Safety of implantable cardioverter-defibrillators in patients with
sarcoidosis: A nationwide database analysis.
Abstract
Rationale : An estimated 5% of patients with
sarcoidosis develop cardiac involvement with associated complications,
including life-threatening arrhythmias and sudden death. Implantable
cardiac defibrillators (ICDs) have been used for primary and secondary
prevention of sudden death in patients with cardiac sarcoidosis (CS).
Post-ICD placement complications have been shown to be higher in CS
populations. However, data comparing postoperative ICD complications
among sarcoidosis patients with the general population is limited. Here,
we evaluated the association of postoperative complications with
implantable cardioverter-defibrillators in sarcoidosis.
Methods: Using the NIS database, we identified cases of
adults aged ≥ 18 years undergoing surgical placement of implantable
cardioverter-defibrillators between 2010 and 2019. Using ICD-9 and
ICD-10 codes, we identified patients with sarcoidosis. In all
statistical analyses, we applied weights provided by HCUP to produce
results representative of national estimates. We compared categorical
and continuous covariates in the baseline characteristics using
chi-square test and analysis of variance, respectively. We employed
multivariable logistic and linear regression to compare binomial and
continuous outcomes to assess mortality rates differences.
Results: We analyzed 114073 patients during the study
period. Of these, 1012 (0.9%) had sarcoidosis and were found to be
significantly younger and female compared to patients without
sarcoidosis (56.4 years +/- 11.5 vs. 65.6 +/- 13.9, p <0.001)
and (39.4% vs. 28.3%, p<0.001) respectively. Further,
patients with sarcoidosis were more likely to be African American (45%
vs. 16.3%), have private insurance (45.4% vs. 23.8%), and less likely
to have Medicare (34.9% vs. 60.9%). Overall, post-ICD placement
complications such as lead complications (4.2% vs. 6.9%, p = 0.03),
post-procedure hemorrhage (4.1% vs. 5.5%, p=0.048), and requirement
for transfusion (2.3% vs. 4.4%) were less likely in patients with
sarcoidosis. Regarding post-ICD placement inpatient mortality,
sarcoidosis was not associated with any difference in mortality (OR:
0.71, 95% CI 0.18-2.88 p=0.634). Conclusion: Placement
of implantable cardioverter-defibrillators in patients with sarcoidosis
is a safe procedure and is associated with significantly lower rates of
lead complications, post-procedure hemorrhage and requirement for
transfusion. This is of great importance as it is known that patients
with underlying sarcoidosis are predisposed to developing more cardiac
complications.