Key result
Subcutaneous ICDs show comparable overall complications to submuscular approaches but link to more lead dislodgments.
Why the study?
Pectoral ICD placement has become routine, but subcutaneous and submuscular surgical approaches had not been previously compared regarding complications.
Does subcutaneous implantation compared to submuscular implantation reduce complications in patients receiving a pectoral ICD?
Population
1,000 consecutive patients receiving a Medtronic Jewel ICD at 93 centers worldwide
Comparison
Subcutaneous vs submuscular pectoral ICD implantation
Design
Multicenter cohort study
Follow-up
Cumulative 633.7 patient-years, with 64.9% followed for > or = 6 months
Authors
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Subcutaneous ICD implantation was associated with fewer complications; leaves open need for randomized confirmation before practice change.
Cohort (n=1,000)
Yes
Does subcutaneous implantation compared to submuscular implantation reduce complications in patients receiving a pectoral ICD?
Absolute Event Rate: 4.1% vs 2.5%
p-value: p=0.1836
Subcutaneous pectoral ICD implantation is safe with comparable overall complication rates to the submuscular approach, though it is associated with a higher risk of early lead dislodgment.
Gold et al. (1996) conducted a cohort in Patients undergoing pectoral cardioverter-defibrillator implantation (n=1,000). Subcutaneous implantation vs. Submuscular implantation was evaluated on Cumulative freedom from complications (p=0.1836). Subcutaneous pectoral ICD implantation had a comparable overall complication rate to the submuscular approach (4.1% vs. 2.5%, p=0.1836), but was associated with more lead dislodgments.
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