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The use of cardiac implantable electronic devices (CIEDs), including implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy with defibrillator (CRT-D), is rising, particularly among geriatrics with multiple comorbidities.
Higher comorbidity burden increases 1-year mortality and MACCE risk in ICD/CRT-D patients, while periprocedural complications and arrhythmic events remain unchanged.
The use of cardiac implantable electronic devices (CIEDs), including implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy with defibrillator (CRT-D), is rising, particularly among geriatrics with multiple comorbidities. However, the influence of cardiometabolic comorbidity burden on periprocedural complications, mortality, and cardiovascular outcomes remains unclear.
This study explored how comorbid conditions impact baseline characteristics, procedure-related complications, and clinical outcomes in patients undergoing ICD and CRT-D implantation or revision.
This prospective multicenter study from the German Device Registry included 5,329 subjects (mean age 65.2 years) undergoing 3,794 ICD and 1,535 CRT-D procedures across 50 centers. Volunteers were segregated on the basis of cardiometabolic comorbidities—stroke, chronic kidney disease, diabetes mellitus, and hypertension:
Key endpoints were 1-year all-cause mortality, major adverse cardiac and cerebrovascular events (MACCE), and arrhythmic vs. non-arrhythmic events. Kaplan–Meier analysis assessed survival. Median follow-up was 17 months.
Among the study population (mean age 65.2 years), 3,794 subjects received ICDs and 1,535 underwent CRT-D implantation. The incidence of periprocedural complications and in-hospital MACCE was low and illustrated no vital association with comorbidity burden (Table 1).
However, those with a higher number of comorbidities illustrated a markedly increased risk of 1-year mortality. Notably, ICD shock rates and ventricular arrhythmia risk remained consistent across all groups. The non-arrhythmic mortality score elevated with greater comorbidity burden, while arrhythmic risk scores remained stable.
In those undergoing ICD or CRT-D implantation, cardiometabolic comorbidities did not appear to increase periprocedural risk. However, multimorbidity was strongly related to higher long-term mortality and MACCE, without impacting arrhythmic outcomes. These findings highlight the importance of comorbidity assessment in predicting clinical prognosis and guiding risk stratification in device therapy.
Clinical Research in Cardiology
The role of comorbidities on periprocedural complications and outcomes in patients with defibrillators and cardiac resynchronization therapy: insights from the German device registry
Nina Becher et al.
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