What is the clinical evidence from this study?

Study design: Observational. Population: Subcutaneous implantable cardioverter defibrillator (S-ICD) implantation (n=4924). Intervention: Subcutaneous implantable cardioverter defibrillator (S-ICD). Primary outcome: Inappropriate shocks at 5 years.

What question did this study set out to answer?

To assess long-term efficacy, complication profiles, and predictors of adverse events associated with subcutaneous implantable cardioverter defibrillators in an unselected nationwide population.

October 28, 2025European Heart Journal

Long-term outcomes of subcutaneous implantable cardioverter defibrillators: the French nationwide HONEST study

Q: What are the key findings of this study?

In a nationwide French cohort of 4,924 patients with an S-ICD, the 5-year cumulative incidence of inappropriate shocks was 13.8%, which was significantly reduced by SMART Pass filtering (HR 0.67).

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Key result

SMART Pass filtering is linked to ~33% fewer inappropriate shocks in S-ICD patients.

n=4,924

Why the study?

Use of the subcutaneous implantable cardioverter defibrillator (S-ICD) is increasing, but evidence from industry-independent and unselected populations remains limited.

Key Points

To assess long-term efficacy, complication profiles, and predictors of adverse events associated with subcutaneous implantable cardioverter defibrillators in an unselected nationwide population.
Academic nationwide observational cohort study (HONEST) analyzing 4,924 patients receiving an S-ICD in France between 2012 and 2019.
Centrally adjudicated five-year clinical endpoints evaluating inappropriate shocks, device failure, infection, battery depletion, and surgical reinterventions.
At five years, cumulative incidence rates were 13.8% for inappropriate shocks, 10.8% for early battery depletion, 2.4% for infections, and 16.9% for surgical reoperation.
Inappropriate shocks were independently associated with male sex (HR 1.29, 95% CI 1.14–1.46, P < .001), obesity (HR 1.35, 95% CI 1.02–1.79, P = .032), arrhythmogenic right ventricular cardiomyopathy (HR 1.70, 95% CI 1.03–2.81, P = .036), and pacemaker presence (HR 2.20, 95% CI 1.16–4.17, P = .016).
SMART Pass filtering significantly reduced inappropriate shocks (HR 0.67, 95% CI 0.50–0.89, P = .007), whereas undetected arrhythmias or ineffective shocks occurred in only 0.2% of patients.

Study Design

Type

Observational (n=4,924)

Multicenter

Yes

Structured PICO

Population

4,924 patients (mean age 49.9 years, 76.7% male) implanted with an S-ICD across France between 2012 and 2019, followed for 5 years.

Exposure

Subcutaneous implantable cardioverter defibrillator (S-ICD)

Outcome

Five-year clinical endpoints including inappropriate shocks, early battery depletion, infections, lead dysfunction, chronic discomfort, reoperation, need for cardiac pacing, definite S-ICD extraction, and death (centrally adjudicated)safety

Discussion

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Implication

In a large, nationwide, unselected French cohort, S-ICD therapy demonstrated a 5-year inappropriate shock rate of 13.8% and early battery depletion in 10.8%, providing real-world long-term safety data.

Cite This Study

Kerkouri et al. (2025) conducted an observational in Subcutaneous implantable cardioverter defibrillator (S-ICD) implantation (n=4,924). Subcutaneous implantable cardioverter defibrillator (S-ICD) was evaluated on Inappropriate shocks at 5 years. In a nationwide French cohort of 4,924 patients with an S-ICD, the 5-year cumulative incidence of inappropriate shocks was 13.8%, which was significantly reduced by SMART Pass filtering (HR 0.67).

synapsesocial.com/papers/69dd69e8fa5182325f100f0d https://doi.org/10.1093/eurheartj/ehaf918

Topics

Cardiac device therapy

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Long-term outcomes of subcutaneous implantable cardioverter defibrillators: the French nationwide HONEST study

Key Points

Study Design

Structured PICO

Discussion

Implication

Cite This Study

Topics

Long-term outcomes of subcutaneous implantable cardioverter defibrillators: the French nationwide HONEST study

Key Points

Study Design

Structured PICO

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider