0
Original Research: COPD |

Implantable Cardioverter-Defibrillators in Patients With COPDImplantable Cardioverter-Defibrillators in COPD FREE TO VIEW

Niyada Naksuk, MD; Ken M. Kunisaki, MD, FCCP; David G. Benditt, MD; Venkatakrishna Tholakanahalli, MD; Selcuk Adabag, MD
Author and Funding Information

From the Division of Cardiology, Veterans Administration Medical Center, and Department of Medicine, University of Minnesota, Minneapolis, MN.

Correspondence to: Selcuk Adabag, MD, Veterans Administration Medical Center, Section of Cardiology (111 C), 1 Veterans Dr, Minneapolis, MN 55417; e-mail: adaba001@umn.edu


Part of this article has been presented in abstract form at the Heart Rhythm Society 33rd Annual Scientific Sessions, May 9-12, 2012, Boston, Massachusetts.

Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(3):778-783. doi:10.1378/chest.12-1883
Text Size: A A A
Published online

Background:  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.

Methods:  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.

Results:  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).

Conclusions:  Patients with COPD have a higher incidence of ICD shocks than those without COPD and appear to benefit from ICD therapy.

Figures in this Article

As one of the leading causes of death in the United States, COPD is responsible for 120,000 deaths each year1,2 and is recognized as a common comorbidity in patients with heart failure. Approximately 20% of patients with heart failure have COPD.3,4

Implantable cardioverter-defibrillators (ICDs) are widely used to prevent sudden cardiac death and reduce mortality in heart failure with reduced left ventricular ejection fraction.59 However, relatively little is known about the efficacy of ICDs in patients with heart failure and concomitant COPD. These patients might not experience the survival benefit expected from the ICD device because of an increased risk of noncardiovascular mortality. On the other hand, patients with COPD might have a higher incidence of ventricular tachycardia or fibrillation because of their tendency to a high catecholamine state, resulting in appropriate, potentially life-saving, shocks. Furthermore, these patients might also have inappropriate ICD shocks because of a high incidence of atrial fibrillation and other supraventricular arrhythmias.

The objective of this investigation was to examine the potential influence of COPD status on ICD therapy and outcomes. Specifically, we sought to determine the incidence of appropriate and inappropriate ICD shocks, all-cause mortality, and potential survival benefit in a large cohort of patients with and without COPD.

This study was approved (No. 4296-B) by the Research and Development Committee of Minneapolis Veterans Administration Medical Center. The requirement for individual consent was waived because of the retrospective collection of data.

Patient Selection

From 2006 to 2011, 628 consecutive patients who underwent defibrillator implantation (ICD or cardiac resynchronization therapy with ICD) and were followed at the Minneapolis Veterans Administration Medical Center cardiac device clinic were included in this analysis. The Minneapolis Veterans Administration Medical Center is a tertiary referral center serving patients in Minnesota, North and South Dakota, and portions of Iowa, Nebraska, and Wisconsin.

COPD

Clinical data and spirometry results were abstracted from electronic medical records.10 All patients with FEV1/FVC < 0.7 on spirometry were adjudicated as having COPD. In addition, patients with COPD but without confirmatory spirometry were included because of a very low false-positive diagnostic rate (< 5%) in this cohort (e-Fig 1).

Among patients with spirometry, severity of airway obstruction was assessed according to GOLD (Global Initiative for Chronic Obstructive Lung Disease) criteria.11 Thus, among patients with FEV1/FVC < 0.7, those with FEV1 ≥ 80% predicted were categorized as having mild obstruction, those with FEV1 50% to 79% predicted having moderate obstruction, and those with FEV1 < 50% predicted as having severe or very severe obstruction.11 Chronic kidney disease was defined as a glomerular filtration rate < 60 mL/min/1.73 m2 for ≥ 3 months.

ICD Shocks

All ICDs were dual-coil and dual-chamber systems except in patients with atrial fibrillation and those who had cardiac resynchronization therapy. All patients underwent device interrogation and follow-up according to a standard protocol. Remote or in-person follow-up was performed every 3 months. For this analysis, device follow-up information was obtained from local device clinic records and the Veterans Administration National Device Surveillance Program.12,13 ICD shocks were adjudicated as appropriate or inappropriate by a cardiac electrophysiologist after reviewing intracardiac electrograms. Mortality was assessed with the Veterans Administration vital status records and Social Security Death Index.14,15

Statistical Analysis

Variables are presented as mean ± SD and percentages. Nonparametric data are presented as median and interquartile range (IQR). Comparisons between patients with or without COPD were made with t test for continuous variables and χ2 test for categorical variables. Comparison of continuous variables that were not normally distributed was made by nonparametric Mann-Whitney U test. ORs of ICD shocks in patients with COPD vs those without COPD were examined with multivariable logistic regression analysis. Variables with P < .1 in the univariable analysis were included in the multivariable model. Sensitivity analyses in the subgroup of 307 patients with spirometry and 423 patients with de novo device implantations were performed. All comparisons were two sided. P < .05 was considered statistically significant.

