs) in elderly patients (≥75 years).

Recent Findings

Current national trends indicate that increasing numbers of ICD recipients are elderly and that elderly patients receive ICDs in a much higher proportion than was represented in randomized controlled trials. Increasing age and increasing comorbidity burden reduce the potential survival benefit from ICD implantation. Multiple risk assessment models are reviewed, as are their limitations. Perspectives regarding ICD deactivation at end of life are explored.

Summary

Because elderly patients are more likely to die from nonarrhythmic causes, the survival benefit that elderly patients receive from ICD implantation is reduced. Physicians should accurately represent the benefits and risks when counseling elderly patients with an indication for ICD implantation.

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Abbreviations

CRT:

Cardiac resynchronization therapy

CRT-D:

Cardiac resynchronization therapy defibrillator

CRT-P:

Cardiac resynchronization therapy pacemaker

EF:

Ejection fraction

ICD:

Implantable cardioverter-defibrillator

NCDR:

National Cardiovascular Data Registry

NYHA:

New York Heart Association

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Papers of particular interest, published recently, have been highlighted as: •Of importance ••Of major importance

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Authors and Affiliations

  1. Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    J. William Schleifer

  2. Department of Cardiovascular Diseases, Mayo Clinic Arizona, 5755 East Mayo Boulevard, Phoenix, AZ, 85054, USA

    Win-Kuang Shen

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This article is part of the Topical Collection on Cardiovascular Disease in the Elderly

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Schleifer, J.W., Shen, WK. Implantable Cardioverter-Defibrillator Implantation, Continuation, and Deactivation in Elderly Patients. Curr Geri Rep 6, 279–289 (2017). https://doi.org/10.1007/s13670-017-0226-9

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