{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T20:39:08Z","timestamp":1769114348541,"version":"3.49.0"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Arrhythmia and Electrophysiology"],"published-print":{"date-parts":[[2018,8]]},"abstract":"<jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>The decision to initially implant an implantable cardioverter-defibrillator (ICD) is informed by robust randomized controlled trials, but no such data exist to guide the decision to replace an ICD generator. In this study, we aimed to determine outcomes after ICD generator replacement.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec sec-type=\"methods\">\n            <jats:title>Methods<\/jats:title>\n            <jats:p>All patients with ischemic or nonischemic cardiomyopathy who underwent ICD generator replacement from 2001 to 2011 at Mayo Clinic, MN, or Beth Israel Deaconess Medical Center, MA, were included. Outcomes included (1) appropriate therapy after generator replacement and (2) death before appropriate therapy after generator replacement. Cox proportional hazards modeling was used to determine the associations between patient characteristics and outcomes.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec sec-type=\"results\">\n            <jats:title>Results<\/jats:title>\n            <jats:p>In 1421 patients undergoing ICD generator replacement (mean\u00b1SD age 69.6\u00b112.1 years, 81% male), appropriate therapy occurred after replacement in 435 patients (30.6%) over a mean follow-up of 2.7\u00b12.6 years. Associated factors included lower left ventricular ejection fraction and history of appropriate therapy before generator replacement. Death before appropriate ICD therapy occurred in 336 (23.7%) patients. Older age, lower left ventricular ejection fraction, and noncardiac comorbidities, including diabetes mellitus, chronic lung disease, peripheral vascular disease, lower hemoglobin, and lower glomerular filtration rate, were associated with greater risk of death before appropriate therapy. A progressive increase in mortality was observed with aggregation of these noncardiac comorbidities.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>The decision to replace the ICD should take into consideration not only left ventricular ejection fraction and history of ventricular arrhythmias, but also comorbid illnesses that may impact the duration and the quality of life.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circep.117.006155","type":"journal-article","created":{"date-parts":[[2018,9,14]],"date-time":"2018-09-14T19:22:44Z","timestamp":1536952964000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":17,"title":["Risk of Appropriate Therapy and Death Before Therapy After Implantable Cardioverter-Defibrillator Generator Replacement"],"prefix":"10.1161","volume":"11","author":[{"given":"Chance M.","family":"Witt","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Diseases (C.M.W., P.A.F., S.K.M., P.A.N., E.C.L., M.B.M., Y.-M.C., B.J.G., M.M.)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan W.","family":"Waks","sequence":"additional","affiliation":[{"name":"Mayo Clinic, Rochester, MN. Cardiovascular Diseases, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (J.W.W., D.B.K., A.E.B.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ramila A.","family":"Mehta","sequence":"additional","affiliation":[{"name":"Department of Health Sciences Research (R.A.M., D.O.H.)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul A.","family":"Friedman","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases (C.M.W., P.A.F., S.K.M., P.A.N., E.C.L., M.B.M., Y.-M.C., B.J.G., M.M.)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel B.","family":"Kramer","sequence":"additional","affiliation":[{"name":"Mayo Clinic, Rochester, MN. Cardiovascular Diseases, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (J.W.W., D.B.K., A.E.B.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alfred E.","family":"Buxton","sequence":"additional","affiliation":[{"name":"Mayo Clinic, Rochester, MN. Cardiovascular Diseases, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (J.W.W., D.B.K., A.E.B.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siva K.","family":"Mulpuru","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases (C.M.W., P.A.F., S.K.M., P.A.N., E.C.L., M.B.M., Y.-M.C., B.J.G., M.M.)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter A.","family":"Noseworthy","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases (C.M.W., P.A.F., S.K.M., P.A.N., E.C.L., M.B.M., Y.-M.C., B.J.G., M.M.)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David O.","family":"Hodge","sequence":"additional","affiliation":[{"name":"Department of Health Sciences Research (R.A.M., D.O.H.)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emilie C.","family":"Lushinsky","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases (C.M.W., P.A.F., S.K.M., P.A.N., E.C.L., M.B.M., Y.-M.C., B.J.G., M.M.)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Megan B.","family":"Mulholland","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases (C.M.W., P.A.F., S.K.M., P.A.N., E.C.L., M.B.M., Y.-M.C., B.J.G., M.M.)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yong-Mei","family":"Cha","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases (C.M.W., P.A.F., S.K.M., P.A.N., E.C.L., M.B.M., Y.-M.C., B.J.G., M.M.)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernard J.","family":"Gersh","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases (C.M.W., P.A.F., S.K.M., P.A.N., E.C.L., M.B.M., Y.-M.C., B.J.G., 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