Key result
Implantable cardioverter-defibrillator therapy in a primary prevention cohort was associated with at least one complication in 13.6% of patients over 2.2 years, including major complications in 7.8%.
Why the study?
While only one third of primary prevention ICD patients receive appropriate therapy, all face risk of device complications, and information on complications in contemporary cohorts is limited.
What is the incidence of ICD-related complications in a contemporary primary prevention cohort?
Cohort (n=1,442)
Yes
What is the incidence of ICD-related complications in a contemporary primary prevention cohort?
In a contemporary primary prevention cohort, 13.6% of patients experienced ICD-related complications over 2.2 years, highlighting the need for careful patient selection and shared decision-making.
Substantial ICD complication rates in primary prevention warrant cautious selection; leaves open refinement of contemporary risk-benefit models.
Background One third of primary prevention implantable cardioverter-defibrillator patients receive appropriate therapy, but all remain at risk of defibrillator complications. Information on these complications in contemporary cohorts is limited. This study assessed complications and their risk factors after defibrillator implantation in a Dutch nationwide prospective registry cohort and forecasts the potential reduction in complications under distinct scenarios of updated indication criteria. Methods and Results Complications in a prospective multicenter registry cohort of 1442 primary implantable cardioverter-defibrillator implant patients were classified as major or minor. The potential for reducing complications was derived from a newly developed prediction model of appropriate therapy to identify patients with a low probability of benefitting from the implantable cardioverter-defibrillator. During a follow-up of 2.2 years (interquartile range, 2.0-2.6 years), 228 complications occurred in 195 patients (13.6%), with 113 patients (7.8%) experiencing at least one major complication. Most common ones were lead related (n=93) and infection (n=18). Minor complications occurred in 6.8% of patients, with lead-related (n=47) and pocket-related (n=40) complications as the most prevailing ones. A surgical reintervention or additional hospitalization was required in 53% or 61% of complications, respectively. Complications were strongly associated with device type. Application of stricter implant indication results in a comparable proportional reduction of (major) complications. Conclusions One in 13 patients experiences at least one major implantable cardioverter-defibrillator-related complication, and many patients undergo a surgical reintervention. Complications are related to defibrillator implantations, and these should be discussed with the patient. Stricter implant indication criteria and careful selection of device type implanted may have significant clinical and financial benefits.
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Barreveld et al. (2021) conducted a cohort in Primary prevention implantable cardioverter-defibrillator therapy (n=1,442). Implantable cardioverter-defibrillator therapy was evaluated on Implantable cardioverter-defibrillator-related complications. Implantable cardioverter-defibrillator therapy in a primary prevention cohort was associated with at least one complication in 13.6% of patients over 2.2 years, including major complications in 7.8%.
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