Key result
S-ICD therapy carries a low ~5% 5-year complication rate in pediatric and young adult patients.
Why the study?
Data on the real-world performance of S-ICDs in paediatric and young patients remain limited.
Does S-ICD therapy provide safe and effective prevention of sudden cardiac death with low complication rates in paediatric and young adult patients?
Observational (n=223)
Yes
Does S-ICD therapy provide safe and effective prevention of sudden cardiac death with low complication rates in paediatric and young adult patients?
S-ICD implantation provides effective therapy with low rates of device-related complications in paediatric and young adult patients, supporting its role as a safer alternative to transvenous systems in this growing population.
Supports S-ICD consideration in select young patients; hypothesis-generating and requires randomized confirmation before practice change.
AIMS: Subcutaneous implantable cardioverter-defibrillators (S-ICDs) are effective in patients who require protection from sudden cardiac death while avoiding the long-term risks associated with transvenous leads. However, data on their real-world performance in paediatric and young patients remain limited. This study aims to evaluate the safety and efficacy of S-ICDs in a large, multicentre cohort of paediatric and young patients across Europe, with a focus on contemporary implantation practices and clinical outcomes. METHODS AND RESULTS: This is an international, multicentre, observational, retrospective registry on S-ICD outcome in paediatric and young adult patients with congenital heart defects (CHD), cardiomyopathies, channelopathies, and idiopathic ventricular fibrillation (IVF). Data were collected on implantation techniques, acute and long-term outcomes, including defibrillation efficacy, inappropriate (IAS) and appropriate shocks, and complications. Follow-up data were analysed to assess device performance and safety. A total of 223 patients (mean age: 15 ± 3 years; 59% male, 53% cardiomyopathies, 18% channelopathies, 15% IVF, 14% CHD) were included. Most patients underwent implantation using an intermuscular (65%) and two-incision technique (88%). Acute defibrillation success was 100%, and no intraoperative complications occurred. The median follow-up was 28 (IQR: 12-55) months. Appropriate shocks were delivered in 41 (18%) patients (26% rate at 5 years). The first shock was effective in 92% of discrete episodes. The IAS and the complication rates were 20% and 5% at 5 years. Older age, intermuscular pocket, and two-incision technique were associated with fewer complications. CONCLUSION: This multicentre S-ICD European registry in paediatric and young patients demonstrated favourable outcomes, low IAS, and complication rates.
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Silvetti et al. (2025) conducted an observational in Congenital heart defects, cardiomyopathies, channelopathies, and idiopathic ventricular fibrillation (n=223). Subcutaneous implantable cardioverter-defibrillator (S-ICD) was evaluated on Device-related complications at 5 years (95% CI 1.6-8.4). S-ICD therapy in paediatric and young adult patients demonstrated a low 5-year device-related complication rate of 5.0% and an inappropriate shock rate of 19.6%.
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