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Year : 2016  |  Volume : 1  |  Issue : 1  |  Page : 12-14

Experience with implantable cardioverter defibrillator in african-americans: Is there an effect of cocaine usage on defibrillation threshold?

1 Department of Surgery, Section of Cardiothoracic Surgery, Atlanta Medical Center, Atlanta, GA, USA
2 Department of Medicine, Section of Cardiology, Morehouse School of Medicine, Atlanta, GA, USA

Correspondence Address:
Jonathan Nwiloh
Section of Cardiothoracic Surgery, Atlanta Medical Center, Atlanta, GA
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Source of Support: None, Conflict of Interest: None

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Objective: Some earlier studies have suggested that cocaine use in African-Americans (AAs) results in higher defibrillation thresholds. We are therefore reviewing our own experience with this racial group for comparison. Materials and Methods: We retrospectively reviewed the medical records of AA patients who had placement by a single operator of implantable cardioverter defibrillator (ICD) at an inner city hospital from January 2006 to December 2015. Results: Seventy-four patients, mean age 59.2 ± 12.9 years, comprising 37 (50.0%) males, underwent ICD implantation of which 67.6% were single chamber and 32.4% dual chamber devices. Diagnosis was nonischemic cardiomyopathy in 68.9% and indication for device therapy was primary prevention in 87.8%. Sixty-six (89.2%) patients were noncocaine users, whereas 8 (10.8%) were cocaine abusers. The mean age, ejection fraction, and defibrillation threshold between the noncocaine and cocaine users were 60.2 ± 12.8 versus 51.3 ± 12.4 (P = 0.642), 21.6 ± 8.3 versus 16.1 ± 4.6 (P = 0.0704), and 23.5 ± 5.0 versus 25.0 ± 8.4 (P = 0.447), respectively. Biotronik device patients had complete follow-up and they had an all-cause mortality of 28.8% (15/52), while 27.0% (10/37) of the survivors had at least one or more antitachycardia pacing or high voltage shock therapies. Conclusion: There was no statistically significant difference in defibrillation threshold testing observed in AA patients in our series between noncocaine and cocaine users as previously seen in some earlier small reviews. Larger studies or meta-analysis of several studies to accumulate a substantial number of AAs using cocaine may be required for a definitive answer to the question.

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