Characteristics and outcomes of diabetic patients with an implantable cardioverter defibrillator in a real world setting: results from the Israeli ICD registry

Effect of implantable cardioverter defibrillator on primary prevention of sudden cardiac death in high-risk patients

OBJECTIVE

To investigate the effect of implantable cardioverter defibrillator (ICD) on primary prevention of sudden cardiac death (SCD) in patients with high risk.

METHODS

This retrospective analysis included 70 patients who received primary prevention of SCD by ICD implantation in Huzhou Central Hospital from March 2016 to May 2019. Based on survival, 15 patients who died during follow-up were placed into the death group and the 55 patients who survived were set as the survival group. The two groups were compared in terms of sex, age, non-sustained ventricular tachycardia (VT), diastolic pressure, systolic pressure, left ventricular ejection fraction (LVEF), urea nitrogen, serum creatinine, history of diabetes, history of atrial fibrillation, history of myocardial ischemia, history of dilated cardiomyopathy, history of hypertrophic cardiomyopathy, type I Brugada wave and cardiac function classification. Further, we analyzed the proportion of discharge, the survival of patients (Kaplan Meier method), and the risk factors of patient death (Logistic regression).

RESULTS

The analysis of baseline data showed that patients in the death group had older age and higher level of serum creatinine than the survival group (P<0.05), and the number of patients with non-sustained VT≥5 times/24 h in the survival group was higher than that in the death group (P<0.05). There was no obvious difference in other baseline indexes between the two groups (P>0.05). In addition, there was no difference in the proportion of patients receiving appropriate/inappropriate discharge (P>0.05) between the two groups. Follow-up data showed that 15 cases (21.43%) of spontaneous VT/ventricular fibrillation events were correctly diagnosed by pacemakers and properly treated by ICD (discharge or antitachycardia pacing (ATP)), while 55 cases (78.57%) received inappropriate ICD treatment. There were 15 patients (21.43%) who died during follow up, including 6 cases of cardiac insufficiency, 1 case of SCD, 2 cases of acute myocardial infarction, 1 case of respiratory failure, and 5 cases of unknown etiology; the survival time was (20.27±7.06) months. Logistic regression analysis showed that age and serum creatinine were the risk factors of patient death.

CONCLUSION

Primary prevention with ICD implantation benefits SCD patients. Non persistent VT≥5 times/24 h is a predictive value for ICD implantation in patients receiving primary prevention of SCD. Age and serum creatinine are risk factors for death.

Influence of diabetes on mortality and ICD therapies in ICD recipients: a systematic review and meta-analysis of 162,780 patients

Background

The influence of diabetes on the mortality and risk of implantable cardioverter defibrillator (ICD) therapies is still controversial, and a comprehensive assessment is lacking. We performed this systematic review and meta-analysis to address this controversy.

Methods

We systematically searched the PubMed, Embase, Web of Science and Cochrane Library databases to collect relevant literature. Fixed and random effects models were used to estimate the hazard ratio (HR) with 95% CIs.

Results

Thirty-six articles reporting on 162,780 ICD recipients were included in this analysis. Compared with nondiabetic ICD recipients, diabetic ICD recipients had higher all-cause mortality (HR = 1.45, 95% CI 1.36–1.55). The subgroup analysis showed that secondary prevention patients with diabetes may suffer a higher risk of all-cause mortality (HR = 1.89, 95% CI 1.56–2.28) (for subgroup analysis, P = 0.03). Cardiac mortality was also higher in ICD recipients with diabetes (HR = 1.68, 95% CI 1.35–2.08). However, diabetes had no significant effect on the risks of ICD therapies, including appropriate or inappropriate therapy, appropriate or inappropriate shock and appropriate anti-tachycardia pacing (ATP). Diabetes was associated with a decreased risk of inappropriate ATP (HR = 0.56, 95% CI 0.39–0.79).

Conclusion

Diabetes is associated with an increased risk of mortality in ICD recipients, especially in the secondary prevention patients, but does not significantly influence the risks of ICD therapies, indicating that the increased mortality of ICD recipients with diabetes may not be caused by arrhythmias. The survival benefits of ICD treatment in diabetes patients are limited.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12933-022-01580-y.

