{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T04:41:53Z","timestamp":1789965713881,"version":"4.0.1"},"reference-count":30,"publisher":"BMJ","issue":"3","funder":[{"DOI":"10.13039\/100010658","name":"St. Paul\u2019s Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010658","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Heart"],"published-print":{"date-parts":[[2018,2]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Implantable cardioverter-defibrillators (ICDs) reduce risk of death in select populations, but are also associated with harms. We aimed to characterise long-term complications and reoperation rate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We assessed the rate, cumulative incidence and predictors of long-term reoperation and survival using a prospective, multicentre registry serving British Columbia in Canada, a universal single payer healthcare system with 4.5\u2009million residents. 3410 patients (mean 63.3 years, 81.7% male) with new primary (n=1854) or secondary prevention (n=1556) ICD implant from 2003 to 2012 were followed for a median of 34 months (single chamber n=1069, dual chamber n=1905, biventricular n=436). Independent predictors of adverse outcomes were defined using Cox regression models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The overall reoperation rate was 12.0% per patient-year, and less for single vs dual vs biventricular ICDs (9.1% vs 12.5% vs 17.8% per patient-year, respectively). The Kaplan-Meier complication estimates (excluding generator end of life) at 1, 3 and 5 years were respectively: single chamber 10.2%, 16.2% and 21.6%; dual 11.7%, 19.1% and 27.4% and biventricular 15.9%, 22.2% and 24.7%. Cardiac resynchronisation therapy had the highest rate of early lead complications, but lower long-term need for upgrade. Device complexity, age and atrial fibrillation were key determinants of complications. Overall mortality at 1, 3 and 5 years was 5.4%, 17.4% and 32.7%,\u2009respectively. In younger patients, observed 5-year survival approached the expected survival in the general population (relative survival ratio=0.96 (0.90\u20130.98)). With increasing age, observed survival steadily declined relative to expected.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In a prospective registry capturing all procedures, complication and reoperation rates following de novo ICD implantation were high. Shared decision making must carefully consider these factors.<\/jats:p><\/jats:sec>","DOI":"10.1136\/heartjnl-2017-311638","type":"journal-article","created":{"date-parts":[[2017,7,27]],"date-time":"2017-07-27T00:40:18Z","timestamp":1501116018000},"page":"237-243","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":43,"title":["Long-term complications, reoperations and survival following cardioverter-defibrillator implant"],"prefix":"10.1136","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1286-2014","authenticated-orcid":false,"given":"Nathaniel Mark","family":"Hawkins","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maja","family":"Grubisic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason G","family":"Andrade","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flora","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lillian","family":"Ding","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamil","family":"Bashir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,7,26]]},"reference":[{"key":"2020050721430012000_104.3.237.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa013474"},{"key":"2020050721430012000_104.3.237.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa043399"},{"key":"2020050721430012000_104.3.237.3","doi-asserted-by":"publisher","DOI":"10.1053\/euhj.2000.2476"},{"key":"2020050721430012000_104.3.237.4","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1056\/NEJMoa1608029","article-title":"Defibrillator implantation in patients with nonischemic systolic\u00a0heart failure","volume":"375","author":"K\u00f8ber","year":"2016","journal-title":"N Engl J Med"},{"key":"2020050721430012000_104.3.237.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.11.029"},{"key":"2020050721430012000_104.3.237.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2015.12.046"},{"key":"2020050721430012000_104.3.237.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2015.02.031"},{"key":"2020050721430012000_104.3.237.8","doi-asserted-by":"crossref","unstructured":"Ranasinghe I , Parzynski CS , Freeman JV , et al . 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