Comparing ICD shock ratios between Type 1, Type 2 and non diabetic patients

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Selçuk Ayhan
Veli Gökhan Cin
Sabri Abuş


Objective: The use of permanent pacemakers and implantable cardioverter defibrillators (ICDs) is increasing. With technological advances, the devices' implantation techniques and programmable features are improving, and indications are expanding. Several technical and clinical problems are encountered during implantation and follow-up of these devices.

Methods: Our study retrospectively evaluated diabetic and non-diabetic patients who underwent ICD implantation in Mersin University Cardiology Department between January 2010 and December 2013 according to current indications. All clinical characteristics, baseline, 1-month and 6-month follow-up pacemaker data and baseline laboratory values were recorded.

Results: A total of 106 ICD patients (57 diabetics and 49 nondiabetics) were enrolled at the 1st and 6th months of follow-up. 47.2% of the patients were male and the mean age was 56±7.3 years. ICDs were implanted for secondary prevention in 83.9% of patients. ICD was implanted for coronary artery disease +/- ventricular tachycardia (VT) or ventricular fibrillation (VF)+/- synchronization disorder. 75.4% of patients had CAD, and 89.6% had heart failure. The mean ejection fraction ratio (EF) was 31.3%. Early complications were observed in 10.3% of patients. 47.1% of patients received any treatment by the ICD, 34.9% had the appropriate shock, and 12.2% had inappropriate shock. The complication rate was 10.3%. While there was no difference in ventricular impedance and threshold values in diabetic patients compared to the control group, ventricular lead R amplitude values were found to be higher. The rate of atrial fibrillation was significantly different in the treated group. Treatment response was obtained in 71.4% of patients who underwent treatment change due to appropriate shock, incorrect shock and ATP.

Conclusion: In conclusion, the incidence of appropriate shock and anti-tachycardic pacing was higher in diabetic patients than non-diabetic patients.


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How to Cite
Ayhan, S., Cin, V. G., & Abuş, S. . (2023). Comparing ICD shock ratios between Type 1, Type 2 and non diabetic patients . Medical Science and Discovery, 10(5), 275–284.
Research Article
Received 2023-04-21
Accepted 2023-04-26
Published 2023-05-08


King H, Aubert RE, Herman WH: Global burden of diabetes, 1995-2025. Diabetes Care. 1998;21:1414-31.

Satman I, Yilmaz T, Sengul A, et al. Population-based study of diabetes and risk characteristics in Turkey: Results of Turkish Diabetes Epidemiology Study (TURDEP) Diabetes Care. 2002;25:1551-6.

Connery LE, Coursin DB. Assessment and therapy of selected endocrine disorders. Anesthesiol. Clin North America. 2004;22:93-123.

Johnstone MT, Nesto R. Diabetes mellitus and heart disease. In: Pickup JC, Williams G, editors. Joslin's Diabetes Mellitus. 14th ed. Philadelphia: Lippincott Williams and Wilkins. 2005. P.975- 98.

Movahed M.R., Mehrtash Hashemzadeh and M. M Jamal. Increased Prevalence of Third-Degree Atrioventricular Block in Patients With Type II Diabetes Mellitus, Chest. 2005;128:11-261.

Strickberger SA, Hummel JD, Bartlett TG. Amiodarone versus implantable cardioverter-defibrillator:randomized trial in patients with nonischemic dilated cardiomyopathy and asymptomatic nonsustained ventricular tachycardia AMIOVIRT. J Am Coll Cardiol. 2003;41:1707-12.

Kleemann T, Becker T, Doenges K. Annual rate of transvenous defibrillation lead defects in implantable cardioverter-defibrillators over a period of 10 years. Circulation. 2007;115:2474-80. Carsten W. Israel. How to avoid inappropriate therapy. Current Opinion in Cardiology. 2008;23:65-71.

Wilkoff BL, Cook JR, Epstein AE. Dual-chamber pacing ventricular back up pacing in patient with an implantable defibrillator: the Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial. JAMA. 2002;288:3115-23.

Zoll PM. Resuscitation of the heart in ventricular standstill by external electric stimulation. N Engl J Med. 1952;247:768-71.

Mirowski M, Mower MM. Transvenous automatic defibrillaton as an approach to prevention of sudden death from ventricular fibrillation. Heart Lung. 1973;2:867-9.

Mirowski M, Reid PR, Mower M. Termination of malignant ventricular arrhythmias with an implantable automatic defibrillator in human beings. N Eng J Med. 1980;303:322-4.

Kroll MW, Lehman MH. Implantable cardioverterdefibrillator therapy: the engineering-clinical interface. Norwell, MA: Kluwer academic publishers. 1996.

Takeuchi ES, Zelinsky MA, Keister P. Proc. 32nd Power Sources Symposium. 1986;286.

Schoenfeld MH, Compton SJ, et al. Remote monitoring of implantable cardioverter defibrillators: a prospective analysis. Pacing Clin Electrophysiol. 2004;27:757-63.

