Subcutaneous ICDs were associated with similar rates of a composite infectious outcome (53.5% vs. 55.1%; p=0.268) compared to transvenous ICDs, but higher rates of dialysis access revisions.
Cohort (n=912)
Yes
Does a subcutaneous implantable cardioverter-defibrillator (S-ICD) reduce infectious complications compared to a transvenous implantable cardioverter-defibrillator (TV-ICD) in end-stage renal disease patients on hemodialysis?
In ESRD patients on hemodialysis, S-ICD and TV-ICD have similar rates of infectious complications and mortality, but S-ICD is associated with a higher rate of dialysis access revisions.
Absolute Event Rate: 53.5% vs 55.1%
p-value: p=0.268
ABSTRACT Background Patients with end‐stage renal disease (ESRD) on dialysis face a high risk of sudden cardiac death, but traditional transvenous implantable cardioverter‐defibrillators (TV‐ICD) carry risks of central venous stenosis and infection. Subcutaneous implantable cardioverter‐defibrillators (S‐ICD) provide an extravascular alternative, though comparative outcomes in dialysis patients remain limited. Methods This study evaluated ESRD patients on hemodialysis who underwent S‐ICD or TV‐ICD implantation between January 2000 and March 2026 using the TriNetX global health network. A 1:1 propensity score matching (PSM) was utilized across 81 clinical covariates. Kaplan‐Meier survival analysis and Cox proportional hazards regression were used to assess long‐term outcomes, including infectious complications, dialysis access revisions, and mortality. Results Following PSM, 456 matched pairs ( N = 912) of ESRD patients on dialysis were identified. There were no significant differences between the S‐ICD and TV‐ICD cohorts regarding the composite outcome of sepsis, bacteremia, or transvenous lead extraction (53.5% vs. 55.1%; p = 0.268). All‐cause mortality (58.7% vs. 60.4%; p = 0.747) and hospitalization rates (87.9% vs. 85.4%; p = 0.874) were also similar between the groups. However, S‐ICD was associated with higher rates of composite open and endovascular dialysis access revision (39.1% vs. 25.8%; p = 0.001), percutaneous dialysis access intervention (p = 0.002), and dialysis access surgery ( p = 0.021). Conclusion S‐ICD and TV‐ICD demonstrated similar rates of infectious complications, hospitalization, and all‐cause mortality in ESRD patients. S‐ICD implantation was associated with higher rates of dialysis access revisions and interventions. Device selection should remain individualized, guided by anatomy, access planning, and clinical context.
Lama et al. (Sat,) conducted a cohort in End-stage renal disease on hemodialysis (n=912). Subcutaneous implantable cardioverter-defibrillators (S-ICD) vs. Transvenous implantable cardioverter-defibrillators (TV-ICD) was evaluated on Composite outcome of sepsis, bacteremia, or transvenous lead extraction (p=0.268). Subcutaneous ICDs were associated with similar rates of a composite infectious outcome (53.5% vs. 55.1%; p=0.268) compared to transvenous ICDs, but higher rates of dialysis access revisions.
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