Study Patients

Baseline characteristics of the 628 study patients are shown in Table 1. Patients were aged 67 ± 10 years, 99% were men, 73% had ischemic cardiomyopathy, and 89% received ICDs for primary prevention of sudden cardiac death. Of the 628 patients, 307 (49%) had spirometry data, which showed obstructive airway disease in 187. Including the 59 additional patients with COPD not confirmed by spirometry, 246 patients (39%) were categorized into the COPD group (e-Fig 1). The rest of the patients, including 120 without COPD by spirometry and 260 patients with neither spirometry nor clinical COPD, were categorized into the non-COPD group. Patients in the COPD group had a higher New York Heart Association functional class (P < .0001), were more likely to be current smokers (P < .0001), and were more likely to have an ICD for primary prevention of sudden cardiac death (P = .04) than those in the non-COPD group (Table 1). However, other baseline demographic and clinical characteristics, including left ventricular ejection fraction, were similar in both groups (0.31 ± 0.11 vs 0.32 ± 0.12 for COPD vs non-COPD, respectively, P = .22). β-Adrenergic receptor blocker use (98% vs 97%, P = .79) and heart rates (72 ± 14/min vs 70 ± 12/min, P = .13) were also similar between the two groups (Table 1).

Table Graphic Jump Location
Table 1 —Baseline Clinical Characteristics of the 628 Study Patients With and Without COPD

Data are mean ± SD or %. NYHA = New York Heart Association.

a 

Chronic kidney disease was defined as a glomerular filtration rate of < 60 mL/min/1.73 m2 for ≥ 3 mo.

ICD Shock and Therapy

Over a median follow-up of 4.1 years (IQR, 2.2-5.7 years), 138 patients (22%) received one or more appropriate ICD shocks and 61 (10%) received one or more inappropriate shocks. Twenty-nine percent of patients with COPD vs 17% without COPD received appropriate ICD shocks (P < .0001) (Figs 1, 2). The incidence of appropriate ICD therapy, including both shocks and antitachycardia pacing, was also higher in patients with vs those without COPD (41% vs 25%, P < .0001). However, the incidence of inappropriate shocks was similar in both groups (9% vs 10%, respectively, P = .61) (Fig 1). The incidence of ICD shocks did not vary with smoking status or COPD treatment.

Figure Jump LinkFigure 1. Incidence of appropriate shock, inappropriate shock, and death in patients with and without COPD and an implantable cardioverter-defibrillator.Grahic Jump Location
Figure Jump LinkFigure 2. Kaplan-Meier curves for time to first appropriate shock in patients with and without COPD. Log-rank test P < .0001. ICD = implantable cardioverter-defibrillator.Grahic Jump Location

Univariable and multivariable predictors of appropriate ICD shock are shown in Table 2. In multivariable analysis, having COPD was associated with a twofold increase in the odds of appropriate shock (OR, 1.97; 95% CI, 1.3-2.9; P = .001) but not with an increase in inappropriate shock (OR, 0.89; 95% CI, 0.51-1.55; P = .67).

Table Graphic Jump Location
Table 2 —Predictors of Appropriate ICD Shock

ICD = implantable cardioverter-defibrillator. See Table 1 legend for expansion of other abbreviation.

Survival Status

A total of 152 patients (24%) died during follow-up. Mortality was higher among those with COPD than among those without COPD (29% vs 21%, P = .029) (Figs 1, 3). A total of 23 patients died within 1 year of device implantation (COPD, 5.3%; no COPD, 2.6%; P = .08). The median duration from first appropriate shock to death or last follow-up was 2.3 years (IQR, 1.2-4.4 years) in patients with COPD vs 2.8 years (IQR, 1.4-5.3 years) in those without COPD (P = .29).

Figure Jump LinkFigure 3. Kaplan-Meier survival curves of patients with and without COPD. Log-rank test P = .02.Grahic Jump Location
Subgroup Analysis in Patients With Spirometry

Of the 307 patients with documented spirometry in the electronic medical record, 187 (61%) had airway obstruction. Of these, 30 (16%) had mild, 100 (53%) had moderate, and 57 (30%) had severe or very severe airway obstruction. In this subgroup, the incidence of appropriate ICD shocks (32% vs 19%, P = .009) and mortality (30% vs 19%, P = .035) was higher in patients with vs without COPD, respectively, reminiscent of the results in the total study cohort. The incidence of ICD shocks did not vary with the severity of COPD (Table 3).

