The association of ICD device complications and risk factors in
patients with cardiac sarcoidosis
With sudden cardiac death accounting for up to 80% of all fatalities in
cardiac sarcoidosis, ICD implantation should always be considered in
those selected groups in whom it is appropriate(28), however
implantation of an ICD is a high-cost procedure with its own risk
profile. A Danish study in 2014 of nearly 6000 patients with cardiac
implantable electronic devices (CIED) for a variety of indications (not
necessarily CS) estimated approximately 10% of their patients
experienced device complications(29).
The first publication to analyse the association between ICD
complications in CS patients was Kron et al. in 2012, showing adverse
events in 17.4% of their 235 patients at a median follow-up of 4.2 ±
4.0 years. Over half of these complications were related to lead
dislodgement or fracture(14). A later retrospective study of 105
patients showed device-related complications at a comparable rate of
~18% at a shorter median follow-up time of 2.8
years(10). Again, complications were most commonly caused by lead
malfunction in nearly 1/3 of patients. Both of these papers link this
specific complication to the young age and increased level of activity
of CS patients when compared to the average ICD patient – a difference
of 10 years at point of implantation(30,5). As commented on by the
authors, combining this variable with the high failure rates of the
‘Medtronic Sprint Fidelis’ leads (particularly in the younger
population), which were prominent at the time of the study, may account
for these particularly high rates of adverse effects(31).
Many patients are also treated with immunosuppressive drugs such as
prednisolone and methotrexate. We expected this to have an impact on
infection rates in the CS cohort. In both the Kron et al. and Mathijssen
et al. papers, infection was the second commonest adverse event after
lead-related complications at rates of 2.6% and 4.8% respectively.
CIED analysis from the previously referenced Danish study showed
infection rates of 0.83% in a their population(29).