{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T09:52:27Z","timestamp":1791280347505,"version":"4.1.0"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Arrhythmia and Electrophysiology"],"published-print":{"date-parts":[[2016,3]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>The effectiveness of implantable cardioverter-defibrillators (ICDs) for primary prevention of sudden death in patients with an ejection fraction (EF) \u226435% and clinical heart failure is well established. However, outcomes after replacement of the ICD generator in patients with recovery of EF to &gt;35% and no previous therapies are not well characterized.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>\n              Between 2001 and 2011, generator replacement was performed at 2 tertiary medical centers in 253 patients (mean age, 68.3\u00b112.7 years; 82% men) who had previously undergone ICD placement for primary prevention but subsequently never received appropriate ICD therapy. EF had recovered to &gt;35% in 72 of 253 (28%) patients at generator replacement. During median (quartiles) follow-up of 3.3 (1.8\u20135.3) years after generator replacement, 68 of 253 (27%) experienced appropriate ICD therapy. Patients with EF \u226435% were more likely to experience ICD therapy compared with those with EF &gt;35% (12% versus 5% per year; hazard ratio, 3.57;\n              <jats:italic>P<\/jats:italic>\n              =0.001). On multivariable analysis, low EF predicted appropriate ICD therapy after generator replacement (hazard ratio, 1.96 [1.35\u20132.87] per 10% decrement;\n              <jats:italic>P<\/jats:italic>\n              =0.001). Death occurred in 25% of patients 5 years after generator replacement. Mortality was similar in patients with EF \u226435% and &gt;35% (7% versus 5% per year; hazard ratio, 1.10;\n              <jats:italic>P<\/jats:italic>\n              =0.68). Atrial fibrillation (3.24 [1.63\u20136.43];\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) and higher blood urea nitrogen (1.28 [1.14\u20131.45] per increase of 10 mg\/dL;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) were associated with mortality.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>Although approximately one fourth of patients with a primary prevention ICD and no previous therapy have EF &gt;35% at the time of generator replacement, these patients continue to be at significant risk for appropriate ICD therapy (5% per year). These data may inform decisions on ICD replacement.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circep.115.003283","type":"journal-article","created":{"date-parts":[[2018,9,17]],"date-time":"2018-09-17T01:17:01Z","timestamp":1537147021000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":57,"title":["Outcomes After Implantable Cardioverter-Defibrillator Generator Replacement for Primary Prevention of Sudden Cardiac Death"],"prefix":"10.1161","volume":"9","author":[{"given":"Malini","family":"Madhavan","sequence":"first","affiliation":[{"name":"From the Department of Cardiovascular Diseases (M.M., P.A.F., P.A.N., T.L.W., C.M.W., Y.-M.C., B.J.G.), Department of Health Sciences Research (R.A.M., D.O.H.), Mayo Clinic, Rochester, MN; and Cardiovascular Diseases, Department of Medicine (J.W.W., D.B.K., A.E.B.), Department of Medicine (A.Y.H.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan W.","family":"Waks","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Diseases (M.M., P.A.F., P.A.N., T.L.W., C.M.W., Y.-M.C., B.J.G.), Department of Health Sciences Research (R.A.M., D.O.H.), Mayo Clinic, Rochester, MN; and Cardiovascular Diseases, Department of Medicine (J.W.W., D.B.K., A.E.B.), Department of Medicine (A.Y.H.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul A.","family":"Friedman","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Diseases (M.M., P.A.F., P.A.N., T.L.W., C.M.W., Y.-M.C., B.J.G.), Department of Health Sciences Research (R.A.M., D.O.H.), Mayo Clinic, Rochester, MN; and Cardiovascular Diseases, Department of Medicine (J.W.W., D.B.K., A.E.B.), Department of Medicine (A.Y.H.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel B.","family":"Kramer","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Diseases (M.M., P.A.F., P.A.N., T.L.W., C.M.W., Y.-M.C., B.J.G.), Department of Health Sciences Research (R.A.M., D.O.H.), Mayo Clinic, Rochester, MN; and Cardiovascular Diseases, Department of Medicine (J.W.W., D.B.K., A.E.B.), Department of Medicine (A.Y.H.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfred E.","family":"Buxton","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Diseases (M.M., P.A.F., P.A.N., T.L.W., C.M.W., Y.-M.C., B.J.G.), Department of Health Sciences Research (R.A.M., D.O.H.), Mayo Clinic, Rochester, MN; and Cardiovascular Diseases, Department of Medicine (J.W.W., D.B.K., A.E.B.), Department of Medicine (A.Y.H.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter A.","family":"Noseworthy","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Diseases (M.M., P.A.F., P.A.N., T.L.W., C.M.W., Y.-M.C., B.J.G.), Department of Health Sciences Research (R.A.M., D.O.H.), Mayo Clinic, Rochester, MN; and Cardiovascular Diseases, Department of Medicine (J.W.W., D.B.K., A.E.B.), Department of Medicine (A.Y.H.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramila A.","family":"Mehta","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Diseases (M.M., P.A.F., P.A.N., T.L.W., C.M.W., Y.-M.C., B.J.G.), Department of Health Sciences Research (R.A.M., D.O.H.), Mayo Clinic, Rochester, MN; and Cardiovascular Diseases, Department of Medicine (J.W.W., D.B.K., A.E.B.), Department of Medicine (A.Y.H.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David O.","family":"Hodge","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Diseases (M.M., P.A.F., P.A.N., T.L.W., C.M.W., Y.-M.C., B.J.G.), Department of Health Sciences Research (R.A.M., D.O.H.), Mayo Clinic, Rochester, MN; and Cardiovascular Diseases, Department of Medicine (J.W.W., D.B.K., A.E.B.), Department of Medicine (A.Y.H.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela Y.","family":"Higgins","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Diseases (M.M., P.A.F., P.A.N., T.L.W., C.M.W., Y.-M.C., B.J.G.), Department of Health Sciences Research (R.A.M., D.O.H.), Mayo Clinic, Rochester, MN; and Cardiovascular Diseases, Department of Medicine (J.W.W., D.B.K., A.E.B.), Department of Medicine (A.Y.H.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tracy L.","family":"Webster","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Diseases (M.M., P.A.F., P.A.N., T.L.W., C.M.W., Y.-M.C., B.J.G.), Department of Health Sciences Research (R.A.M., D.O.H.), Mayo Clinic, Rochester, MN; and Cardiovascular Diseases, Department of Medicine (J.W.W., D.B.K., A.E.B.), Department of Medicine (A.Y.H.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chance M.","family":"Witt","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Diseases (M.M., P.A.F., P.A.N., T.L.W., C.M.W., Y.-M.C., B.J.G.), Department of Health Sciences Research (R.A.M., D.O.H.), Mayo Clinic, Rochester, MN; and Cardiovascular Diseases, Department of Medicine (J.W.W., D.B.K., A.E.B.), Department of Medicine (A.Y.H.), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong-Mei","family":"Cha","sequence":"additional","affiliation":[{"name":"From the Department of Cardiovascular Diseases (M.M., P.A.F., P.A.N., T.L.W., C.M.W., Y.-M.C., B.J.G.), Department of Health Sciences Research (R.A.M., D.O.H.), Mayo Clinic, Rochester, MN; 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