Subcutaneous implantable cardioverter defibrillators demonstrated >96% overall shock efficacy and a 2.7% pocket infection rate, suggesting similar short-term outcomes to transvenous ICDs.
Systematic Review (n=5,380)
Does the subcutaneous implantable cardioverter defibrillator (S-ICD) provide acceptable efficacy and safety compared to conventional transvenous ICDs in patients not requiring pacing?
S-ICDs demonstrate high shock efficacy (>96%) and acceptable short-term complication rates, supporting their use as an alternative to transvenous ICDs in patients not requiring pacing.
BACKGROUND: Subcutaneous implantable cardioverter defibrillators (S-ICDs) are considered an alternative to conventional transvenous ICDs (TV-ICDs) in patients not requiring pacing. METHODS: We searched MEDLINE and EMBASE for studies evaluating efficacy and safety outcomes in S-ICD patients. Outcomes were pooled across studies. RESULTS: Sixteen studies were included with 5380 participants (mean age range 33-56 years). Short-term follow-up data were available for 1670 subjects. The most common complication was pocket infection, affecting 2.7%. Other complications included delayed wound healing (0.6%) and wound discomfort (0.8%). 3.8% of S-ICDs were explanted, most commonly for pocket infection. Mortality rates in hospital (0.4%) and during follow-up (3.4% from 12 studies reporting) were low. Incidence of ventricular arrhythmia varied from 0% to 12%. Overall shock efficacy exceeded 96%. Inappropriate shocks affected 4.3% and was most commonly caused by T-wave oversensing. CONCLUSIONS: Although long-term randomised data are lacking, observational data suggest similar shock efficacy and short-term complication rates between the S-ICD and TV-ICD.
Chue et al. (Fri,) conducted a systematic review in patients not requiring pacing (n=5,380). Subcutaneous implantable cardioverter defibrillators (S-ICDs) vs. conventional transvenous ICDs (TV-ICDs) was evaluated on efficacy and safety outcomes. Subcutaneous implantable cardioverter defibrillators demonstrated >96% overall shock efficacy and a 2.7% pocket infection rate, suggesting similar short-term outcomes to transvenous ICDs.