Background: mplantable cardioverter defibrillators (ICDs) are widely used for primary and secondary prevention of sudden cardiac death in high-risk patients with ventricular arrhythmias and structural heart disease. Despite their life-saving role, ICD implantation may be associated with several early and late complications that can influence patient outcomes and healthcare burden.Aim: To evaluate the long-term risk of device-related complications after ICD implantation and to determine the major predictors associated with these complications.Patients and Methods: This retrospective cohort study was conducted at the Cardiology Department of Ibn Al-Baitar Cardiac Center between January 2010 and April 2019. A total of 923 patients who underwent de novo ICD implantation were included. Clinical records were retrospectively reviewed for demographic characteristics, indications for ICD implantation, echocardiographic findings, device type, and complications during follow-up. Statistical analysis was performed using SPSS version 23. Odds ratios and 95% confidence intervals were calculated, and p-values <0.05 were considered statistically significant.Results: The mean age of the patients was 51.5 ± 17.2 years, with male predominance accounting for 677 (73.3%) patients. Secondary prevention represented the most common indication for ICD implantation in 741 (80.3%) patients. Single-chamber ICDs were used in 554 (60.0%) patients, while dual-chamber devices were implanted in 369 (40.0%) patients. The mean left ventricular ejection fraction was 28.6 ± 4.7%. The overall complication rate was 11.3%. Lead dislodgement was the most frequent complication occurring in 40 (4.3%) patients, followed by generator migration in 16 (1.7%), pocket hematoma in 15 (1.6%), infection in 12 (1.3%), lead fracture in 10 (1.08%), erosion in 9 (0.98%), and pneumothorax in 3 (0.33%) patients. Diabetes mellitus and re-intervention significantly increased the risk of infection. Female gender, ischemic cardiomyopathy, and dual-chamber ICD implantation were significant predictors of overall complications.Conclusion: ICD implantation demonstrated acceptable long-term safety with no procedure-related mortality reported during the study period. Lead dislodgement was the most common complication. Female gender, dual-chamber ICDs, diabetes mellitus, and ischemic cardiomyopathy were important predictors of complications. Careful patient selection and close long-term follow-up may reduce complication rates and improve clinical outcomes