Octogenarians are a growing section of the community. Implantable cardioverter defibrillator
(ICD) implantations and replacements in this age group are becoming frequent. There
are no randomised control trials or large observational studies of octogenarians and
indications for ICD implantations are extrapolated from published primary and secondary
prevention trials, where the age group has been in its sixties. About 75% of ICDs
are implanted for primary prevention guided by patient's ejection fraction.
Most patients who have ICDs do not have a clear idea about the function and limitation
of ICDs. Patient education about ICDs is an important aspect which deserves consideration,
particularly in this age group.
The use of ICDs in octogenarians should be individualised and carefully scrutinised.
It should take into consideration overall health status, symptom severity, co-morbidities
and intermediate and long-term prognosis. There should be detailed discussion about
patient preference and expectations. Physicians must provide a realistic appraisal
of potential benefits and risks and address device management issues at end of life.
This discussion should also take place when ICD replacement is considered.
Keywords
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Article info
Publication history
Published online: November 21, 2013
Accepted:
September 23,
2013
Received:
June 24,
2013
Identification
Copyright
© 2013 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved.
