Key result
S-ICD linked to ~4-fold higher expectation of improved QoL after explant vs TV-ICD, driven by pocket pain.
Why the study?
Although the S-ICD is a viable alternative to TV-ICDs for patients at risk of sudden cardiac death without a pacing indication, its impact on quality of life compared with TV-ICDs required evaluation.
Does subcutaneous cardioverter defibrillator (S-ICD) therapy impair quality of life compared to transvenous cardioverter defibrillator (TV-ICD) therapy in patients at risk of sudden cardiac death?
Cohort (n=104)
No
Does subcutaneous cardioverter defibrillator (S-ICD) therapy impair quality of life compared to transvenous cardioverter defibrillator (TV-ICD) therapy in patients at risk of sudden cardiac death?
Despite contemporary smaller 2nd- and 3rd-generation S-ICD generators, over one-quarter of S-ICD patients desire device explantation or deactivation to improve quality of life, driven primarily by pocket discomfort and pain rather than fear of shocks.
Answers are grounded in this paper and cite their sources.
May warrant attention to pocket discomfort in S-ICD patients; leaves open effects on long-term adherence versus TV-ICD.
Background: The subcutaneous cardioverter defibrillator (S-ICD) has been shown to be a viable alternative to transvenous ICDs (TV-ICD) in all patients at risk of sudden cardiac death (SCD) but without pacing indication. Aim: The aim of this study was to examine the impact of therapy with current S-ICD devices on quality of life (QoL) in comparison to patients with TV-ICD devices. Methods: In our single-centre study, 52 consecutive patients with S-ICD and 52 matched patients with TV-ICD were analysed. QoL has been assessed by a standardized questionnaire (EQ-5D-3L, modified). Additionally, clinical baseline and follow-up data were evaluated. Results: Two-thirds of the total study population reported restrictions in daily routine compared to their life before ICD implantation. A total of 27.7% of S-ICD patients stated to expect an improvement of QoL by deactivation or explantation of their defibrillator compared to only 6.4% of patients with TV-ICD ( p =0.006), which was mainly caused by discomfort and pain from the S-ICD pocket (relevant discomfort and pain in 32.6% vs 11.5%; p < 0.01). Limitations: Main limitation of the study is that quality of life was assessed for one single time point only and time since implantation differed significantly between S-ICD and TV-ICD. Furthermore our collective is younger, and, due to the high proportion of patients without cardiomyopathy, the mean EF is better than usual ICD collective. The absence of heart failure in about the half of our patients might have relevant impact on our QoL analysis. Conclusion: A relevant proportion of S-ICD patients expects an improvement of QoL by explantation of the device. Of note, this impression was not driven by the fear of receiving shocks but mainly by discomfort and pain caused by the pulse generator.
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Thienel et al. (2022) conducted a cohort in Sudden cardiac death risk requiring implantable cardioverter defibrillator therapy (n=104). Subcutaneous cardioverter defibrillator (S-ICD) vs. Transvenous cardioverter defibrillator (TV-ICD) was evaluated on Expected improvement of quality of life by deactivation or explantation of the defibrillator (p=0.006). Subcutaneous ICD patients more frequently expected quality of life improvement from device explantation or deactivation than transvenous ICD patients (27.7% vs 6.4%, p=0.006), driven by pocket pain.
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