Real-world implantable cardioverter-defibrillator outcomes in a north-african tertiary centre: baseline profile, arrhythmic therapies, device-related events and early outcomes
N Dahimene, Y Aoudia, M M Baouni, F Chaouat, A M C Alouache, A Makhloufi, D Djermane, S Bachtarzi, Z BenouiAbstract
Background
Large international registries report improving ICD safety and lower inappropriate therapy rates with contemporary programming. Outcomes remain strongly influenced by substrate and indication, and case-mix varies across regions, including younger cohorts. However, a lack of published real-world data limits our understanding of how these patterns apply to North-African centres.
Purpose
To characterise patient profile and electrophysiology-relevant outcomes after ICD implantation in a North-African tertiary centre, and to identify predictors of appropriate ICD therapy.
Methods
Retrospective cohort of consecutive ICD recipients (n=66). Indications were primary (n=35) or secondary prevention (n=31). Follow-up was calculated from implantation to last visit: median 7 months (IQR 3–14). Sustained ventricular tachycardia/ventricular fibrillation (VT/VF) was analysed separately from non-sustained VT (NSVT). Outcomes included appropriate therapies (ATP and/or shock), inappropriate therapies, device-related events, heart-failure (HF) hospitalisation and all-cause mortality during follow-up, and telemonitoring uptake. Multivariable logistic regression explored predictors of appropriate therapy (secondary vs primary prevention, age, sex, ischaemic aetiology).
Results
Mean age was 51.1 years (14–78); 69.7% were male. Substrate was predominantly non-ischaemic/inherited (ischaemic 41%; hypertrophic cardiomyopathy 18%; dilated cardiomyopathy 17%; arrhythmogenic right ventricular cardiomyopathy 15%). Device type was VVI 48.5%, DDD 27.3% and CRT-D 24.2%. Sustained VT/VF occurred in 15/66 (22.7%) and NSVT in 18/66 (27.3%). At least one appropriate ICD therapy occurred in 15/66 (22.7%): ATP 9/66 (13.6%) and ATP+shock 6/66 (9.1%). Appropriate therapy was higher in secondary versus primary prevention (12/31, 38.7% vs 3/35, 8.6%; p=0.0068). Secondary prevention independently predicted appropriate therapy (adjusted OR 6.28, 95% CI 1.51–26.11; p=0.011). Inappropriate therapies were uncommon (2/66, 3.0%). Device-related events occurred in 5/66 (7.6%), including infections in 3/66 (4.5%). HF hospitalisation occurred in 6/66 (9.1%) and mortality in 1/66 (1.5%) during follow-up. Telemonitoring uptake was limited (10/66, 15.2%).
Conclusions
In this North-African real-world ICD cohort with a young profile and predominant non-ischaemic/inherited substrates, secondary prevention was the strongest independent predictor of appropriate ICD therapy. Inappropriate therapies were low and device-related event rates acceptable. Limited telemonitoring uptake highlights an actionable target to strengthen EP follow-up pathways and align outcomes with contemporary international practice.Patient profile and ICD outcomes