Puljevic Mislav, Ciglenecki Eugen, Pasara Vedran, Prepolec Ivan, Dosen Mia Dubravcic, Hrabac Pero, Brekalo Ana-Marija, Bencic Martina Lovric, Krpan Miroslav, Matasic Richard, Pezo-Nikolic Borka, Puljevic Davor, Milicic Davor, Velagic Vedran
Department of Cardiovascular Diseases, University Hospital Centre Zagreb, 10000 Zagreb, Croatia.
Department of Cardiovascular Diseases, University of Zagreb School of Medicine, 10000 Zagreb, Croatia.
Rev Cardiovasc Med. 2025 Apr 16;26(4):26349. doi: 10.31083/RCM26349. eCollection 2025 Apr.
Implantable cardioverter defibrillators (ICDs) have significantly reduced the incidence of sudden cardiac death in patients with heart failure, particularly those with ischemic heart disease. However, the impact on overall mortality remains controversial, especially in non-ischemic heart failure patients. The Danish Study to Assess the Efficacy of ICDs in Patients with Non-Ischemic Systolic Heart Failure (DANISH) trial and subsequent studies have questioned the efficacy of ICDs in this population, particularly among older patients. The present study aimed to evaluate survival outcomes and predictors in a Croatian cohort of patients with an ICD or cardiac resynchronization therapy defibrillator (CRT-D) device.
This retrospective cohort study analyzed data from 614 patients who received an ICD or CRT-D device at KBC Zagreb between 2009 and 2018. Patient data, including demographic information, device indication, and clinical parameters, were collected at the time of implantation. Follow-up data were systematically recorded to assess device activation and survival outcomes. Statistical analyses included a detailed descriptive analysis, Kaplan-Meier survival estimates, and Cox regression models.
The cohort consisted predominantly of males (83.4%), with a mean age of 58.7 years. Most had reduced left ventricular ejection fraction (mean 31.4%) and were classified as New York Heart Association (NYHA) class II or III. Over a median follow-up of 48.4 months, 36.6% of patients died. Device activation occurred in 30.3% of patients, with appropriate activation observed in 88.2% of these cases. Cox regression identified age, non-sustained ventricular tachycardia (NSVT), and decompensation history as significant survival predictors.
This study confirmed that appropriate device activation improved survival in patients with an ICD/CRT-D. Age, NSVT, and history of decompensation were key predictors of device activation and survival outcomes. These findings underscore the need for individualized patient assessment when considering inserting ICDs, particularly in non-ischemic heart failure patients. Further research is needed to refine clinical guidelines and optimize patient selection for ICD therapy.
植入式心脏复律除颤器（ICD）显著降低了心力衰竭患者，尤其是缺血性心脏病患者的心源性猝死发生率。然而，其对总体死亡率的影响仍存在争议，特别是在非缺血性心力衰竭患者中。丹麦评估ICD对非缺血性收缩性心力衰竭患者疗效的研究（DANISH）试验及后续研究对ICD在该人群中的疗效提出了质疑，尤其是在老年患者中。本研究旨在评估克罗地亚一组植入ICD或心脏再同步化治疗除颤器（CRT-D）装置患者的生存结局及预测因素。
这项回顾性队列研究分析了2009年至2018年期间在萨格勒布大学医院中心接受ICD或CRT-D装置的614例患者的数据。在植入时收集患者数据，包括人口统计学信息、装置适应证和临床参数。系统记录随访数据以评估装置激活情况和生存结局。统计分析包括详细的描述性分析、Kaplan-Meier生存估计和Cox回归模型。
该队列主要由男性（83.4%）组成，平均年龄为58.7岁。大多数患者左心室射血分数降低（平均31.4%），并被归类为纽约心脏协会（NYHA）II级或III级。在中位随访48.4个月期间，36.6%的患者死亡。30.3%的患者发生了装置激活，其中88.2%的激活是恰当的。Cox回归确定年龄、非持续性室性心动过速（NSVT）和失代偿史为重要的生存预测因素。
本研究证实，恰当的装置激活可改善ICD/CRT-D患者的生存。年龄、NSVT和失代偿史是装置激活和生存结局的关键预测因素。这些发现强调在考虑植入ICD时，尤其是在非缺血性心力衰竭患者中，需要对患者进行个体化评估。需要进一步研究以完善临床指南并优化ICD治疗的患者选择。
