Subcutaneous ICDs had a similar 5-year complication rate compared to transvenous ICDs (13.7% vs 18.0%; p=0.80), but significantly reduced lead-related complications (0.8% vs 11.5%; p=0.03).
Cohort (n=1,160)
Sí
Does subcutaneous ICD therapy reduce device-related complications or alter ICD therapy rates compared to transvenous ICD therapy in patients requiring an ICD?
S-ICDs and TV-ICDs have similar overall 5-year complication and shock rates, but S-ICDs significantly reduce lead-related complications at the expense of increased nonlead-related complications.
Tasa de eventos absoluta: 13.7% vs 18%
valor p: p=0.80
BACKGROUND: Transvenous implantable cardioverter-defibrillators (TV-ICDs) improve survival in patients at risk for sudden cardiac death, but complications remain an important drawback. The subcutaneous ICD (S-ICD) was developed to overcome lead-related complications. Comparison of clinical outcomes of both device types in previous studies was hampered by dissimilar patient characteristics. OBJECTIVES: This retrospective study compares long-term clinical outcomes of S-ICD and TV-ICD therapy in a propensity-matched cohort. METHODS: The authors analyzed 1,160 patients who underwent S-ICD or TV-ICD implantation in 2 high-volume hospitals in the Netherlands. Propensity matching for 16 baseline characteristics, including diagnosis, yielded 140 matched pairs. Clinical outcomes were device-related complications requiring surgical intervention, appropriate and inappropriate ICD therapy, and were reported as 5-year Kaplan-Meier rate estimates. RESULTS: All 16 baseline characteristics were balanced in the matched cohort of 140 patients with S-ICDs and 140 patients with TV-ICDs (median age 41 years interquartile range: 30 to 52 years and 40% women). The complication rate was 13.7% in the S-ICD group versus 18.0% in the TV-ICD group (p = 0.80). The infection rate was 4.1% versus 3.6% in the TV-ICD groups (p = 0.36). Lead complications were lower in the S-ICD arm compared with the TV-ICD arm, 0.8% versus 11.5%, respectively (p = 0.03). S-ICD patients had more nonlead-related complications than TV-ICD patients, 9.9% versus 2.2%, respectively (p = 0.047). Appropriate ICD intervention (antitachycardia pacing and shocks) occurred more often in the TV-ICD group (hazard ratio HR: 2.42; p = 0.01). The incidence of appropriate (TV-ICD HR: 1.46; p = 0.36) and inappropriate shocks (TV-ICD HR: 0.85; p = 0.64) was similar. CONCLUSIONS: The complication rate in patients implanted with an S-ICD or TV-ICD was similar, but their nature differed. The S-ICD reduced lead-related complications significantly, at the cost of nonlead-related complications. Rates of appropriate and inappropriate shocks were similar between the 2 groups.
Brouwer et al. (Mon,) conducted a cohort in Risk for sudden cardiac death (n=1,160). Subcutaneous implantable cardioverter-defibrillator (S-ICD) vs. Transvenous implantable cardioverter-defibrillator (TV-ICD) was evaluated on Device-related complications requiring surgical intervention (p=0.80). Subcutaneous ICDs had a similar 5-year complication rate compared to transvenous ICDs (13.7% vs 18.0%; p=0.80), but significantly reduced lead-related complications (0.8% vs 11.5%; p=0.03).
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