Impact of atrial fibrillation on early complications and one year-survival after cardioverter defibrillator implantation: Results from the German DEVICE registry

Abstract

Outcome data of patients with implantable cardioverter defibrillators (ICD) and atrial fibrillation (AF) are conflicting. The German DEVICE registry aims to add further information on this particular cohort. The German DEVICE registry is a nationwide prospective multicenter database of ICD implantations. 3261 patients are included (81% males, 2701 (82.8%) first ICD implantations, 560 (17.2%) ICD replacements). Cardiac resynchronization therapy (CRT-D) was performed in 882 patients (27.0%). Sinus rhythm (SR) was present in 2654 (81.4%) and atrial fibrillation (AF) in 607 (18.6%). Left ventricular ejection fraction (LVEF) did not differ between groups (SR 32.3%, AF 30.4%; p = 0.09). AF patients were older (AF 70.9 versus SR 63.9 years; p < 0.0001), presented with more co-morbidities (diabetes, hypertension, chronic kidney disease; all p < 0.001). In-hospital complications were not significantly different between groups (p = 0.58). Follow-up information after one year was available in 2967 patients (91%). One-year overall mortality after first ICD implantation was 4.9% for SR and 11.2% for AF patients (p < 0.0001); mortality one year after ICD replacement was 8.4% for SR and 12.0% for AF (p = 0.34). No statistically significant difference between SR and AF patients receiving a CRT device was observed (SR 6.9%, AF 10.7%, p = 0.16) in terms of one-year mortality. The German DEVICE registry demonstrates that patients with AF who receive ICD devices are older, have more co-morbidity and more severe heart failure. AF carries an independent 1.39 fold risk (95% CI 1.02-1.89) of death after one year in patients only with first ICD implantation.