Table Graphic Jump Location
Table 3 —Incidence of Appropriate and Inappropriate ICD Shock and Death in Relation to Severity of Airway Obstruction in 187 Patients With COPD on Spirometry

Data are presented as %. See Table 2 legend for expansion of abbreviation.

Subgroup Analysis in Patients With De Novo Device Implantation

Of the 628 study patients, 423 had de novo device implantation (176 with COPD). In this subgroup, patients with COPD had a higher incidence of appropriate ICD shocks than those without COPD (22% vs 13%, P = .02) and an increased mortality rate (29% vs 23%, P = .14).

This investigation showed that in a large cohort of patients with ICDs from a tertiary-care Veterans Administration medical center, almost 40% of the patients had concomitant COPD, which was associated with a twofold increase in the odds of appropriate ICD shocks and higher mortality than in patients without COPD. However, although overall mortality was higher in the patients with COPD, 1-year mortality and the average time from the first appropriate shock to death was not different in patients with or without COPD. These data suggest that ICD therapy is efficacious in patients with COPD.

There are few published data on the efficacy of ICD therapy in patients with COPD and the influence of COPD status on ICD shocks. In a study of 168 patients with secondary prevention ICDs, Dougherty and Hunziker16 reported that a history of COPD, congestive heart failure, and nonsustained ventricular tachycardia were associated with a fourfold increase in the risk of ICD shocks during 1 year of follow-up; however, the appropriateness of the ICD shocks was not adjudicated. Furthermore, in a retrospective case-control study, Razak et al17 compared the survival of 30 patients with COPD and ICDs to a matched control group of 70 patients with COPD but without ICDs. Left ventricular ejection fractions were similar in both groups. After 2 years of follow-up, they found that survival was significantly better in ICD-treated patients with COPD than in those without ICDs (88% vs 59%). The results of the present cohort study advance these previous observations one step farther by providing adjudicated ICD shock and survival data. Collectively, these studies suggest that ICD therapy is efficacious in patients with COPD.

In studies of long-term ECG monitoring, ventricular arrhythmias, including ventricular tachycardia, were found commonly in patients with COPD at baseline stable state and during COPD exacerbations.1820 Furthermore, sudden death has been identified as a significant cause of death in patients with COPD. Among nearly 6,000 participants with COPD in a multicenter trial of inhaled tiotropium, almost 8% of the deaths occurred suddenly.21,22 There are several potential explanations for these observations and the findings of the present study. First, the high catecholamine state in patients with COPD could trigger ventricular arrhythmias.23 Second, low Po2 and high Pco2 could potentially trigger arrhythmias by way of ischemia or respiratory acidosis.24 Finally, β2-agonists, a cornerstone treatment of obstructive airway disease, stimulate adrenergic receptors and could lower arrhythmia threshold.23 Indeed, inhaled β-agonists have been associated with increased risk of hospitalization and mortality in patients with left ventricular systolic dysfunction.25 Both β-agonist therapy and respiratory acidosis could transiently induce hypokalemia, further increasing the risk for ventricular arrhythmias.26

The incidence of inappropriate ICD shocks was relatively low in the present cohort compared with the Multicenter Automatic Defibrillator Implantation Trial II (MADIT II) study.7 The reason for this finding could be due to the use of newer-generation devices with novel discrimination algorithms for supraventricular tachycardias and optimization of device programming parameters to reduce inappropriate ICD shocks.2730 The incidence of inappropriate ICD shocks in the present study was comparable to that observed in more recent cohorts.28,29,31,32

Accurate diagnosis of COPD might be challenging in patients with heart failure because shortness of breath and dyspnea on exertion are hallmark symptoms in both conditions. Although COPD status is frequently reclassified in patients with congestive heart failure, the present data suggest that in those with either clinical or spirometry-proven COPD, the incidence of appropriate shock is significantly higher in the population with COPD.10,3335

Several limitations in this study merit comment. First, retrospective study design increases the risk for bias and confounding. However, consecutive patients who underwent defibrillator implantation at our center were included, and device follow-up was performed according to a uniform protocol. Furthermore, multivariable regression analysis was performed to account for potential confounding. These methods would be expected to reduce the likelihood of bias, although potential bias and residual confounding cannot be fully eliminated. Second, time from first appropriate shock to death was considered a surrogate for survival benefit from defibrillator therapy. However, it is possible that some appropriate ICD shocks were delivered for arrhythmias that would have terminated spontaneously.36 Therefore, accurate determination of survival benefit would require a randomized clinical trial design. Third, ICD tachycardia parameters were not recorded in each patient. However, a systematic bias in programming in relation to COPD status is unlikely. Indeed, in a randomly selected group of 200 patients (100 with COPD), we found no significant differences in programmed ICD tachycardia parameters pertaining to COPD status. Finally, almost all the study patients were men; thus, the results may not apply to female patients.

