Hospitalization Patterns and Complications in ICD and CRT-D Implantations: VIDEO Study
Overview
The VIDEO Study analyzed 2,001 patients undergoing ICD or CRT-D implantation across Germany, revealing significant differences in baseline characteristics, ICU utilization, and peri-procedural complications among single-chamber ICD, dual-chamber ICD, and CRT-D recipients. CRT-D patients were older with more comorbidities and had higher ICU admission rates and longer hospital stays compared to ICD groups.
Background
Implantable cardioverter-defibrillators (ICDs) are critical for preventing sudden cardiac death in patients at risk of ventricular arrhythmias. Device types include single-chamber ICDs, dual-chamber ICDs, and cardiac resynchronization therapy defibrillators (CRT-Ds), each with varying procedural complexities and patient indications. CRT-Ds are typically implanted in patients with heart failure and electrical dyssynchrony, often with more comorbidities. Real-world data comparing hospitalization parameters and complications among these device types are limited but essential for optimizing clinical management.
Data Highlights
Parameter
Single-Chamber ICD (n=815)
Dual-Chamber ICD (n=463)
CRT-D (n=723)
p-value
Mean Age (years)
63.0 ± 12.6
63.7 ± 12.2
67.5 ± 10.4
<0.01
Female (%)
20.1%
20.1%
20.1%
NS
Obesity (%)
Not specified
Not specified
12.3%
0.03
Diabetes Mellitus (%)
Not specified
Not specified
30.2%
<0.01
Chronic Renal Disease (%)
Not specified
Not specified
31.0%
<0.01
Psychological/Behavioral Disorders (%)
Not specified
22.7%
Not specified
<0.01
History of Sudden Cardiac Arrest (%)
15.0%
20.5%
7.6%
<0.01
Left Bundle Branch Block (LBBB) (%)
3.2%
5.8%
46.3%
<0.01
Permanent Atrial Fibrillation (%)
1.7%
7.6%
10.1%
<0.01
Key Findings
CRT-D recipients were significantly older and had higher rates of obesity, diabetes, and chronic renal disease compared to ICD recipients.
Dual-chamber ICD patients had a higher prevalence of psychological/behavioral disorders and history of sudden cardiac arrest than other groups.
Left bundle branch block was markedly more prevalent in CRT-D patients (46.3%) versus single- and dual-chamber ICD patients.
Permanent atrial fibrillation was more common in CRT-D patients compared to ICD groups.
A substantial proportion of CRT-D implantations were performed in patients without classical guideline criteria based on QRS morphology and duration.
Clinical Implications
Clinicians should recognize that CRT-D patients typically present with greater comorbidity burden and may require more intensive peri-procedural care, including higher ICU utilization. Device selection should consider patient-specific factors such as age, comorbidities, and arrhythmia history to optimize outcomes. Awareness of the deviation from guideline-based CRT-D implantation criteria highlights the need for careful patient evaluation and adherence to evidence-based indications.
Conclusion
The VIDEO Study provides valuable real-world insights into differences in patient profiles and hospitalization patterns among ICD and CRT-D recipients in Germany, underscoring the importance of tailored clinical management strategies to address varying procedural risks and resource needs.
References
VIDEO Study Group 2023 -- Analysis of Hospitalization Patterns and Complications Related to ICD and CRT-D Implantations in Germany
by Tugba Aktemur Oezalp, Kohei Ukita, Thomas Riemer, Jochen Senges, Johannes Brachmann, Thorsten Lewalter, Thomas Deneke, Nicolas Doll, Lars Eckardt, Daniel Steven, Ibrahim Akin, Roland Richard Tilz
