Appropriate Shocks and Mortality in Patients With Versus Without Diabetes With Prophylactic Implantable Cardioverter Defibrillators
Authors: Junttila M. Juhani , Pelli Ari , Kenttä Tuomas V. , Friede Tim , Willems Rik , Bergau Leonard , Malik Marek , Vandenberk Bert , Vos Marc A. , Schmidt Georg , Merkely Bela , Lubinski Andrzej , Svetlosak Martin , Braunschweig Frieder , Harden Markus , Zabel Markus , Huikuri Heikki V. , Sticherling Christian ,   EU-CERT-ICD Investigators, Zabel Markus , Seegers Joachim , Bergau Leonard , Hasenfuß Gerd , Munoz-Exposito Pascal , Tichelbäcker Tobias , Kirova Aleksandra , Schlögl Simon , Sritharan Rajevaa , Jörß Katharina , Macken Jessica , Misdaq Misbah , Rudolph Kornelia , Zabel Markus , Hasenfuß Gerd , Friede Tim , Bauer Axel , Meyer-Zürn Christine , Eick Christian , rechts der Isar Klinikum , Schmidt Goerg , Müller Alexander , Dommasch Michael , Sinnecker Daniel , Kääb Stefan , Sinner Moritz F. , Bauer Axel , Dissmann Rüdiger , Burmester Ute , Behrens Steffen , Gregor Martina , Stefanow Stefan , Rüb Norman , Wolpert Christian , Bimmel Dieter , Lieberz Christiane , Seegers Joachim , Maier Lars S. , Schwinger Robert H.G. , Blaschke Florian , Pieske Burkert , Grönefeld Gerian , Klein Gunnar , Gardiwal Ajmal , Merkely Bela , Szeplaki Gabor , Perge Peter , Szavits Nossan Janko , Rotkvić Luka , Pavlovic Nikola , Manola Sime , Vinter Ozren , Benko Ivica , Brusic Sandro , Avdovic Ervin , Klasan Marina , Bakotic Zoran , Anic Ante , Jurisic Zrinka , Lubinski Andrzej , Kowalczyk Emilia , Kucejko Tomasz , Czechowska Agnieszka , Wybor Katarina , Cygankiewicz Iwona , Ptaszyński Pawel , Kasprzak Jaroslaw , Qavoq Dariusz , Guzik Przemyslaw , Krauze Tomasz , Sterlinski Maciej , Hatala Robert , Svetlosak Martin , Kaliska Gabriela , Martinek Jozef , Hastrup Svendsen Jesper , Thamsborg Karen , Hansen Jim , Schloett-Hyldelund Ida-Maria , Laage-Petersen Julie , Willems Rik , Vandenberk Bert , van Soest Sofie , Flevari Panayota , Katsaras Dimitrios , Katsimardos Andreas , Leftheriotis Dionyssios , Papangelopoulou Konstantinia , Varlamos Charalambos , Traykov Vassil , Velchev Vasil , Iovev Svetoslav , Shalganov Tchavdar , Sticherling Christian , Conen David , Giesebart Sarah , Novotny Tomas , Kozak Milan , Taborsky Milos , Galuszka Jan , Tuinenburg Anton E. , Wijers Sofieke , Vos Marc A. , Wijers Sofieke , Dunnink Albert , Sprenkeler David , Brugada Josep , Arbelo Elena , Trucco Emilce , Vidorreta Silvia , Huikuri Heikki V. , Kenttä Tuomas , Pelli Ari , Huikuri Pirkko , Koski Päivi , Braunschweig Frieder , Karlsson Helena , Ersgaard David , Platonov Pyotr , Grönefeld Gerian , Klingenheben Thomas 
Published: October 2019

OBJECTIVE
Diabetes increases the risk of all-cause mortality and sudden cardiac death (SCD). The exact mechanisms leading to sudden death in diabetes are not well known. We compared the incidence of appropriate shocks and mortality in patients with versus without diabetes with a prophylactic implantable cardioverter defibrillator (ICD) included in the retrospective EU-CERT-ICD registry.

RESEARCH DESIGN AND METHODS AND RESULTS
A total of 3,535 patients from 12 European EU-CERT-ICD centers with a mean age of 63.7 ± 11.2 years (82% males) at the time of ICD implantation were included in the analysis. A total of 995 patients (28%) had a history of diabetes. All patients had an ICD implanted for primary SCD prevention. End points were appropriate shock and all-cause mortality. Mean follow-up time was 3.2 ± 2.3 years. Diabetes was associated with a lower risk of appropriate shocks (adjusted hazard ratio [HR] 0.77 [95% CI 0.62–0.96], P = 0.02). However, patients with diabetes had significantly higher mortality (adjusted HR 1.30 [95% CI 1.11–1.53], P = 0.001).

CONCLUSIONS
All-cause mortality is higher in patients with diabetes than in patients without diabetes with primary prophylactic ICDs. Subsequently, patients with diabetes have a lower incidence of appropriate ICD shocks, indicating that the excess mortality might not be caused primarily by ventricular tachyarrhythmias. These findings suggest a limitation of the potential of prophylactic ICD therapy to improve survival in patients with diabetes with impaired left ventricular function.