COPD is a common comorbidity in patients with ICDs and is associated with an increased incidence of appropriate ICD shocks and higher mortality. However, 1-year mortality and the average time from first appropriate shock to death was not different in patients with or without COPD. The data suggest that ICD therapy is efficacious in patients with COPD.

Author contributions: Drs Naksuk and Adabag had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Dr Naksuk: contributed to the study conception and design; data acquisition, analysis, and interpretation; and drafting and final approval of the manuscript.

Dr Kunisaki: contributed to the study conception and design, data interpretation, critical revision of the manuscript for important intellectual content, and final approval of the manuscript.

Dr Benditt: contributed to the study conception and design, data interpretation, critical revision of the manuscript for important intellectual content, and final approval of the manuscript.

Dr Tholakanahalli: contributed to the study conception and design, data interpretation, critical revision of the manuscript for important intellectual content, and final approval of the manuscript.

Dr Adabag: contributed to the study conception and design; data acquisition, analysis, and interpretation; and drafting and final approval of the manuscript.

Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Benditt is a consultant for and has equity with Medtronic, Inc; St. Jude Medical, Inc; and CardioNet. He also has equity with Boston Scientific, is a consultant for Nanostim, Inc, and has equity with and serves on the board of directors for Advanced Circulatory. Dr Adabag has received investigator-initiated research grants from Medtronic, Inc, and Boston Scientific. Drs Naksuk, Kunisaki, and Tholakanahalli have reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Other contributions: The views expressed in this article are those of the authors and do not necessarily reflect the views of the Minneapolis Veterans Administration Health Care System, the Department of Veterans Affairs, the US Government, or the University of Minnesota. The authors thank Deborah J. Johnson, RN, for her efforts in administering the study.

Additional information: The e-Figure can be found in the “Supplemental Materials” area of the online article.

ICD

implantable cardioverter-defibrillator

IQR

interquartile range

Murphy SL, Xu J, Kochanek KD. Deaths: preliminary data for 2010. Natl Vital Stat Rep. 2012;60(4):1-51.
 
Buist AS, McBurnie MA, Vollmer WM, et al; BOLD Collaborative Research Group. International variation in the prevalence of COPD (the BOLD Study): a population-based prevalence study. Lancet. 2007;370(9589):741-750. [CrossRef] [PubMed]
 
Rutten FH, Cramer M-J, Grobbee DE, et al. Unrecognized heart failure in elderly patients with stable chronic obstructive pulmonary disease. Eur Heart J. 2005;26(18):1887-1894. [CrossRef] [PubMed]
 
Sin DD, Man SF. Chronic obstructive pulmonary disease as a risk factor for cardiovascular morbidity and mortality. Proc Am Thorac Soc. 2005;2(1):8-11. [CrossRef] [PubMed]
 
Adabag S, Roukoz H, Anand IS, Moss AJ. Cardiac resynchronization therapy in patients with minimal heart failure: a systematic review and meta-analysis. J Am Coll Cardiol. 2011;58(9):935-941. [CrossRef] [PubMed]
 
Adabag AS, Luepker RV, Roger VL, Gersh BJ. Sudden cardiac death: epidemiology and risk factors. Nat Rev Cardiol. 2010;7(4):216-225. [CrossRef] [PubMed]
 
Moss AJ, Zareba W, Hall WJ, et al; Multicenter Automatic Defibrillator Implantation Trial II Investigators. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002;346(12):877-883. [CrossRef] [PubMed]
 
Epstein AE, Dimarco JP, Ellenbogen KA, et al; American College of Cardiology/American Heart Association Task Force on Practice; American Association for Thoracic Surgery; Society of Thoracic Surgeons. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: executive summary. Heart Rhythm. 2008;5(6):934-955. [CrossRef] [PubMed]
 
Bardy GH, Lee KL, Mark DB, et al; Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) Investigators. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med. 2005;352(3):225-237. [CrossRef] [PubMed]
 
Adabag AS, Wassif HS, Rice K, et al. Preoperative pulmonary function and mortality after cardiac surgery. Am Heart J. 2010;159(4):691-697. [CrossRef] [PubMed]
 
