Detect Long-term Complications After ICD Replacement (DECODE): Rationale and Study Design of a Multicenter Italian Registry

Abstract

The replacement of implantable cardioverter-defibrillators (ICDs) may give rise to considerable clinical consequences, the importance of which is underrated by the medical community. Replacement-related adverse events are difficult to identify and require monitoring of both short-term complications and long-term patient outcome. The aim of this study is to perform a structured evaluation of both short- and long-term adverse events and a cost analysis of consecutive ICD replacement procedures. Detect Long-term Complications After ICD Replacement (DECODE) is a prospective, single-arm, multicenter cohort study designed to estimate long-term complication rates (at 12 months and 5 years) in patients undergoing ICD generator replacement. The study will also evaluate predictors of complications, patient management before and during the replacement procedure in clinical practice, and the costs related to use of health care resources. About 800 consecutive patients with standard indications for ICD generator replacement will be enrolled in this study. The decision to undertake generator replacement/upgrade will be made according to the investigators' own judgment (which will be recorded). Patients will be followed for 60 months through periodic in-hospital examinations or remote monitoring. Detailed data on complications related to ICD replacement in current clinical practice are still lacking. The analysis of adverse events will reveal the value of new preventive strategies, thereby yielding both clinical and economic benefits. Moreover, assessment of complication rates after ICD replacement in a real-life setting will help estimate the actual long-term cost of ICD therapy and assess the real impact of increasing ICD longevity on cost-effectiveness.

Trial registration: ClinicalTrials.gov NCT02076789.

© 2015 Wiley Periodicals, Inc.

Figures

Figure 1

DECODE study flowchart. Abbreviations: DECODE, Detect Long‐term Complications After ICD Replacement; ESC, European Society of Cardiology; ICD, implantable cardioverter‐defibrillator.

Figure 2

Possible temporal evolution of different types of treatment: (A) drug therapy and surgery/interventional procedures and (B) CIED implantation. The color of each arrow reflects the probability of the indicated event/option, from high (black) to low (white). Abbreviations: CIED, cardiac implantable electronic device.