Winters SL, Packer DL, Marchlinski FE, et al. Consensus statement on indications, guidelines for use, and recommendations for follow-up of implantable cardioverter defibrillators. North American Society of Electrophysiology and Pacing North American Society of Electrophysiology and Pacing. Pacing Clin Electrophysiol. 2001;24:262.

Brunn J, Block M, Weber M, et al. Results of testing defibrillator function of implanted cardioverter/defibrillators. Z Cardiol. 1997;86:450-9.

Connolly SJ, Dorian P, Roberts RS. Comparison of beta-blockers, amiodarone plus beta-blockers, or sotalol for prevention of shocks from implantable cardioverter defibrillators: the OPTIC Study: a randomized trial. J Am Med Ass 2006;295:165-171.

Trappe HJ, Klein H, Kielblock B. Role of antitachycardia pacing in patients with third generation cardioverter defibrillators. Pacing Clin Electrophysiol. 1994;17:506-513.

Fetter JG, Stanton MS, Benditt DG, Trusty J, Collins J. Transtelephonic monitoring and transmission of stored arrhythmia detection and therapy data from an implantable cardioverter defibrillator. Pacing Clin Electrophysiol. 1995;18:1531-9.

Schoenfeld MH. Contemporary pacemaker and defibrillator device therapy: challenges confronting the general cardiologist. Circulation. 2007;115:638-53.

William G. Stevenson, MD, Chair; Bernard R. Chaitman, MD., et al. For the Subcommittee on Electrocardiography and Arrhythmias of the American Heart Association Council on Clinical Cardiology, in Collaboration Clinical Assessment and Management of Patients With Implanted Cardioverter-Defibrillators Presenting to Nonelectrophysiologists With the Heart Rhythm Society, Circulation. 2004;110:3866-9.

Senges-Becker JC, Klostermann M, Becker R. What is the "optimal" follow-up schedule for ICD patients? Europace. 2005;7:319-26.

Bayes de Luna A, Coumel P. Ambulatory sudden cardiac death: mechanisms of production of fatal arrhythmia on the basis of data from 157 cases. Am Heart J. 1989;117:151-9.

Cobb LA, Baum RS, Alvarez H. Resuscitation from out-of-hospital ventricular fibrillation: 4 years follow-up. Circulation. 1975;52:223-35.

Goldstein S, Landis JR, Leighton R. Predictive survival models for resuscitated victims of out-of-hospital cardiac arrest with coronary heart disease. Circulation. 1985;71:873-80.

Buxton AE, Marchlinski FE, Waxman HL, Flores BT, Cassidy DM, Josephson ME. Prognostic factors in nonsustained ventricular tachycardia. Am J Cardiol. 1984;53:1275-9.

Preliminary report: effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. The Cardiac Arrhythmia Suppression Trial (CAST) Investigators. N Engl J Med. 1989;321:406-12.

Stevenson WG, Middlekauff HR, Saxon LA: Ventricular arrhythmias in heart failure. In Zipes DP, Jalife J (eds) Cardiac Electrophysiology: From cell to bedside. Second Edition W.B. Saunders Company, Philadelphia. 1995. p 848.

Wilkoff BL, Cook JR, Epstein AE. Dual-chamber pacing ventricular back up pacing in patient with an implantable defibrillator: the Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial. JAMA. 2002;288:3115-23.

A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. The Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators. N Engl J Med. 1997;337:1576-83.

Sharma R, Francis DP, Pitt B, Poole-Wilson PA, Coats AJ, Anker SD. Haemoglobin predicts survival in patients with chronic heart failure: a substudy of the ELITE II trial. Eur Heart J 2004;25:10218.

Grimm W, Flores BT, Marchlinski FE. Shock occurrence and survival in 241 patients with implantable cardioverter-defibrillator therapy, Circulation. 1993;87:1880-8.

Connolly SJ, Hallstrom AP, Cappato R. Meta-analysis of the implantable cardioverter defibrillator secondary prevention trials. AVID, CASH and CIDS studies. Antiarrhythmics vs Implantable Defibrillator study. Cardiac Arrest Study Hamburg. Canadian Implantable Defibrillator Study. Eur Heart J. 2000;21:2071-8.

Moss AJ. Implantable cardioverter defibrillator therapy: the sickest patients benefit the most. Circulation. 2000,101:1638-40.

Begley DA, Mohiddin SA, Tripodi D, Winkler JB, Fananapazir L. Efficacy of implantable cardioverter defibrillator therapy for primary and secondary prevention of sudden cardiac death in hypertrophic cardiomyopathy. Pacing Clin Electrophysiol. 2003. 26:1887-96.

Diabetic cardiomyopathy: insights into pathogenesis, diagnostic challenges, and therapeutic options. Am J Med. 2008;121:748-757.

Vinik AI, Ziegler D Diabetic cardiovascular autonomic neuropathy.Circulation. 2007;115:387-397.

Schelbert HR,Coronary circulatory function abnormalities in insulin resistance: insights from positron emission tomography. J Am Coll Cardiol.2009;53:S3-S8.