Key result
S-ICDs carry a ~13% explantation rate driven primarily by infection, abnormal sensing, and pacing needs.
Why the study?
The S-ICD is an appealing alternative to transvenous ICD systems, but data on indications for S-ICD explantations are sparse.
Observational (n=64)
No
In a real-world tertiary center cohort, S-ICD explantation occurred in 12.9% of patients, primarily driven by infection, abnormal sensing, and the need for pacing, highlighting the importance of careful patient selection.
Answers are grounded in this paper and cite their sources.
May inform stricter S-ICD selection to reduce explantation; leaves open need for prospective durability trials.
The subcutaneous implantable cardioverter-defibrillator (S-ICD) is an appealing alternative to transvenous ICD systems. However, data on indications for S-ICD explantations are sparse. The objective of this study was to assess the incidence and indications for S-ICD explantation at a large tertiary referral center. We conducted a retrospective study of all S-ICD explantations performed from 2014-2020. Data on demographics, comorbidities, implantation characteristics, and indications for explantation were collected. A total of 64 patients underwent S-ICD explantation during the study period. During that time, there were 410 S-ICD implantations at our institution, of which 53 (12.9%) were explanted with a mean duration from implant to explant of 19.7 20.1 months. The mean age of the patients at explantation was 44.8 15.3 years, and 42% (n = 27) were women. The indication for S-ICD implantation was primary prevention in 58% and secondary prevention in 42% of patients, respectively. The most common reason for explantation was infection (32.8%), followed by abnormal sensing (25%) and the need for pacing (18.8%). Those who underwent S-ICD explantation for pacing indications were significantly older (55.7 13.6 vs. 42.3 14.6 years, P = 0.005) with a wider QRS duration (111 19 vs. 98 19 ms, P = 0.03) at device implantation compared to patients who underwent explantation for other indications. The incidence of S-ICD explantation in a large tertiary practice was 12.9%. While infection was the indication for one-third of the explantations, a significant number of explantations were due to sensing abnormalities and the need for pacing. These data may have implications for patient selection for S-ICD implantation.
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Pothineni et al. (2022) conducted an observational in Subcutaneous implantable cardioverter-defibrillator (S-ICD) complications (n=64). Subcutaneous implantable cardioverter-defibrillator (S-ICD) was evaluated on Incidence of S-ICD explantation. Subcutaneous implantable cardioverter-defibrillators had an explantation incidence of 12.9%, primarily driven by infection (32.8%), abnormal sensing (25%), and the need for pacing (18.8%).
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