Key result
In a cohort of 79 patients implanted with an S-ICD, 7.6% received appropriate shock therapy, while 8.9% experienced inappropriate shocks and 5.1% required system revision over 12.8 months.
Cohort (n=79)
No
S-ICDs are a feasible and effective treatment for preventing sudden cardiac death in a real-world tertiary setting, though inappropriate shocks and infections remain notable clinical challenges.
S-ICD use was associated with low appropriate therapy rates but notable inappropriate shocks; leaves open refined selection and programming strategies.
BACKGROUND: The aim of the study was to evaluate subcutaneous implantable cardioverter-defibrillator (S-ICD) patients with regard to underlying etiology, peri-procedural outcome, appropriate/inappropriate shocks, and complications during follow-up. METHODS: All patients who underwent S-ICD implantation from February 2013 to March 2017 at an academic hospital in Vienna were included. Medical records were examined and follow-up interrogations of devices were conducted. RESULTS: A total of 79 S-ICD patients (58.2% males) with a mean age of 44.5 ± 17.2 years were followed for a mean duration of 12.8 ± 13.7 months. A majority of patients (58.2%) had S-ICD for primary prevention of sudden cardiac death. The most common of the 16 underlying etiologies were ischemic cardiomyopathy, non-ischemic cardiomyopathy, and idiopathic ventricular fibrillation. The lead was implanted to the left sternal border in 96.2% of cases, between muscular layers in 72.2%. Mean implant time was 45 min, 3 patients were induced, and all patients except one were programmed to two zones. Six (7.6%) patients experienced at least one appropriate therapy for ventricular arrhythmias and the time to first event ranged from 1 to 52 months. Seven patients experienced inappropriate shocks due to T-wave oversensing, atrial tachycardia with rapid atrioventricular conduction, external electromagnetic interference, and/or baseline oversensing due to lead movement. Four patients underwent revision for lead repositioning (n = 1), loose device suture (n = 1), and infection (n = 2). CONCLUSIONS: While S-ICDs are a feasible and effective treatment, issues remain with inappropriate shock and infection.
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Khazen et al. (2018) conducted a cohort in Risk of sudden cardiac death (n=79). Subcutaneous implantable cardioverter-defibrillator (S-ICD) was evaluated on Appropriate therapy for ventricular arrhythmias. In a cohort of 79 patients implanted with an S-ICD, 7.6% received appropriate shock therapy, while 8.9% experienced inappropriate shocks and 5.1% required system revision over 12.8 months.
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