Background
Atrial fibrillation (AF) in patients with implantable cardioverter-defibrillators (ICD or CRT-D) is frequently associated with cardiovascular comorbidities, potentially influencing therapeutic decisions and clinical outcomes. The multicenter VIDEO registry investigates the impact of diabetes mellitus (DM), chronic kidney disease (CKD), and arterial hypertension (aHT) on device selection, rhythm management, and in-hospital course.
Methods
As mandated by German law, hospitals annually submit case-level data—including diagnoses (ICD-10-GM) and procedural codes—to the Institute for the Hospital Remuneration System (InEK). The VIDEO project utilizes these data to analyze and report real-world patterns in patients undergoing device implantation in Germany. This analysis includes data from 20.056 patients, contributed by 12 participating centers.A total of 976 patients with AF and ICD/CRT-D from 12 German centers were retrospectively analyzed for this subanalysis. Four groups were compared: DM (n = 176), CKD (n = 342), aHT (n =294), and patients without these comorbidities (n = 164). Key parameters included device type, ICU treatment, discharge destination, length of stay, and AF therapy strategy.
Results
Device distribution differed significantly: CRT-D was used most frequently in CKD patients (46.4%), followed by DM (42.0%), aHT (42.6%), and only 32.9% in patients without comorbidities. ICU admission rates were highest in CKD (50.0%), DM (40.3%), and aHT (41.2%), but only 29.3% in patients without comorbidities. Median hospital stay was longest in the CKD group (13.0 days), followed by DM (7.0), aHT (7.0), and shortest in patients without comorbidities (6.0 days). Discharge to home occurred in 82.2% of CKD patients, 90.3% (DM), 87.8% (aHT), and 89.6% of those without comorbidities. In contrast, referral to rehabilitation or nursing facilities was more common in CKD patients (4.7% and 1.8%, respectively).Atrial fibrillation ablation was performed in 8.5% of CKD patients, 6.3% with DM, 13.9% with aHT, and 7.3% without comorbidities. Pulmonary vein isolation was most common in the aHT group (6.5%). There was no clear trend indicating a higher ablation rate in patients without comorbidities. Catheter ablation was performed in 8.5% of CKD patients, 6.3% of DM, 13.9% of aHT, and 7.3% of patients without comorbidities. Ablation of the pulmonary veins only was most common in aHT (6.5%) and least in CKD (2.0%).
Conclusion
The VIDEO registry shows that patients with CKD and DM undergoing ICD or CRT-D implantation are more likely to require intensive care and experience longer hospital stays. While CRT-D use was highest in comorbid patients, atrial fibrillation ablation rates did not consistently correlate with comorbidity burden, suggesting that other factors (e.g., age, institutional preference) may influence rhythm control strategies.