Pauwels RA, Buist AS, Ma P, Jenkins CR, Hurd SS; GOLD Scientific Committee. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: National Heart, Lung, and Blood Institute and World Health Organization Global Initiative for Chronic Obstructive Lung Disease (GOLD): executive summary. Respir Care. 2001;46(8):798-825. [PubMed]
 
Davis N, Xue Y, Roberts L, Massie B, Keung E. Remote monitoring of implantable cardioverter defibrillators: experience from the VA National ICD Surveillance Program. Heart Rhythm. 2005;2(suppl 5):S244. [CrossRef]
 
Keung E, Xue Y. Remote web-based device monitoring.. InWang PJ, Naccarelli GV, Rosen MR, Estes NA, Hayes DL, Haines DE., eds. New Arrhythmia Technologies. Malden, MA: Blackwell Publishing; 2005:206-218.
 
Naksuk N, Adabag S. Application of the Multicenter Automatic Defibrillator Implantation Trial (MADIT) II risk score in a non-trial setting. Am J Cardiol. In press. doi:pii: S0002-9149(13)00993-4. 10.1016/j.amjcard.2013.04.019.
 
Coumbe AG, Naksuk N, Newell MC, Somasundaram PE, Benditt DG, Adabag S. Long-term follow-up of older patients with Mobitz type I second degree atrioventricular block. Heart. 2013;99(5):334-338. [CrossRef] [PubMed]
 
Dougherty CM, Hunziker J. Predictors of implantable cardioverter defibrillator shocks during the first year. J Cardiovasc Nurs. 2009;24(1):21-28. [CrossRef] [PubMed]
 
Razak E, Kamireddy S, Saba S. Implantable cardioverter-defibrillators confer survival benefit in patients with chronic obstructive pulmonary disease. Pacing Clin Electrophysiol. 2010;33(9):1125-1130. [CrossRef] [PubMed]
 
Kleiger RE, Senior RM. Longterm electrocardiographic monitoring of ambulatory patients with chronic airway obstruction. Chest. 1974;65(5):483-487. [CrossRef] [PubMed]
 
Shih HT, Webb CR, Conway WA, Peterson E, Tilley B, Goldstein S. Frequency and significance of cardiac arrhythmias in chronic obstructive lung disease. Chest. 1988;94(1):44-48. [CrossRef] [PubMed]
 
Fuso L, Incalzi RA, Pistelli R, et al. Predicting mortality of patients hospitalized for acutely exacerbated chronic obstructive pulmonary disease. Am J Med. 1995;98(3):272-277. [CrossRef] [PubMed]
 
McGarvey LP, Magder S, Burkhart D, et al. Cause-specific mortality adjudication in the UPLIFT® COPD trial: findings and recommendations. Respir Med. 2012;106(4):515-521. [CrossRef] [PubMed]
 
Tashkin DP, Celli B, Senn S, et al; UPLIFT Study Investigators. A 4-year trial of tiotropium in chronic obstructive pulmonary disease. N Engl J Med. 2008;359(15):1543-1554. [CrossRef] [PubMed]
 
Anand IS, Chandrashekhar Y, Ferrari R, et al. Pathogenesis of congestive state in chronic obstructive pulmonary disease. Studies of body water and sodium, renal function, hemodynamics, and plasma hormones during edema and after recovery. Circulation. 1992;86(1):12-21. [CrossRef] [PubMed]
 
Incalzi RA, Pistelli R, Fuso L, Cocchi A, Bonetti MG, Giordano A. Cardiac arrhythmias and left ventricular function in respiratory failure from chronic obstructive pulmonary disease. Chest. 1990;97(5):1092-1097. [CrossRef] [PubMed]
 
Au DH, Udris EM, Fan VS, Curtis JR, McDonell MB, Fihn SD. Risk of mortality and heart failure exacerbations associated with inhaled beta-adrenoceptor agonists among patients with known left ventricular systolic dysfunction. Chest. 2003;123(6):1964-1969. [CrossRef] [PubMed]
 
Salpeter SR, Ormiston TM, Salpeter EE. Cardiovascular effects of beta-agonists in patients with asthma and COPD: a meta-analysis. Chest. 2004;125(6):2309-2321. [CrossRef] [PubMed]
 
Wathen MS, DeGroot PJ, Sweeney MO, et al; PainFREE Rx II Investigators. Prospective randomized multicenter trial of empirical antitachycardia pacing versus shocks for spontaneous rapid ventricular tachycardia in patients with implantable cardioverter-defibrillators: Pacing Fast Ventricular Tachycardia Reduces Shock Therapies (PainFREE Rx II) trial results. Circulation. 2004;110(17):2591-2596. [CrossRef] [PubMed]
 
