{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T11:18:03Z","timestamp":1774351083988,"version":"3.50.1"},"reference-count":38,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T00:00:00Z","timestamp":1766361600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T00:00:00Z","timestamp":1766361600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum Hamburg-Eppendorf (UKE)"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin Res Cardiol"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cardiac implantable electronic devices (CIEDs) are increasingly implanted in older patients with multiple comorbidities. The impact of comorbidities on procedural complications and clinical outcomes during and after defibrillator implantation remains a subject of ongoing debate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To investigate the associations of the comorbidity burden on baseline characteristics, periprocedural complications, and on outcomes in patients with implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy with defibrillator (CRT-D) implantations or revisions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients who underwent ICD or CRT-D implantations or revisions at 50 centers were prospectively enrolled in the German Device Registry. Data on patient characteristics, periprocedural complications, and outcomes were collected. Patients were categorized into four groups based on cardiometabolic comorbidities (stroke, chronic kidney disease (CKD), diabetes, hypertension): group I (no comorbidities), group II (one), group III (two), and group IV (three or four). Primary outcomes included 1-year all-cause mortality, major adverse cardiac and cerebrovascular events (MACCE), and arrhythmic\/non-arrhythmic events. The Kaplan\u2013Meier analysis was used to determine 1-year mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Overall, 5329 patients (mean age 65.2\u00a0years) underwent 3794 ICD and 1535 CRT-D implantations. Median follow-up was 17\u00a0months. Periprocedural complications (group\u00a0I: 2.1%, group\u00a0II: 1.5%, group\u00a0III: 2.1%, group\u00a0IV: 2.4%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.91) and in-hospital MACCE (group\u00a0I: 0.2%, group\u00a0II: 0.4%, group\u00a0III: 0.6%, group\u00a0IV: 0.4%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.25) were not related to comorbidity burden. Higher comorbidity burden was associated with a higher 1-year all-cause mortality (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), but ICD shocks did not differ between groups (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.97). The MADIT-ICD non-arrhythmic mortality score increased with comorbidities (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), while the VT\/VF score remained unchanged.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Periprocedural complications do not appear to be affected by cardiometabolic comorbidities in patients undergoing ICD or CRT-D implantation in Germany. As expected, multimorbidity was associated with a higher risk of mortality and MACCE without detectable effects on ventricular arrhythmias.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                    <jats:p>The role of comorbidities on periprocedural complications and outcomes in patients with defibrillators and cardiac resynchronization therapy. Abbreviations: CD; comorbidity, CKD, chronic kidney disease; CRT-D\/-P, cardiac resynchronization therapy-defibrillator\/-pacemaker; ICD, implantable cardioverter-defibrillator; MACCE, major adverse cardiac and cerebrovascular events<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00392-025-02821-2","type":"journal-article","created":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T11:32:58Z","timestamp":1766403178000},"page":"645-656","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The role of comorbidities on periprocedural complications and outcomes in patients with defibrillators and cardiac resynchronization therapy: insights from the German device registry"],"prefix":"10.1007","volume":"115","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4476-1341","authenticated-orcid":false,"given":"Nina","family":"Becher","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0499-704X","authenticated-orcid":false,"given":"Matthias","family":"Hochadel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3547-2126","authenticated-orcid":false,"given":"Jochen","family":"Senges","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3735-8503","authenticated-orcid":false,"given":"Lars","family":"Eckardt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H\u00fcseyin","family":"Ince","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Kleemann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8429-2826","authenticated-orcid":false,"given":"Christoph","family":"Stellbrink","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9221-9856","authenticated-orcid":false,"given":"Johannes","family":"Brachmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1320-8091","authenticated-orcid":false,"given":"Werner","family":"Jung","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5372-9228","authenticated-orcid":false,"given":"Frederik","family":"Voss","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1881-0197","authenticated-orcid":false,"given":"Paulus","family":"Kirchhof","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7351-0621","authenticated-orcid":false,"given":"Tobias","family":"Toennis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6818-6396","authenticated-orcid":false,"given":"Andreas","family":"Metzner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,12,22]]},"reference":[{"issue":"3","key":"2821_CR1","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1002\/ejhf.685","volume":"19","author":"AC Ruwald","year":"2017","unstructured":"Ruwald AC, Vinther M, Gislason GH, Johansen JB, Nielsen JC, Petersen HH et al (2017) The impact of co-morbidity burden on appropriate implantable cardioverter defibrillator therapy and all-cause mortality: insight from Danish nationwide clinical registers. 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The registry was approved by the ethics committee of the state medical.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval and consent to participate"}},{"value":"NB received speaker fees from Medtronic and Abbott and received an educational grant form\u00a0Biotronik all outside this submitted work.\u00a0AM received speaker fees from Medtronic, Biosense Webster, Boston Scientific, Bayer, BMS,\u00a0Abbott, Lifetech and is consultant for Medtronic, Biosense Webster and Boston Scientific.\u00a0PK received research support for basic, translational, and clinical research projects from\u00a0European Union, British Heart Foundation, Leducq Foundation, Medical Research Council\u00a0(UK), and German Center for Cardiovascular Research, from several drug and device\u00a0companies active in atrial fibrillation, and has received honoraria from several such companies\u00a0in the past, but not in the last five years. PK is listed as inventor on two issued patents held by\u00a0University of Hamburg (Atrial Fibrillation Therapy WO 2015140571, Markers for Atrial\u00a0Fibrillation WO 2016012783).\u00a0The other authors had nothing to declare.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}