Implantable cardioverter-defibrillators in patients with COPD.

Abstract

COPD is a common comorbidity in heart failure. The efficacy of implantable cardioverter-defibrillator (ICD) therapy has not been determined in patients with heart failure and COPD. We examined the incidence of ICD shocks and mortality in 628 consecutive patients who underwent defibrillator implantation at the Minneapolis Veterans Affairs Medical Center from 2006 to 2010. The mean age of the patients was 67 ± 10 years, and 99% were men. Patients with COPD (n = 246 [39%]) were functionally more limited (P < .0001) and more likely to have an ICD for primary prevention of sudden death (P = .04) than those without COPD. Over a median 4.1 years (interquartile range [IQR] 2.2-5.7) of follow-up, patients with COPD had a higher incidence of appropriate shocks than those without COPD (29% vs 17%; P < .0001), whereas the incidence of inappropriate shocks was similar (9% vs 10%, P = .61). In multivariable analysis, COPD was associated with a twofold increase in the odds of an appropriate ICD shock (95% CI, 1.3-2.9; P = .001). Incidence of ICD shocks did not vary with severity of COPD. Although all-cause mortality was higher in patients with COPD than in those without COPD (29% vs 21%, P = .029), 1-year mortality (5.3% vs 2.6%, P = .08) and the average time from first appropriate ICD shock to death was comparable (median, 2.3 [IQR, 1.2-4.4] vs 2.8 [IQR, 1.4-5.3] years; P = .29). Patients with COPD have a higher incidence of ICD shocks than those without COPD and appear to benefit from ICD therapy.