Implantable Cardioverter-Defibrillator - do we have alternative predictors to administered shocks?

Introduction Predictors of administered shocks in patients with implantable cardioverter-defibrillators (ICDs) have been studied extensively, with heart failure (HF), a history of chronic obstructive pulmonary disease (COPD), and ventricular tachycardia (VT) at the time of ICD implantation being primary factors. Understanding these predictors remains crucial for improving patient outcomes and quality of life. Objective To identify alternative predictors of administered shocks in ICD patients and evaluate whether these shocks influenced a composite outcome of death, myocardial infarction, stroke, or hospitalization for HF. Methods This retrospective study (2020–2023) analyzed 264 patients with ICDs, stratified into "shocks administered" and "no shocks administered" groups. Categorical variables were reported as frequencies and percentages. Logistic regression was employed for multivariate analysis, with p < 0.05 considered statistically significant. Results The cohort had a mean age of 66 ± 8 years and a mean follow-up period of 29 ± 13 months. Of the participants, 28 (12.5%) experienced administered shocks, while 196 (87.5%) did not. Binary analysis revealed a significantly higher use of antiarrhythmic drugs in the shocks-administered group, but no significant differences were observed for other predictors, including age, gender, hypertension, diabetes mellitus, dyslipidemia, obesity, alcohol use, smoking, left ventricular ejection fraction (LVEF), chronic kidney disease, atrial fibrillation, non-ischemic heart disease, optimized medical therapy, or the etiology of ICD implantation. There was no difference between the two groups regarding the composite outcome (p = 0.550). Multivariate analysis identified obesity as the sole independent predictor of administered shocks (OR: 3.144, p = 0.042). Conclusion This study highlights obesity as a strong independent predictor of administered shocks. These findings underscore the importance of managing established ICD predictors while addressing body weight to improve quality of life and reduce distressing, painful shocks. Given the potential protective properties of obesity against overall mortality, these results prompt further discussion regarding the riskbenefit balance of obesity management in ICD patients.