Real-world implantable cardioverter-defibrillator outcomes in a north-african tertiary centre: baseline profile, arrhythmic therapies, device-related events and early outcomes

Background Large international registries report improving ICD safety and lower inappropriate therapy rates with contemporary programming. Outcomes remain strongly influenced by substrate and indication, and case-mix varies across regions, including younger cohorts. However, a lack of published real-world data limits our understanding of how these patterns apply to North-African centres. Purpose To characterise patient profile and electrophysiology-relevant outcomes after ICD implantation in a North-African tertiary centre, and to identify predictors of appropriate ICD therapy. Methods Retrospective cohort of consecutive ICD recipients (n=66). Indications were primary (n=35) or secondary prevention (n=31). Follow-up was calculated from implantation to last visit: median 7 months (IQR 3–14). Sustained ventricular tachycardia/ventricular fibrillation (VT/VF) was analysed separately from non-sustained VT (NSVT). Outcomes included appropriate therapies (ATP and/or shock), inappropriate therapies, device-related events, heart-failure (HF) hospitalisation and all-cause mortality during follow-up, and telemonitoring uptake. Multivariable logistic regression explored predictors of appropriate therapy (secondary vs primary prevention, age, sex, ischaemic aetiology). Results Mean age was 51.1 years (14–78); 69.7% were male. Substrate was predominantly non-ischaemic/inherited (ischaemic 41%; hypertrophic cardiomyopathy 18%; dilated cardiomyopathy 17%; arrhythmogenic right ventricular cardiomyopathy 15%). Device type was VVI 48.5%, DDD 27.3% and CRT-D 24.2%. Sustained VT/VF occurred in 15/66 (22.7%) and NSVT in 18/66 (27.3%). At least one appropriate ICD therapy occurred in 15/66 (22.7%): ATP 9/66 (13.6%) and ATP+shock 6/66 (9.1%). Appropriate therapy was higher in secondary versus primary prevention (12/31, 38.7% vs 3/35, 8.6%; p=0.0068). Secondary prevention independently predicted appropriate therapy (adjusted OR 6.28, 95% CI 1.51–26.11; p=0.011). Inappropriate therapies were uncommon (2/66, 3.0%). Device-related events occurred in 5/66 (7.6%), including infections in 3/66 (4.5%). HF hospitalisation occurred in 6/66 (9.1%) and mortality in 1/66 (1.5%) during follow-up. Telemonitoring uptake was limited (10/66, 15.2%). Conclusions In this North-African real-world ICD cohort with a young profile and predominant non-ischaemic/inherited substrates, secondary prevention was the strongest independent predictor of appropriate ICD therapy. Inappropriate therapies were low and device-related event rates acceptable. Limited telemonitoring uptake highlights an actionable target to strengthen EP follow-up pathways and align outcomes with contemporary international practice.