Moss AJ, Schuger C, Beck CA, et al; MADIT-RIT Trial Investigators. Reduction in inappropriate therapy and mortality through ICD programming. N Engl J Med. 2012;367(24):2275-2283. [CrossRef] [PubMed]
 
Wilkoff BL, Williamson BD, Stern RS, et al; PREPARE Study Investigators. Strategic programming of detection and therapy parameters in implantable cardioverter-defibrillators reduces shocks in primary prevention patients: results from the PREPARE (Primary Prevention Parameters Evaluation) study. J Am Coll Cardiol. 2008;52(7):541-550. [CrossRef] [PubMed]
 
Wilkoff BL, Ousdigian KT, Sterns LD, Wang ZJ, Wilson RD, Morgan JM; EMPIRIC Trial Investigators. A comparison of empiric to physician-tailored programming of implantable cardioverter-defibrillators: results from the prospective randomized multicenter EMPIRIC trial. J Am Coll Cardiol. 2006;48(2):330-339. [CrossRef] [PubMed]
 
van Rees JB, Borleffs CJ, de Bie MK, et al. Inappropriate implantable cardioverter-defibrillator shocks: incidence, predictors, and impact on mortality. J Am Coll Cardiol. 2011;57(5):556-562. [CrossRef] [PubMed]
 
Daubert JP, Zareba W, Cannom DS, et al; MADIT II Investigators. Inappropriate implantable cardioverter-defibrillator shocks in MADIT II: frequency, mechanisms, predictors, and survival impact. J Am Coll Cardiol. 2008;51(14):1357-1365. [CrossRef] [PubMed]
 
Damarla M, Celli BR, Mullerova HX, Pinto-Plata VM. Discrepancy in the use of confirmatory tests in patients hospitalized with the diagnosis of chronic obstructive pulmonary disease or congestive heart failure. Respir Care. 2006;51(10):1120-1124. [PubMed]
 
Mannino DM, Gagnon RC, Petty TL, Lydick E. Obstructive lung disease and low lung function in adults in the United States: data from the National Health and Nutrition Examination Survey, 1988-1994. Arch Intern Med. 2000;160(11):1683-1689. [CrossRef] [PubMed]
 
Tinkelman DG, Price DB, Nordyke RJ, Halbert RJ. Misdiagnosis of COPD and asthma in primary care patients 40 years of age and over. J Asthma. 2006;43(1):75-80. [CrossRef] [PubMed]
 
Germano JJ, Reynolds M, Essebag V, Josephson ME. Frequency and causes of implantable cardioverter-defibrillator therapies: is device therapy proarrhythmic? Am J Cardiol. 2006;97(8):1255-1261. [CrossRef] [PubMed]
 

Figures

Figure Jump LinkFigure 1. Incidence of appropriate shock, inappropriate shock, and death in patients with and without COPD and an implantable cardioverter-defibrillator.Grahic Jump Location
Figure Jump LinkFigure 2. Kaplan-Meier curves for time to first appropriate shock in patients with and without COPD. Log-rank test P < .0001. ICD = implantable cardioverter-defibrillator.Grahic Jump Location
Figure Jump LinkFigure 3. Kaplan-Meier survival curves of patients with and without COPD. Log-rank test P = .02.Grahic Jump Location

Tables

Table Graphic Jump Location
Table 1 —Baseline Clinical Characteristics of the 628 Study Patients With and Without COPD

Data are mean ± SD or %. NYHA = New York Heart Association.

a 

Chronic kidney disease was defined as a glomerular filtration rate of < 60 mL/min/1.73 m2 for ≥ 3 mo.

Table Graphic Jump Location
Table 2 —Predictors of Appropriate ICD Shock

ICD = implantable cardioverter-defibrillator. See Table 1 legend for expansion of other abbreviation.

Table Graphic Jump Location
Table 3 —Incidence of Appropriate and Inappropriate ICD Shock and Death in Relation to Severity of Airway Obstruction in 187 Patients With COPD on Spirometry

Data are presented as %. See Table 2 legend for expansion of abbreviation.

References

Murphy SL, Xu J, Kochanek KD. Deaths: preliminary data for 2010. Natl Vital Stat Rep. 2012;60(4):1-51.
 
