Evaluation of adherence to clinical recommendations оf implantable cardioverter defibrillators

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Relevance: Sudden cardiac death (SCD) as an irreversible outcome, sudden circulatory arrest (VOC) reaches 50% among other outcomes in people aged 35-50 years, mainly males[1].
SCD as an irreversible outcome and the result of sudden cardiac arrest reaches 50% among other outcomes in people aged 35-50 years, mainly males, but recently there has been a tendency to increase the proportion of women, as well as adolescents and young adults. The risk of SCD is higher in men and increases with age due to the higher prevalence of coronary heart disease among the elderly [4]. The number of SCD cases varies from 1.4 per 100,000 person-years (95% CI – 0.95–1.98) in women and up to 6.68 per 100,000 person-years (95% CI – 6.24–7.14) in men. The number of SCD cases among the younger generation is 0.46–3.7 per 100,000 person-years [5], which translates into 1,100-9,000 deaths in Europe and 800-6,200 deaths in the United States each year.
An implantable cardioverter defibrillator (ICD) is a device for interrupting a life-threatening arrhythmia in order to prevent VOC. A number of studies have shown that ICD significantly reduces cardiovascular mortality among patients at high risk of SCD [2, 3].
Objective: To study the clinical results of cardioverter defibrillator implantation according to clinical guidelines.
Materials and methods: The study was conducted on the basis of a retrospective study of the medical records of inpatient patients who had ICDs implanted at the Kazan Medical Center in the period from 2019 to 2024. A total of 154 devices were implanted, and the average follow-up was in 33 (21.4%) patients. The patients underwent instrumental examinations (ECG, ECHO-KG, HOLTEKG) before and after surgery. Currently, the only approved clinical recommendations of the Ministry of Health of the Russian Federation on the basis of which indications are determined are the recommendations "Ventricular arrhythmias. Ventricular tachycardia and sudden cardiac death" since 2020. Indications were decreased LV systolic function (less than 40%), cardiomyopathy, and the presence of stable or unstable VT runs on the Holter ECG.
The median age of the patients was 60±(58;83) years. There were 132 (85.7%) men, 22 (14.3%) women, 72% of women were employed, and 33.3% of men. The etiology of ICD implantation was ischemic cardiomyopathy in 93 (60.4%) patients, dilated cardiomyopathy in 61 (39.6%) patients. According to ECHOCG data, the average LVEF was 27±9.8%. Among the 33 patients observed in the long-term period, the following results were obtained. Arterial hypertension was present in 19 (57.5%) patients, chronic heart failure - 25 (75%) (of which FC 2 in women in 60% of cases, FC 3 in men in 35.7%, FC 3 in 40% and 64.3%, respectively), type 2 diabetes mellitus - 9 (27%), chronic kidney disease in 14 (42.2%). The patients had a history of surgical interventions: coronary artery stenting in 7 (21%), prosthetics of heart valves in 2 (0.6%), CABG in 3 (0.9%), and MCG in 4 (12%). According to the results of daily electrocardiogram monitoring, the indications for ICD in patients were ventricular tachycardia in 15 (45.4%) patients, unstable ventricular tachycardia in 11 (33.3%), atrial fibrillation in 8 (24%). ICD implantation was performed as a primary prophylaxis in 30 (90.9%) patients, and as a secondary prophylaxis in 3 (9.1%). Single-chamber ICDs were installed in 16 (48.5%) people, double-chamber ICDs - in 17 (51.5%). Ventricular electrodes were installed in the outflow tract of the right ventricle in 10 (30.3%) people, in the apex of the left ventricle in 23 (69.7%). After ICD installation, sinus rhythm was recorded in 17 (51.5%) people, various forms of atrial fibrillation in 15 (45.5%), extrasystole in 1 (3%). Complications occurred in 6 (9.4%) patients, and included hematoma in 3 (4.6%), electrode dislocation in 2 (1.2%), and perforation in 1 (0.6%) patient. No cases of mortality were recorded in the postoperative period.
The interval from the moment of implantation to the first ICD therapy varies from 8 to 33.5 months. After implantation, defibrillation due to VF occurred in 13 (39.3%) patients. Antithachycardial stimulation (ATS) was activated in 13 (39.3%) patients. ATS activation and defibrillation were performed in 8 (24.2%) patients. During the follow-up period, 13 (39.3%) patients had no therapy.
Conclusions:
An implantable cardioverter defibrillator effectively reduces the risk of sudden cardiac death in high-risk patients. Our study has demonstrated adherence to clinical guidelines.

About the authors

Said Mukhibdzhonovich Azizov

Email: azizovssx.4546@mail.ru
ORCID iD: 0009-0003-9318-1671
Russian Federation, 36, Butlerova street, 420012, Kazan, Russian Federation

lldar Vasylovich Abdulyanov

Author for correspondence.
Email: ildaruna@mail.ru
ORCID iD: 0000-0003-2892-2827
Russian Federation, 36, Butlerova street, 420012, Kazan, Russian Federation

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