Survival outcomes and prevalence of complications associated with the presence of an implantable electronic device with defibrillation function in patients with chronic heart failure with improved left ventricular ejection fraction

Aim. To evaluate survival outcomes, the frequency of adverse events and repeat interventions, and to identify predictors of adverse outcomes in patients with chronic heart failure (CHF) with improved left ventricular ejection fraction (LVEF) receiving implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-D) for primary prevention of sudden cardiac death (SCD).

Methods. A single-center retrospective study was conducted including 87 patients with CHF and improved LVEF (baseline LVEF ≤35%, LVEF ≥40% at enrollment with absolute increase ≥10%), who underwent ICD (n=34; 39.1%) or CRT-D (n=53; 60.9%) implantation at the Almazov National Medical Research Centre, Ministry of Health of Russia between 2016 and 2022. The primary endpoint was all-cause mortality; secondary endpoints included episodes of inappropriate electrical therapy and complications related to implanted devices. The median follow-up period after enrollment was 5.2±2.8 years. Statistical analysis was performed using StatTech v. 4.8.5 software.

Results. During the follow-up period, 10 deaths (11.9%) were registered: 4 cases among ICD patients (11.8%) and 6 cases among CRT-D patients (12.0%) with no statistically significant differences between groups. The overall rate of device-related complications was 16.1%, with the highest incidence of lead dislodgement (6.9%) and lead damage (4.6%). Inappropriate electrical therapy was registered in 13.8% of patients. Risk factors associated with unfavorable prognosis were identified: ischemic etiology of CHF, valvular heart disease, incomplete recovery of left ventricular systolic function, and atrial fibrillation.

Conclusion. The presence of ICD/CRT-D in patients with CHF and improved LVEF is associated with substantial risks of complications and inappropriate therapy, indicating the need for improvement of personalized approaches to primary SCD prevention in this patient category.

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