Abstract：
OBJECTIVE: Pacemaker (PM) patients may require a subsequent upgrade to an implantable cardioverter defibrillator (ICD). Limited data exists on this patient population. We sought to characterize this population, to assess predictors for ICD upgrade, and to report the outcome.
METHODS: From our prospective PM and ICD implantation registry, all patients who underwent PM and/or ICD implantations at our center were analyzed. Patient characteristics and outcomes of PM patients with subsequent ICD upgrade were compared to age- and sex-matched patients with de novo ICD implantation, and to PM patients without subsequent upgrade.
RESULTS: Of 1\'301 ICD implantations, 60 (5%) were upgraded from PMs. Median time from PM implantation to ICD upgrade was 2.6 years (IQR 1.3-5.4). Of 2\'195 PM patients, 28 patients underwent subsequent ICD upgrades, corresponding to an estimated annual incidence of an ICD upgrade of at least 0.33%. Lower LVEF (p = .05) and male sex (p = .038) were independent predictors for ICD upgrade. Survival without death, transplant and LVAD implantation were worse both for upgraded ICD patients compared to matched patients with de novo ICD implantation (p = .05), as well as for PM patients with subsequent upgrade compared to matched PM patients not requiring an upgrade (p = .036).
CONCLUSIONS: One of 20 ICD implantations are upgrade of patients with a PM. At least one of 30 PM patients will require an ICD upgrade in the following 10 years. Predictors for ICD upgrade are male sex and lower LVEF at PM implantation. Upgraded patients have worse outcomes.
METHODS: From our prospective PM and ICD implantation registry, all patients who underwent PM and/or ICD implantations at our center were analyzed. Patient characteristics and outcomes of PM patients with subsequent ICD upgrade were compared to age- and sex-matched patients with de novo ICD implantation, and to PM patients without subsequent upgrade.
RESULTS: Of 1\'301 ICD implantations, 60 (5%) were upgraded from PMs. Median time from PM implantation to ICD upgrade was 2.6 years (IQR 1.3-5.4). Of 2\'195 PM patients, 28 patients underwent subsequent ICD upgrades, corresponding to an estimated annual incidence of an ICD upgrade of at least 0.33%. Lower LVEF (p = .05) and male sex (p = .038) were independent predictors for ICD upgrade. Survival without death, transplant and LVAD implantation were worse both for upgraded ICD patients compared to matched patients with de novo ICD implantation (p = .05), as well as for PM patients with subsequent upgrade compared to matched PM patients not requiring an upgrade (p = .036).
CONCLUSIONS: One of 20 ICD implantations are upgrade of patients with a PM. At least one of 30 PM patients will require an ICD upgrade in the following 10 years. Predictors for ICD upgrade are male sex and lower LVEF at PM implantation. Upgraded patients have worse outcomes.
摘要：
目的：起搏器（PM）患者可能需要随后升级为植入式心律转复除颤器（ICD）。关于该患者群体的数据有限。我们试图描述这个群体的特征，为了评估ICD升级的预测因素，并报告结果。
方法：根据我们的前瞻性PM和ICD植入登记，我们分析了在我们中心接受PM和/或ICD植入的所有患者.将随后ICD升级的PM患者的患者特征和结果与年龄和性别匹配的从头ICD植入患者进行比较。和PM患者没有后续升级。
结果：在1\'301个ICD植入中，从PM升级60例（5%）。从PM植入到ICD升级的中位时间为2.6年（IQR1.3-5.4）。在下午2点195名患者中，28名患者接受了随后的ICD升级，对应于ICD升级的估计年发生率至少为0.33%。较低的LVEF（p=0.05）和男性（p=0.038）是ICD升级的独立预测因子。没有死亡的生存，与新生ICD植入的匹配患者相比，升级ICD患者的移植和LVAD植入均较差（p=0.05），以及与不需要升级的匹配PM患者相比，随后升级的PM患者（p=.036）。
结论：20例ICD植入中有一例是PM患者的升级。在接下来的10年内，30名PM患者中至少有一名需要ICD升级。ICD升级的预测因素是男性和PM植入时LVEF较低。升级的患者结果更差。
方法：根据我们的前瞻性PM和ICD植入登记，我们分析了在我们中心接受PM和/或ICD植入的所有患者.将随后ICD升级的PM患者的患者特征和结果与年龄和性别匹配的从头ICD植入患者进行比较。和PM患者没有后续升级。
结果：在1\'301个ICD植入中，从PM升级60例（5%）。从PM植入到ICD升级的中位时间为2.6年（IQR1.3-5.4）。在下午2点195名患者中，28名患者接受了随后的ICD升级，对应于ICD升级的估计年发生率至少为0.33%。较低的LVEF（p=0.05）和男性（p=0.038）是ICD升级的独立预测因子。没有死亡的生存，与新生ICD植入的匹配患者相比，升级ICD患者的移植和LVAD植入均较差（p=0.05），以及与不需要升级的匹配PM患者相比，随后升级的PM患者（p=.036）。
结论：20例ICD植入中有一例是PM患者的升级。在接下来的10年内，30名PM患者中至少有一名需要ICD升级。ICD升级的预测因素是男性和PM植入时LVEF较低。升级的患者结果更差。
