AimsPacemaker (PM) patients may require a subsequent upgrade to an implantable cardioverter defibrillator (ICD). Limited data exists on this patient population. We sought to characterize this population, to assess predictors for ICD upgrade, and to report the outcome.MethodsFrom our prospective PM and ICD implantation registry, all patients who underwent PM and/or ICD implantations at our center were analyzed. Patient characteristics and outcomes of PM patients with subsequent ICD upgrade were compared to age‐ and sex‐matched patients with de novo ICD implantation, and to PM patients without subsequent upgrade.ResultsOf 1′301 ICD implantations, 60 (5%) were upgraded from PMs. Median time from PM implantation to ICD upgrade was 2.6 years (IQR 1.3‐5.4). Of 2′195 PM patients, 28 patients underwent subsequent ICD upgrades, corresponding to an estimated annual incidence of an ICD upgrade of at least 0.33%. Lower LVEF (p = .05) and male sex (p = .038) were independent predictors for ICD upgrade. Survival without death, transplant and LVAD implantation were worse both for upgraded ICD patients compared to matched patients with de novo ICD implantation (p = .05), as well as for PM patients with subsequent upgrade compared to matched PM patients not requiring an upgrade (p = .036).ConclusionsOne of 20 ICD implantations are upgrade of patients with a PM. At least one of 30 PM patients will require an ICD upgrade in the following 10 years. Predictors for ICD upgrade are male sex and lower LVEF at PM implantation. Upgraded patients have worse outcomes.

中文翻译：

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起搏器患者升级为植入式心脏复律除颤器的患者特征、预测因素和结果

目标起搏器 (PM) 患者可能需要随后升级为植入式心脏复律除颤器 (ICD)。关于该患者群体的数据有限。我们试图描述这一人群的特征，评估 ICD 升级的预测因素，并报告结果。方法根据我们的前瞻性 PM 和 ICD 植入登记，对所有在我们中心接受 PM 和/或 ICD 植入的患者进行了分析。将随后进行 ICD 升级的 PM 患者的患者特征和结果与年龄和性别匹配的重新植入 ICD 的患者以及未进行后续升级的 PM 患者进行比较。结果 在 1’301 例 ICD 植入中，60 例 (5%) 从 ICD 升级到升级下午。从 PM 植入到 ICD 升级的中位时间为 2.6 年（IQR 1.3‐5.4）。在 2'195 名 PM 患者中，28 名患者接受了后续 ICD 升级，相当于 ICD 升级的估计年发生率至少为 0.33%。降低 LVEF（p= .05) 和男性 (p= .038) 是 ICD 升级的独立预测因子。与重新植入 ICD 的匹配患者相比，升级 ICD 患者的无死亡、移植和 LVAD 植入的生存率均较差（p= .05），以及随后升级的 PM 患者与不需要升级的匹配 PM 患者相比（p= .036)。结论 20 例 ICD 植入中的 1 例是 PM 患者的升级。未来 10 年内，至少 30 名 PM 患者中至少有 1 名需要升级 ICD。 ICD 升级的预测因素是男性和 PM 着床时较低的 LVEF。升级的患者结果更差。