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Int J Cardiol. 2018 May 15;259:94-99. doi: 10.1016/j.ijcard.2018.02.063. Epub 2018 Feb 20.

Relation between total shock energy and mortality in patients with implantable cardioverter-defibrillator.

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Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan.
Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan. Electronic address:
Department of Cardiovascular Medicine, Hokkaido Ohno Memorial Hospital, Japan.
Department of Cardiovascular Medicine, National Hospital Organization Hokkaido Medical Center, Japan.
Division of Medical Engineering Center, Hokkaido University Hospital, Japan.



Implantable Cardioverter-Defibrillator (ICD) shocks have been associated with mortality. However, no study has examined the relation between total shock energy and mortality. The aim of this study is to assess the association of total shock energy with mortality, and to determine the patients who are at risk of this association.


Data from 316 consecutive patients who underwent initial ICD implantation in our hospital between 2000 and 2011 were retrospectively studied. We collected shock energy for 3 years from the ICD implantation, and determined the relation of shock energy on mortality after adjusting confounding factors.


Eighty-seven ICD recipients experienced shock(s) within 3 years from ICD implantation and 43 patients had died during the follow-up. The amount of shock energy was significantly associated with all-cause death [adjusted hazard ratio (HR) 1.26 (per 100 joule increase), p < 0.01] and tended to be associated with cardiac death (adjusted HR 1.30, p = 0.08). The survival rate of patients with high shock energy accumulation (≥182 joule) was lower (p < 0.05), as compared to low shock energy accumulation (<182 joule), likewise to no shock. Besides, the relation between high shock energy accumulation and all-cause death was remarkable in the patients with low left ventricular ejection fraction (LVEF ≤40%) or atrial fibrillation (AF).


Increase of shock energy was related to mortality in ICD recipients. This relation was evident in patients with low LVEF or AF.


Atrial fibrillation; Implantable cardioverter-defibrillator; Low left ventricular ejection fraction; Mortality; Shock accumulation; Total shock energy

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