Do Implantable Cardioverter-Defibrillators Lower the Risk of Sudden Death and Total Mortality in Patients with End-Stage
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ARRHYTHMIAS (J. BUNCH, SECTION EDITOR)
Do Implantable Cardioverter-Defibrillators Lower the Risk of Sudden Death and Total Mortality in Patients with End-Stage Renal Disease? Sana M. Al-Khatib 1,2 & Daniel J. Friedman 1,2 & Paul L. Hess 3 & Patrick H. Pun 4 & Gillian D. Sanders 5
# Springer Science+Business Media, LLC 2017
Abstract Purpose of Review Although the risk of sudden cardiac death is high in patients with end-stage renal disease (ESRD), it is not clear if such patients benefit from the implantable cardioverter defibrillator (ICD). This paper reviews data on the risk of sudden cardiac death in ESRD patients and examines data on outcomes of ICDs in such patients. Recent Findings Data from observational studies suggest that primary prevention ICDs may lower the risk of mortality in patients with mild to moderate chronic kidney disease but not in patients with ESRD. Data on secondary prevention ICDs in the setting of ESRD suggest survival benefit in select patients. The subcutaneous ICD is a promising therapy in patients with ESRD, but more data are needed on its short- and long-term outcomes in these patients. Summary Future studies should examine the outcomes of transvenous and subcutaneous ICDs in patients with ESRD.
This article is part of the Topical Collection on Arrhythmias * Sana M. Al-Khatib [email protected]
1
Division of Cardiology and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27710, USA
2
Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC 27705, USA
3
Cardiology Section, Veterans Affairs Eastern Colorado Health Care System and Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
4
Division of Nephrology and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27710, USA
5
Clinical Pharmacology and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27710, USA
Keywords Sudden cardiac death . Implantable cardioverter defibrillator . End-stage renal disease
Introduction The implantable cardioverter defibrillator (ICD) reduces the risk of sudden cardiac death (SCD) and improves the overall survival of patients with cardiac arrest, patients with sustained ventricular arrhythmias in the presence of structural heart disease, as well as many patients with significant left ventricular dysfunction due to ischemic or non-ischemic cardiomyopathy [1–8]. The presence of end-stage renal disease (ESRD) in such patients increases the risk of SCD; however, this increased risk is accompanied by an increase in the risk of other modes of death and complications related to ICD implantation [9, 10]. Therefore, one cannot generalize data on the favorable outcomes of the ICD in patients with no or mild kidney disease to patients with advanced kidney disease including those with ESRD. Instead, ideally, one would critically review published data on the ICD in patients with ESRD. Unfortunately, patients with ESRD were excluded from the pivotal randomized clinical trial
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