Buist AS, McBurnie MA, Vollmer WM, et al; BOLD Collaborative Research Group. International variation in the prevalence of COPD (the BOLD Study): a population-based prevalence study. Lancet. 2007;370(9589):741-750. [CrossRef] [PubMed]
 
Rutten FH, Cramer M-J, Grobbee DE, et al. Unrecognized heart failure in elderly patients with stable chronic obstructive pulmonary disease. Eur Heart J. 2005;26(18):1887-1894. [CrossRef] [PubMed]
 
Sin DD, Man SF. Chronic obstructive pulmonary disease as a risk factor for cardiovascular morbidity and mortality. Proc Am Thorac Soc. 2005;2(1):8-11. [CrossRef] [PubMed]
 
Adabag S, Roukoz H, Anand IS, Moss AJ. Cardiac resynchronization therapy in patients with minimal heart failure: a systematic review and meta-analysis. J Am Coll Cardiol. 2011;58(9):935-941. [CrossRef] [PubMed]
 
Adabag AS, Luepker RV, Roger VL, Gersh BJ. Sudden cardiac death: epidemiology and risk factors. Nat Rev Cardiol. 2010;7(4):216-225. [CrossRef] [PubMed]
 
Moss AJ, Zareba W, Hall WJ, et al; Multicenter Automatic Defibrillator Implantation Trial II Investigators. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002;346(12):877-883. [CrossRef] [PubMed]
 
Epstein AE, Dimarco JP, Ellenbogen KA, et al; American College of Cardiology/American Heart Association Task Force on Practice; American Association for Thoracic Surgery; Society of Thoracic Surgeons. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: executive summary. Heart Rhythm. 2008;5(6):934-955. [CrossRef] [PubMed]
 
Bardy GH, Lee KL, Mark DB, et al; Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) Investigators. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med. 2005;352(3):225-237. [CrossRef] [PubMed]
 
Adabag AS, Wassif HS, Rice K, et al. Preoperative pulmonary function and mortality after cardiac surgery. Am Heart J. 2010;159(4):691-697. [CrossRef] [PubMed]
 
Pauwels RA, Buist AS, Ma P, Jenkins CR, Hurd SS; GOLD Scientific Committee. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: National Heart, Lung, and Blood Institute and World Health Organization Global Initiative for Chronic Obstructive Lung Disease (GOLD): executive summary. Respir Care. 2001;46(8):798-825. [PubMed]
 
Davis N, Xue Y, Roberts L, Massie B, Keung E. Remote monitoring of implantable cardioverter defibrillators: experience from the VA National ICD Surveillance Program. Heart Rhythm. 2005;2(suppl 5):S244. [CrossRef]
 
Keung E, Xue Y. Remote web-based device monitoring.. InWang PJ, Naccarelli GV, Rosen MR, Estes NA, Hayes DL, Haines DE., eds. New Arrhythmia Technologies. Malden, MA: Blackwell Publishing; 2005:206-218.
 
Naksuk N, Adabag S. Application of the Multicenter Automatic Defibrillator Implantation Trial (MADIT) II risk score in a non-trial setting. Am J Cardiol. In press. doi:pii: S0002-9149(13)00993-4. 10.1016/j.amjcard.2013.04.019.
 
Coumbe AG, Naksuk N, Newell MC, Somasundaram PE, Benditt DG, Adabag S. Long-term follow-up of older patients with Mobitz type I second degree atrioventricular block. Heart. 2013;99(5):334-338. [CrossRef] [PubMed]
 
Dougherty CM, Hunziker J. Predictors of implantable cardioverter defibrillator shocks during the first year. J Cardiovasc Nurs. 2009;24(1):21-28. [CrossRef] [PubMed]
 
Razak E, Kamireddy S, Saba S. Implantable cardioverter-defibrillators confer survival benefit in patients with chronic obstructive pulmonary disease. Pacing Clin Electrophysiol. 2010;33(9):1125-1130. [CrossRef] [PubMed]
 
Kleiger RE, Senior RM. Longterm electrocardiographic monitoring of ambulatory patients with chronic airway obstruction. Chest. 1974;65(5):483-487. [CrossRef] [PubMed]
 
Shih HT, Webb CR, Conway WA, Peterson E, Tilley B, Goldstein S. Frequency and significance of cardiac arrhythmias in chronic obstructive lung disease. Chest. 1988;94(1):44-48. [CrossRef] [PubMed]
 
Fuso L, Incalzi RA, Pistelli R, et al. Predicting mortality of patients hospitalized for acutely exacerbated chronic obstructive pulmonary disease. Am J Med. 1995;98(3):272-277. [CrossRef] [PubMed]
 
McGarvey LP, Magder S, Burkhart D, et al. Cause-specific mortality adjudication in the UPLIFT® COPD trial: findings and recommendations. Respir Med. 2012;106(4):515-521. [CrossRef] [PubMed]
 
