Key result
Elective S-ICD generator replacement maintains a ~98% defibrillation success rate, matching initial implant efficacy.
Why the study?
Data on defibrillation test efficacy at S-ICD generator replacement were scarce, with a limited number of patients and conflicting results.
Does elective S-ICD generator replacement maintain high defibrillation test conversion efficacy in patients with prior S-ICD implants?
Cohort (n=121)
No
Does elective S-ICD generator replacement maintain high defibrillation test conversion efficacy in patients with prior S-ICD implants?
Absolute Event Rate: 98% vs 98%
Despite age and impedance increases over a mean of 5.4 years, elective S-ICD generator replacements exhibit exceptionally high successful defibrillation conversion rates (98%), reassuring operators of long-term mechanical and clinical device reliability.
AIMS: After implantation of a subcutaneous implantable cardioverter-defibrillator (S-ICD), a defibrillation test (DFT) is performed to ensure that the device can effectively detect and terminate the induced ventricular arrhythmia. Data on DFT efficacy at generator replacement are scarce with a limited number of patients and conflicting results. This study evaluates conversion efficacy during DFT at elective S-ICD generator replacement in a large cohort from our tertiary centre. METHODS AND RESULTS: Retrospective data of patients who underwent an S-ICD generator replacement for battery depletion with subsequent DFT between February 2015 and June 2022 were collected. Defibrillation test data were collected from both implant and replacement procedures. PRAETORIAN scores at implant were calculated. Defibrillation test was defined unsuccessful when two conversions at 65 J failed. A total of 121 patients were included. The defibrillation test was successful in 95% after the first and 98% after two consecutive tests. This was comparable with success rates at implant, despite a significant rise in shock impedance (73 ± 23 vs. 83 ± 24 Ω, P < 0.001). Both patients with an unsuccessful DFT at 65 J successfully converted with 80 J. CONCLUSION: This study shows a high DFT conversion rate at elective S-ICD generator replacement, which is comparable to conversion rates at implant, despite a rise in shock impedance. Evaluating device position before generator replacement may be recommended to optimize defibrillation success at generator replacement.
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Veld et al. (2023) conducted a cohort in Elective subcutaneous implantable cardioverter-defibrillator (S-ICD) generator replacement (n=121). Elective S-ICD generator replacement vs. Defibrillation testing at initial S-ICD implant (historical self-control) was evaluated on Successful conversion within two consecutive defibrillation tests (DFTs). Elective S-ICD generator replacement demonstrated a 98% successful defibrillation conversion rate, comparable to the success rate at initial implant, despite a significant rise in shock impedance.
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