Appropriate Shocks and Mortality in Patients With Versus Without Diabetes With Prophylactic
Implantable Cardioverter Defibrillators.
Junttila, M Juhani; Pelli, Ari; Kenttä, Tuomas V; Friede, Tim; Willems, Rik; Bergau, Leonard; Malik, Marek; Vandenberk, Bert; Vos, Marc A; Schmidt, Georg; Merkely, Bela [Merkely, Béla Péter (Kardiológia), author] Cardiovascular Center (SU
/ FM / C); Department of Cardiology – Heart and Vascular C... (SU / FM / C); Faculty
of Sports Medicine (SU / FM / C); Lubinski, Andrzej; Svetlosak, Martin; Braunschweig, Frieder; Harden, Markus; Zabel, Markus; Huikuri, Heikki V; Sticherling, Christian; Zabel, Markus [Collaborator]; Seegers, Joachim [Collaborator]; Bergau, Leonard [Collaborator]; EU-CERT-ICD Investigators [Collaborative Organization]; Hasenfuß, Gerd [Collaborator]; Munoz-Exposito, Pascal [Collaborator]; Tichelbäcker, Tobias [Collaborator]; Kirova, Aleksandra [Collaborator]; Schlögl, Simon [Collaborator]; Sritharan, Rajevaa [Collaborator]; Jörß, Katharina [Collaborator]; Macken, Jessica [Collaborator]; Misdaq, Misbah [Collaborator]; Rudolph, Kornelia [Collaborator]; Zabel, Markus [Collaborator]; Hasenfuß, Gerd [Collaborator]; Friede, Tim [Collaborator]; Bauer, Axel [Collaborator]; Meyer-Zürn, Christine [Collaborator]; Eick, Christian [Collaborator]; Rechts der Isar, Klinikum [Collaborator]; Schmidt, Goerg [Collaborator]; Müller, Alexander [Collaborator]; Dommasch, Michael [Collaborator]; Sinnecker, Daniel [Collaborator]; Kääb, Stefan [Collaborator]; Sinner, Moritz F [Collaborator]; Bauer, Axel [Collaborator]; Dissmann, Rüdiger [Collaborator]; Burmester, Ute [Collaborator]; Behrens, Steffen [Collaborator]; Gregor, Martina [Collaborator]; Stefanow, Stefan [Collaborator]; Rüb, Norman [Collaborator]; Wolpert, Christian [Collaborator]; Bimmel, Dieter [Collaborator]; Lieberz, Christiane [Collaborator]; Seegers, Joachim [Collaborator]; Maier, Lars S [Collaborator]; Schwinger, Robert H G [Collaborator]; Blaschke, Florian [Collaborator]; Pieske, Burkert [Collaborator]; Grönefeld, Gerian [Collaborator]; Klein, Gunnar [Collaborator]; Gardiwal, Ajmal [Collaborator]; Merkely, Bela [Merkely, Béla Péter (Kardiológia), Collaborator] Cardiovascular Center
(SU / FM / C); Department of Cardiology – Heart and Vascular C... (SU / FM / C); Faculty
of Sports Medicine (SU / FM / C); Szeplaki, Gabor [Széplaki, Gábor (Kardiológia), Collaborator] Department of Cardiology
– Heart and Vascular C... (SU / FM / C); Perge, Peter [Perge, Péter (orvostudományok), Collaborator] Department of Cardiology
– Heart and Vascular C... (SU / FM / C); Szavits Nossan, Janko [Collaborator]; Rotkvić, Luka [Collaborator]; Pavlovic, Nikola [Collaborator]; Manola, Sime [Collaborator]; Vinter, Ozren [Collaborator]; Benko, Ivica [Collaborator]; Brusic, Sandro [Collaborator]; Avdovic, Ervin [Collaborator]; Klasan, Marina [Collaborator]; Bakotic, Zoran [Collaborator]; Anic, Ante [Collaborator]; Jurisic, Zrinka [Collaborator]; Lubinski, Andrzej [Collaborator]; Kowalczyk, Emilia [Collaborator]; Kucejko, Tomasz [Collaborator]; Czechowska, Agnieszka [Collaborator]; Wybor, Katarina [Collaborator]; Cygankiewicz, Iwona [Collaborator]; Ptaszyński, Pawel [Collaborator]; Kasprzak, Jaroslaw [Collaborator]; Qavoq, Dariusz [Collaborator]; Guzik, Przemyslaw [Collaborator]; Krauze, Tomasz [Collaborator]; Sterlinski, Maciej [Collaborator]; Hatala, Robert [Collaborator]; Svetlosak, Martin [Collaborator]; Kaliska, Gabriela [Collaborator]; Martinek, Jozef [Collaborator]; Hastrup Svendsen, Jesper [Collaborator]; Thamsborg, Karen [Collaborator]; Hansen, Jim [Collaborator]; Schloett-Hyldelund, Ida-Maria [Collaborator]; Laage-Petersen, Julie [Collaborator]; Willems, Rik [Collaborator]; Vandenberk, Bert [Collaborator]; van Soest, Sofie [Collaborator]; Flevari, Panayota [Collaborator]; Katsaras, Dimitrios [Collaborator]; Katsimardos, Andreas [Collaborator]; Leftheriotis, Dionyssios [Collaborator]; Papangelopoulou, Konstantinia [Collaborator]; Varlamos, Charalambos [Collaborator]; Traykov, Vassil [Collaborator]; Velchev, Vasil [Collaborator]; Iovev, Svetoslav [Collaborator]; Shalganov, Tchavdar [Collaborator]; Sticherling, Christian [Collaborator]; Conen, David [Collaborator]; Giesebart, Sarah [Collaborator]; Novotny, Tomas [Collaborator]; Kozak, Milan [Collaborator]; Taborsky, Milos [Collaborator]; Galuszka, Jan [Collaborator]; Tuinenburg, Anton E [Collaborator]; Wijers, Sofieke [Collaborator]; Vos, Marc A [Collaborator]; Wijers, Sofieke [Collaborator]; Dunnink, Albert [Collaborator]; Sprenkeler, David [Collaborator]; Brugada, Josep [Collaborator]; Arbelo, Elena [Collaborator]; Trucco, Emilce [Collaborator]; Vidorreta, Silvia [Collaborator]; Huikuri, Heikki V [Collaborator]; Kenttä, Tuomas [Collaborator]; Pelli, Ari [Collaborator]; Huikuri, Pirkko [Collaborator]; Koski, Päivi [Collaborator]; Braunschweig, Frieder [Collaborator]; Karlsson, Helena [Collaborator]; Ersgaard, David [Collaborator]; Platonov, Pyotr [Collaborator]; Grönefeld, Gerian [Collaborator]; Klingenheben, Thomas [Collaborator]
Diabetes increases the risk of all-cause mortality and sudden cardiac death (SCD).
The exact mechanisms leading to sudden death in diabetes are not well known. We compared
the incidence of appropriate shocks and mortality in patients with versus without
diabetes with a prophylactic implantable cardioverter defibrillator (ICD) included
in the retrospective EU-CERT-ICD registry.A total of 3,535 patients from 12 European
EU-CERT-ICD centers with a mean age of 63.7 ± 11.2 years (82% males) at the time of
ICD implantation were included in the analysis. A total of 995 patients (28%) had
a history of diabetes. All patients had an ICD implanted for primary SCD prevention.
End points were appropriate shock and all-cause mortality. Mean follow-up time was
3.2 ± 2.3 years. Diabetes was associated with a lower risk of appropriate shocks (adjusted
hazard ratio [HR] 0.77 [95% CI 0.62-0.96], P = 0.02). However, patients with diabetes
had significantly higher mortality (adjusted HR 1.30 [95% CI 1.11-1.53], P = 0.001).All-cause
mortality is higher in patients with diabetes than in patients without diabetes with
primary prophylactic ICDs. Subsequently, patients with diabetes have a lower incidence
of appropriate ICD shocks, indicating that the excess mortality might not be caused
primarily by ventricular tachyarrhythmias. These findings suggest a limitation of
the potential of prophylactic ICD therapy to improve survival in patients with diabetes
with impaired left ventricular function.