Impact of COVID-19 Pandemic on the Implantation of Intra-Cardiac Devices in Diabetic and Non-Diabetic Patients in the Western of Romania

Background and Objectives: COVID-19 pandemic severely impacted public health services worldwide, determining a significant decrease of elective cardiovascular (CV) procedures, especially in patients with associated chronic diseases such as diabetes mellitus (DM). Materials and Methods: This study was first started in 2019 in the western of Romania, to analyze the differences regarding the implantations of intra-cardiac devices such as permanent pacemakers (PPM), cardiac resynchronization therapy (CRT), or implantable cardioverter-defibrillators (ICD) in 351 patients with and without DM and the situation was reanalyzed at the end of 2020. Results: of the first 351 patients with and without DM. 28.20% of these patients had type 2 DM (p = 0.022), exceeding more than twice the prevalence of DM in the general population (11%). Patients with DM were younger (p = 0.022) and required twice as often CRT (p = 0.002) as non-diabetic patients. The state of these procedures was reanalyzed at the end of 2020, a dramatic decrease of all new device implantations being observed, both in non-diabetic and in patients with type 2 DM (79.37%, respectively 81.82%). Conclusions: COVID-19 pandemic determined a drastic decrease, with around 75% reduction of all procedures of new intra-cardiac devices implantation, both in non-diabetics, this activity being reserved mostly for emergencies.

Type 2 diabetes is independently associated with all-cause mortality secondary to ventricular tachyarrhythmias

OBJECTIVES

The study sought to assess the prognostic impact of type 2 diabetes in patients presenting with ventricular tachyarrhythmias on admission.

BACKGROUND

Data regarding the prognostic outcome of diabetics presenting with ventricular tachyarrhythmias is limited.

METHODS

A large retrospective registry was used including all consecutive patients presenting with ventricular tachycardia (VT) and fibrillation (VF) on admission from 2002 to 2016. Patients with type 2 diabetes (diabetics) were compared to non-diabetics applying multivariable Cox regression models and propensity-score matching for evaluation of the primary prognostic endpoint of long-term all-cause mortality at 2 years. Secondary prognostic endpoints were cardiac death at 24 h, in-hospital death at index, all-cause mortality at 30 days, all-cause mortality in patients surviving index hospitalization at 2 years (i.e. "after discharge") and rehospitalization due to recurrent ventricular tachyarrhythmias at 2 years.

RESULTS

In 2411 unmatched high-risk patients with ventricular tachyarrhythmias, diabetes was present in 25% compared to non-diabetics (75%). Rates of VT (57% vs. 56%) and VF (43% vs. 44%) were comparable in both groups. Multivariable Cox regression models revealed diabetics associated with the primary endpoint of long-term all-cause mortality at 2 years (HR = 1.513; p = 0.001), which was still proven after propensity score matching (46% vs. 33%, log rank p = 0.001; HR = 1.525; p = 0.001). The rates of secondary endpoints were higher for in-hospital death at index, all-cause mortality at 30 days, as well as after discharge, but not for cardiac death at 24 h or rehospitalization due to recurrent ventricular tachyarrhythmias.

CONCLUSION

Presence of type 2 diabetes is independently associated with an increase of all-cause mortality in patients presenting with ventricular tachyarrhythmias on admission.

Multipolar pacing by cardiac resynchronization therapy with a defibrillators treatment in type 2 diabetes mellitus failing heart patients: impact on responders rate, and clinical outcomes

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a multi factorial disease, affecting clinical outcomes in failing heart patients treated by cardiac resynchronization therapy with a defibrillator (CRT-d).

METHODS

One hundred and ninety-five T2DM patients received a CRT-d treatment. Randomly the study population received a CRT-d via multipolar left ventricle (LV) lead pacing (n 99, multipolar group), vs a CRT-d via bipolar LV pacing (n 96, bipolar group). These patients were followed by clinical, and instrumental assessment, and telemetric device control at follow up. In this study we evaluated, in a population of failing heart T2DM patients, cardiac deaths, all cause deaths, arrhythmic events, CRT-d responders rate, hospitalizations for HF worsening, phrenic nerve stimulation (PNS), and LV catheter dislodgment events (and re-intervention for LV catheter re-positioning), comparing multipolar CRT-d vs bipolar CRT-d group of patients at follow up.

RESULTS

At follow up there was a statistical significant difference about atrial arrhythmic events [7 (7%) vs 16 (16.7%), p value 0.019], hospitalizations for HF worsening [15 (15.2% vs 24 (25%), p value 0.046], LV catheter dislodgments [1 (1%) vs 9 (9.4%), p value 0018], PNS [5 (5%) vs 18 (18.7%), p value 0.007], and LV re-positioning [1 (1%) vs 9 (9.4%), p value 0.018], comparing multipolar CRT-d vs bipolar CRT-d group of patients. Multipolar pacing was an independent predictor of all these events.

CONCLUSIONS

CRT-d pacing via multipolar LV lead vs bipolar LV lead may reduce arrhythmic burden, hospitalization rate, PNS, LV catheters dislodgments, and re-interventions in T2DM failing heart patients. Clinical trial number NCT03095196.