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Determinants of inappropriate implantable cardioverter-defibrillator shocks: the German Device Registry perspective

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Abstract

Background

In the present study, we have focused upon rates and clinical determinants of inappropriate shock (IS) after implantable cardioverter-defibrillator (ICD).

Methods

Data were collected prospectively in the German Device II Registry.

Results

A total of 783 patients were included. Three sub-groups were identified: non-shock (NS) included 725 patients (92.6%), IS 24 (3.1%), and appropriate shock (AS) 34 (4.3%). IS patients were younger (AS 68 (58–77); IS 59 (51–68); NS 66 (56–75) years; p = 0.03), had been mainly referred for primary prophylaxis (AS 42.4%; IS 70.8%; NS 67.3%; p = 0.01), had a higher resting heart rate (AS 70 (63–80); IS 80 (71–98); NS 70 (60–81) BPM; p = 0.003), had more often atrial fibrillation (AF) (AS 14.7%; IS 45.8%; NS 18.8%; p = 0.006), and shorter QRS duration (AS 100 (90–120); IS 95 (90–100); NS 120 (98–150) msec.; p = 0.001). VVI-ICD was more common in IS (AS 64.7%; IS 83.3%; NS 49.8%; p = 0.002). At a follow-up of 18.2 months (75% IQR 13.6–22.4), no deaths were observed in the IS group, one (2.9%) in the AS, and 36 (4.9%) in the NS (p = 0.9). At logistic regression, VVI-ICD implantation was the strongest IS independent determinant (OR 5.0; 95% CI 1.6–15.9; p = 0.004) together with age < 70 years (OR 4.6; CI 1.4–14.7; p = 0.009), AF at time of ICD implantation (OR 3.5; CI 1.3–9.1; p = 0.01), and resting heart rate > 70/min (OR 2.8; CI 1.0–7.3; p = 0.03).

Conclusion

In a contemporary setting, some specific conditions such as VVI-ICD, younger age, and faster resting heart rates remain important IS determinants after ICD implantation.

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Data availability

This is a multicenter study and data are protected by local patients’ privacy regulations. In any case, data will be made available upon request.

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Funding

The registry has been supported by “Stiftung Institut für Herzinfarktforschung (IHF)” and by Biotronik, Medtronic, and St. Jude Medical.

Author information

Authors and Affiliations

  1. Vivantes Klinikum Am Urban, Diffenbach strasse, Berlin, Germany

    Erdal Safak, Hüseyin Ince & Giuseppe D’Ancona

  2. Rostock University Medical Center, Rostock, Germany

    Erdal Safak, Hüseyin Ince & Giuseppe D’Ancona

  3. Klinik für Kardiologie II – Rhythmologie, Universitätsklinikum Münster, Münster, Germany

    Lars Eckardt

  4. Klinik für Innere Medizin III Kardiologie, Schwarzwald-Baar Klinikum, Villingen-Schwenningen, Germany

    Werner Jung

  5. Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany

    Jochen Senges & Matthias Hochadel

  6. Katholisches Klinikum Lünen, Lünen, Germany

    Christian Perings

  7. Praxisklinik Herz und Gefäße Dresden and Institute of Medical Technology, Brandenburg University of Technology Cottbus, Cottbus, Germany

    Stefan Spitzer

  8. Klinikum Coburg, Coburg, Germany

    Johannes Brachmann

  9. Klinikum Ingolstadt, Ingolstadt, Germany

    Karlheinz Seidl

  10. Klinikum Frankfurt Höchst, Frankfurt, Germany

    Hans Ulrich Hink

Authors
  1. Erdal Safak
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  2. Lars Eckardt
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  3. Werner Jung
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  4. Hüseyin Ince
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  6. Matthias Hochadel
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  7. Christian Perings
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  8. Stefan Spitzer
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  9. Johannes Brachmann
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  10. Karlheinz Seidl
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  11. Hans Ulrich Hink
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  12. Giuseppe D’Ancona
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Contributions

All authors have contributed to database designing and patients’ clinical management. GD, HI, JS, and MH have designed the study. GD has written the manuscript. MH has performed the analysis. LE and ES ha have given a first critical reading and correction to the original version of the manuscript. All other authors have read and approved the final version of the manuscript.

Corresponding author

Correspondence to Giuseppe D’Ancona.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval and consent to participate

A positive vote was obtained from the ethics committee of the Landesaerztekammer Rheinland-Pfalz in April 2011. All patients have given written informed consent to data collection and publication.

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Safak, E., Eckardt, L., Jung, W. et al. Determinants of inappropriate implantable cardioverter-defibrillator shocks: the German Device Registry perspective. J Interv Card Electrophysiol 56, 71–77 (2019). https://doi.org/10.1007/s10840-019-00600-4

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  • DOI: https://doi.org/10.1007/s10840-019-00600-4

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