Key result
Subcutaneous implantable cardioverter-defibrillators significantly reduced the risk of electrode migration compared to transvenous devices (OR 0.19), while maintaining comparable overall efficacy and infection rates.
Why the study?
The subcutaneous implantable cardioverter-defibrillator was developed to overcome limitations of transvenous devices, motivating a comparison of efficacy and complications between subcutaneous and transvenous devices.
Does the subcutaneous implantable cardioverter-defibrillator reduce complications and improve efficacy compared to the transvenous implantable cardioverter-defibrillator in adult patients with complex ventricular arrhythmia?
Systematic Review (n=2,111)
Does the subcutaneous implantable cardioverter-defibrillator reduce complications and improve efficacy compared to the transvenous implantable cardioverter-defibrillator in adult patients with complex ventricular arrhythmia?
Subcutaneous ICDs demonstrate lower rates of lead migration and inappropriate shocks due to supraventricular tachycardia compared to transvenous ICDs, with comparable infection rates.
Subcutaneous ICDs link to lower appropriate shock rates with comparable inappropriate shocks; extends meta-analytic support for device selection in ventricular arrhythmias.
BACKGROUND/OBJECTIVES: Implantable cardioverter defibrillators are used to prevent sudden cardiac death. The subcutaneous implantable cardioverter-defibrillator was newly developed to overcome the limitations of the conventional implantable cardioverter defibrillator-transvenous device. The subcutaneous implantable cardioverter defibrillator is indicated for young patients with heart disease, congenital heart defects, and poor venous access, who have an indication for implantable cardioverter defibrillator without the need for anti-bradycardic stimulation. We aimed to compare the efficacy and complications of subcutaneous with transvenous implantable cardioverter- defibrillator devices. METHODOLOGY: A systematic review was conducted using different databases. The inclusion criteria were observational and clinical randomized trials with no language limits and no publication date limit that compared subcutaneous with transvenous implantable cardioverter-defibrillators. The selected patients were aged > 18 years with complex ventricular arrhythmia. RESULTS: Five studies involving 2111 patients who underwent implantable cardioverter defibrillator implantation were included. The most frequent complication in the subcutaneous device group was infection, followed by hematoma formation and electrode migration. For the transvenous device, the most frequent complications were electrode migration and infection. Regarding efficacy, the total rates of appropriate shocks were 9.04% and 20.47% in the subcutaneous and transvenous device groups, respectively, whereas inappropriate shocks to the subcutaneous and transvenous device groups were 11,3% and 10,7%, respectively. CONCLUSION: When compared to the transvenous device, the subcutaneous device had lower complication rates owing to lead migration and less inappropriate shocks due to supraventricular tachycardia; nevertheless, infection rates and improper shocks due to T wave oversensing were comparable for both devices CRD42021251569.
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Araújo et al. (2021) conducted a systematic review in Complex ventricular arrhythmia requiring implantable cardioverter defibrillator (n=2,111). Subcutaneous implantable cardioverter-defibrillator (ICD-S) vs. Transvenous implantable cardioverter-defibrillator (ICD-TV) was evaluated on Electrode migration (OR 0.19, 95% CI 0.09-0.41). Subcutaneous implantable cardioverter-defibrillators significantly reduced the risk of electrode migration compared to transvenous devices (OR 0.19), while maintaining comparable overall efficacy and infection rates.
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