ABSTRACT
Background:
Patients with progressive
chronic kidney disease (CKD) are at higher
risk of
infections and
complications from cardiac implantable
electronic devices (CIED). In
patients with a primary or
secondary prophylactic indication, implantable cardiac
defibrillators (ICD) can prevent sudden cardiac deaths (SCD). We retrospectively compared transvenous-ICD (TV-ICD) and intermuscularly implanted subcutaneous-ICD (S-ICD) associated
infections and complication rates together with
hospitalizations in recipients with stage 4
kidney disease.
Methods:
We retrospectively analyzed 70
patients from six German centers with stage 4 CKD
who received either a prophylactic TV-ICD with a single right ventricular
lead, 49
patients, or a S-ICD, 21
patients. Follow-Ups (FU) were performed bi-annually.
Results:
The TV-ICD
patients were significantly older. This group had more
patients with a
history of atrial arrhythmias and more were prescribed
anti-arrhythmic medication compared with the S-ICD group. There were no significant differences for other baseline characteristics. The median and interquartile range of FU durations were 55.2 (57.6-69.3) months. During FU,
patients with a TV-ICD system experienced significantly more
device associated
infections (n = 8, 16.3% vs. n = 0; p < 0.05),
device-associated
complications (n = 13, 26.5% vs. n = 1, 4.8%; p < 0.05) and
device associated
hospitalizations (n = 10, 20.4% vs. n = 1, 4.8%; p < 0.05).
Conclusion:
In this long-term FU of
patients with stage 4 CKD and an indication for a prophylactic ICD, the S-ICD was associated with significantly fewer
device associated
infections,
complications and
hospitalizations compared with TV-ICDs.
