Subcutaneous ICDs were associated with a complication rate of 57.1% compared to 29.4% for transvenous ICDs in patients with CPVT, though S-ICDs avoided lead-related complications.
Meta-Analysis (n=784)
Does subcutaneous ICD compared to transvenous ICD reduce complications in patients with Catecholaminergic Polymorphic Ventricular Tachycardia?
While S-ICDs avoid lead-related complications compared to T-ICDs in CPVT patients, they are still associated with a high rate of inappropriate shocks, necessitating case-by-case decision making.
Absolute Event Rate: 57.1% vs 29.4%
BACKGROUND: Catecholaminergic polymorphic ventricular tachycardia (CPVT) is associated with arrhythmic events which may lead to sudden cardiac death (SCD). A leading therapy for CPVT besides medical treatment with beta-blockers is the use of an implantable cardioverter-defibrillator (ICD). For this paper we compared data from a pooled analysis to get further evidence about the complications of transvenous and subcutaneous ICDs. METHODS: We gathered data from a search of PubMed, Web of Science, Cochrane Library and Cinahl. For our analysis, we chose 30 studies with a total number of 784 patients. We compared the data regarding complications caused by different ICD device types. RESULTS: = 337), data showed a complication rate of 101 (30%). A total of 330 (98%) of them received a transvenous-ICD (T-ICD) and 7 (2%) a subcutaneous-ICD (S-ICD). A total of 97 (29.4%) of the T-ICD patients and 4 (57.1%) of the S-ICD patients had at least one complication. Of the 234 complications that occurred in T-ICD patients 152 (65%) were inappropriate shocks due to supraventricular arrhythmias, T/R-wave oversensing or electrode defect, 26 (11.1%) lead fracture/failure, 1 (0.4%) electrode defect, 46 were (19.7%) events of electrical storms, 1 (0.4%) thromboembolic event, 2 (0.8%) cases of endocarditis and 6 (2.6%) infections of the ICD-pocket. Ten (100%) of the complications for the four patients with the S-ICD were an event of an inappropriate shock due to supraventricular arrhythmias, T/R-wave oversensing or electrode defect. CONCLUSION: Subcutaneous ICDs (S-ICD) show a certain advantage over T-ICDs regarding lead-related complications. Nevertheless, they still show problems with inappropriate shocks and other ICD related complications. Therefore, a case-by-case decision is advised, but the continuous improvement of S-ICD might make it an overall advantageous therapy option in the future.
Eckert et al. (Mon,) conducted a meta-analysis in Catecholaminergic polymorphic ventricular tachycardia (CPVT) (n=784). Subcutaneous ICD (S-ICD) vs. Transvenous ICD (T-ICD) was evaluated on Complications caused by different ICD device types. Subcutaneous ICDs were associated with a complication rate of 57.1% compared to 29.4% for transvenous ICDs in patients with CPVT, though S-ICDs avoided lead-related complications.