Tashkin DP, Celli B, Senn S, et al; UPLIFT Study Investigators. A 4-year trial of tiotropium in chronic obstructive pulmonary disease. N Engl J Med. 2008;359(15):1543-1554. [CrossRef] [PubMed]
 
Anand IS, Chandrashekhar Y, Ferrari R, et al. Pathogenesis of congestive state in chronic obstructive pulmonary disease. Studies of body water and sodium, renal function, hemodynamics, and plasma hormones during edema and after recovery. Circulation. 1992;86(1):12-21. [CrossRef] [PubMed]
 
Incalzi RA, Pistelli R, Fuso L, Cocchi A, Bonetti MG, Giordano A. Cardiac arrhythmias and left ventricular function in respiratory failure from chronic obstructive pulmonary disease. Chest. 1990;97(5):1092-1097. [CrossRef] [PubMed]
 
Au DH, Udris EM, Fan VS, Curtis JR, McDonell MB, Fihn SD. Risk of mortality and heart failure exacerbations associated with inhaled beta-adrenoceptor agonists among patients with known left ventricular systolic dysfunction. Chest. 2003;123(6):1964-1969. [CrossRef] [PubMed]
 
Salpeter SR, Ormiston TM, Salpeter EE. Cardiovascular effects of beta-agonists in patients with asthma and COPD: a meta-analysis. Chest. 2004;125(6):2309-2321. [CrossRef] [PubMed]
 
Wathen MS, DeGroot PJ, Sweeney MO, et al; PainFREE Rx II Investigators. Prospective randomized multicenter trial of empirical antitachycardia pacing versus shocks for spontaneous rapid ventricular tachycardia in patients with implantable cardioverter-defibrillators: Pacing Fast Ventricular Tachycardia Reduces Shock Therapies (PainFREE Rx II) trial results. Circulation. 2004;110(17):2591-2596. [CrossRef] [PubMed]
 
Moss AJ, Schuger C, Beck CA, et al; MADIT-RIT Trial Investigators. Reduction in inappropriate therapy and mortality through ICD programming. N Engl J Med. 2012;367(24):2275-2283. [CrossRef] [PubMed]
 
Wilkoff BL, Williamson BD, Stern RS, et al; PREPARE Study Investigators. Strategic programming of detection and therapy parameters in implantable cardioverter-defibrillators reduces shocks in primary prevention patients: results from the PREPARE (Primary Prevention Parameters Evaluation) study. J Am Coll Cardiol. 2008;52(7):541-550. [CrossRef] [PubMed]
 
Wilkoff BL, Ousdigian KT, Sterns LD, Wang ZJ, Wilson RD, Morgan JM; EMPIRIC Trial Investigators. A comparison of empiric to physician-tailored programming of implantable cardioverter-defibrillators: results from the prospective randomized multicenter EMPIRIC trial. J Am Coll Cardiol. 2006;48(2):330-339. [CrossRef] [PubMed]
 
van Rees JB, Borleffs CJ, de Bie MK, et al. Inappropriate implantable cardioverter-defibrillator shocks: incidence, predictors, and impact on mortality. J Am Coll Cardiol. 2011;57(5):556-562. [CrossRef] [PubMed]
 
Daubert JP, Zareba W, Cannom DS, et al; MADIT II Investigators. Inappropriate implantable cardioverter-defibrillator shocks in MADIT II: frequency, mechanisms, predictors, and survival impact. J Am Coll Cardiol. 2008;51(14):1357-1365. [CrossRef] [PubMed]
 
Damarla M, Celli BR, Mullerova HX, Pinto-Plata VM. Discrepancy in the use of confirmatory tests in patients hospitalized with the diagnosis of chronic obstructive pulmonary disease or congestive heart failure. Respir Care. 2006;51(10):1120-1124. [PubMed]
 
Mannino DM, Gagnon RC, Petty TL, Lydick E. Obstructive lung disease and low lung function in adults in the United States: data from the National Health and Nutrition Examination Survey, 1988-1994. Arch Intern Med. 2000;160(11):1683-1689. [CrossRef] [PubMed]
 
Tinkelman DG, Price DB, Nordyke RJ, Halbert RJ. Misdiagnosis of COPD and asthma in primary care patients 40 years of age and over. J Asthma. 2006;43(1):75-80. [CrossRef] [PubMed]
 
Germano JJ, Reynolds M, Essebag V, Josephson ME. Frequency and causes of implantable cardioverter-defibrillator therapies: is device therapy proarrhythmic? Am J Cardiol. 2006;97(8):1255-1261. [CrossRef] [PubMed]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Supporting Data

Online Supplement

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543