Impact of atrial fibrillation on 1-year outcome in patients with implantable cardioverter defibrillator or cardiac resynchronization therapy with defibrillator: results from the German DEVICE Registry

Sebastian Feickert; Niels Christian Ewertsen; Julia Köbe; Thomas Kleemann; Joachim Jehle; Jochen Senges; Matthias Hochadel; Dietrich Andresen; Christoph Stellbrink; Lars Eckardt; Stefan Spitzer; Johannes Brachmann; Hüseyin Ince; Giuseppe D'Ancona

doi:10.21037/jtd-23-274

Impact of atrial fibrillation on 1-year outcome in patients with implantable cardioverter defibrillator or cardiac resynchronization therapy with defibrillator: results from the German DEVICE Registry

J Thorac Dis. 2024 Mar 29;16(3):1825-1835. doi: 10.21037/jtd-23-274. Epub 2024 Mar 27.

Authors

Sebastian Feickert^{1

2}, Niels Christian Ewertsen^{1

2}, Julia Köbe³, Thomas Kleemann⁴, Joachim Jehle⁵, Jochen Senges⁶, Matthias Hochadel⁶, Dietrich Andresen⁷, Christoph Stellbrink⁸, Lars Eckardt³, Stefan Spitzer^{9

10}, Johannes Brachmann¹¹, Hüseyin Ince^{1

2}, Giuseppe D'Ancona¹

Affiliations

¹ Department of Cardiology and Internal Intensive Care Unit, Berlin Heartrhythm Center, Vivantes Clinic Am Urban, Berlin, Germany.
² Department of Cardiology, University Medical Center Rostock, Rostock, Germany.
³ Department of Cardiology and Angiology, Division of Electrophysiology, University Hospital of Muenster, Muenster, Germany.
⁴ Department of Cardiology, Pneumology, Angiology and Internal ICU, Klinikum Ludwigshafen, Ludwigshafen, Germany.
⁵ Department of Cardiology, Klinikum St. Elisabeth Straubing, Straubing, Germany.
⁶ Foundation Institute for Myocardial Infarction Research, Ludwigshafen, Germany.
⁷ Herzmedizin.berlin, Berlin, Germany.
⁸ Department of Cardiology, Klinikum Bielefeld, Bielefeld, Germany.
⁹ Heart and Vascular Practice Clinic, Dresden, Germany.
¹⁰ Brandenburg University of Technology Cottbus-Senftenberg, Institute of Medical Technology, Cottbus, Germany.
¹¹ Department of Cardiology, Klinikum Coburg, Coburg, Germany.

Abstract

Background: Atrial fibrillation (AF) is a cardiac arrhythmia frequently documented in patients requiring implantable cardioverter defibrillators (ICDs) and/or cardiac resynchronization therapy with defibrillator (CRT-D). Patients with diagnosed AF at the point of ICD or CRT-D implantation may have an impaired follow-up outcome.

Methods: The German DEVICE I-II registry is a nationwide prospective multicentre database of patients implanted with ICD and CRT-D with clinical follow-up data. We analysed a 1-year follow up of implanted patients with AF and with sinus rhythm (SR).

Results: A total of 4,929 ICD/CRT patients are included in the present analysis: 946 (19.2%) were in AF and 3,983 (80.8%) were SR at time of device implantation. AF patients had a significantly more comorbid profile including older age {72 [interquartile range (IQR), 66-77] vs. 66 (IQR, 56-73) years; P<0.001}, and higher rate of patients with left ventricular ejection fraction <30% (68.2% vs. 61.0%; P<0.001), peripheral artery disease (4.5% vs. 2.7%; P=0.002), diabetes (33.6% vs. 25.5%; P<0.001), hypertension (58.4% vs. 51.1%; P<0.001) and renal failure (22.6% vs. 15.3%; P<0.001). The intra-hospital complication rate was 4.3% in the AF and 3.6% in the SR group (P=0.38). In 1-year follow-up AF patients experienced a significantly higher rate of defibrillator shocks (25% vs. 15.3%; P<0.001). One-year estimated mortality was 10.8% in the AF and 5.9% in the SR group (P<0.001), while estimated 1-year major adverse cardiac and cerebrovascular events (MACCE) rate was 11.2% vs. 7.0% (P<0.001). The effects of AF on electrical shocks and mortality persisted after adjusting for age, sex, advanced New York Heart Association (NYHA) class, severely impaired left ventricular ejection fraction (LVEF), coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM), chronic renal failure (CRF), QRS duration, and type of indication for electronic device implantation.

Conclusions: Our clinical data on an extended cohort of contemporary patients confirm the significant impact of AF, and its associated comorbidities, upon mortality and major adverse events after implantation of ICD/CRT.

Keywords: Implantable cardioverter defibrillators (ICDs); atrial fibrillation (AF); cardiac resynchronization therapy with defibrillator (CRT-D); follow-up; registry.