Implantable cardioverter defibrillators in diabetics: efficacy and safety in patients at risk of sudden cardiac death

Abstract

Summary Diabetes mellitus is a major risk factor for arrhythmogenesis and is associated with a 2-fold increase in all-cause mortality and a 4-fold increase in cardiovascular mortality including sudden cardiac death when compared to nondiabetics. Implantable cardioverter defibrillators (ICD) have been shown to effectively reduce arrhythmic death and all-cause mortality in patients with severe myocardial dysfunction. With a high competing risk of nonarrhythmic cardiac and noncardiac death, survival benefit of ICD in patients with diabetes mellitus could be reduced, but the sub-analysis of diabetic patients in randomized clinical trials provides reassurance regarding a similar beneficial survival effect of ICD and cardiac resynchronization therapy in diabetics, as observed in the overall population with advanced heart disease. In this article, the authors highlight some of the clinical issues related to diabetes, summarize the data on the efficacy of ICD in diabetics when compared to nondiabetics and discuss concerns related to ICD implantation in patients with diabetes.

Sociodemographic and clinical correlates of diabetes self‐efficacy in adults with type 2 diabetes and comorbid heart failure

“…An ICD is effective in preventing sudden death in individuals with ischemic or nonischemic HF (Theuns, Smith, Hunink, Bardy, & Jordaens, ). This survival benefit also exists in patients with comorbid T2D and HF (Echouffo‐Tcheugui, Masoudi, Bao, Spatz, & Fonarow, ; Shahreyar et al, ). An ICD may be a proxy either for higher NYHA class indicating worsening HF or diabetes end organ failure, given its significant association with both outcomes.…”

Advantages of Intra-cardiac Polymer Coated Electrodes Leads in Patients with Diabetes Mellitus and Cardiovascular Implantable Electronic Devices

“…It is intriguing that there were no events related to polymer coated electrode leads in patients with CRT or ICD, possibly explained by different design, these leads being thicker, more compact and with more inner coils and a smoother outer surface that can prevent tissue ingrowth and may facilitate lead extraction [5,8,10,19].…”

“…Type 2 diabetes mellitus (DM) represents a major risk factor for ischemic heart disease (IHD), dilated cardiomyopathy (DCM) and chronic heart failure (CHF) being associated with increased cardiovascular morbidity and mortality [1]. Patients with DM are exposed to an elevated risk of arrhythmias, including atrial fibrillation, conduction disturbances and ventricular arrhythmias triggering an increased predisposition for stroke and sudden cardiac death (SCD) [2,3]. For the treatment of these pathologies, cardiac implantable electronic devices (CIED) like permanent pacemakers (PPM), resynchronization therapy (CRT) or cardioverter-defibrillators (ICD) are often required in diabetic patients to save their lives and/or to improve the quality of life.…”

“…The most required proprieties were good electrical conductibility, flexibility and durability, biostability and compatibility. Thus, some complications related to the presence of electrodes leads like fractures or infections grafted on right heart structures seem to be more frequent in patients with DM [2,5].…”

Impact of COVID-19 Pandemic on the Implantation of Intra-Cardiac Devices in Diabetic and Non-Diabetic Patients in the Western of Romania

“…Another important aspect is the increased prevalence of dilated cardiomyopathy (DCM) associated with important systolic dysfunction and a high risk of ventricular arrhythmias resulting in sudden cardiac death (SCD) [ 13 , 14 ]. In order to save their lives and/or to improve their quality of life, these patients often require the implantation of ICDs or CRTs [ 15 , 16 , 17 ].…”