Key result
Patient age under 65 linked to ~2.1-fold higher odds of S-ICD selection over TV-ICD.
Why the study?
With the recent introduction of the extravascular ICD, there is a need to quantify intercentre heterogeneity and identify patient characteristics influencing ICD technology selection in France.
Cross-Sectional (n=315)
Yes
There is substantial centre-level heterogeneity in the selection of ICD technology, which is influenced by institutional practice patterns as well as patient age and BMI.
Answers are grounded in this paper and cite their sources.
Centre variation in ICD selection warrants caution against generalizing practices; leaves open optimal criteria for device choice.
Background: With the recent introduction of the extravascular implantable cardioverter-defibrillator (EV-ICD), clinicians now have three distinct devices for sudden cardiac death prevention: the transvenous implantable cardioverter-defibrillator (TV-ICD); the subcutaneous implantable cardioverter-defibrillator (S-ICD); and the EV-ICD. Aims: To quantify intercentre heterogeneity in device choice, and identify patient characteristics independently associated with selecting a TV-ICD, an S-ICD or an EV-ICD. Methods: We conducted a cross-sectional vignette-based survey across 15 French implanting centres. Centres selected a first-line implantable cardioverter-defibrillator for 21 standardized scenarios in which all three devices were feasible (315 centre-level decisions). Results: Intercentre agreement on device choice was slight (κ = 0.065), and the median per-vignette majority consensus was 53% (range 40–93%), indicating substantial between-centre heterogeneity. Unsupervised clustering of centres identified three distinct selection strategies: a TV-ICD first cluster (5/15 centres; TV-ICD 51.4% of choices); an S-ICD first cluster (7/15 centres; S-ICD 68.7% of choices); and an EV-ICD forward cluster (3/15 centres; EV-ICD 81.0% of choices). In adjusted analyses, age < 65 years was associated with selection of both S-ICDs (odds ratio [OR] 2.10, 95% confidence interval [CI] 1.11–4.00; P = 0.024) and EV-ICDs (OR 2.27, 95% CI 1.05–4.91; P = 0.038) versus TV-ICDs. Low body mass index (17 vs 25 kg/m²) was associated with lower odds of selection of an S-ICD versus a TV-ICD (OR 0.30, 95% CI 0.09–0.94; P = 0.039) and higher odds of selection of an EV-ICD versus an S-ICD (OR 3.81, 95% CI 1.27–11.44; P = 0.017). Sex, heart disease and prevention setting were not independently associated with device selection. Conclusions: Implantable cardioverter-defibrillator selection showed a marked centre-level practice effect, and was also influenced by age and body mass index. These findings support harmonized selection pathways to reduce unwarranted variability, while preserving patient profile-oriented shared decision-making.
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Kerkouri et al. (2026) conducted a cross-sectional in Sudden cardiac death prevention (n=315). Age < 65 years vs. Age ≥ 65 years (selection of TV-ICD) was evaluated on Selection of a subcutaneous implantable cardioverter-defibrillator (S-ICD) versus a transvenous ICD (TV-ICD) (OR 2.10, 95% CI 1.11–4.00, p=0.024). ICD selection showed marked between-centre heterogeneity, while patient age < 65 years increased the odds of selecting an S-ICD over a TV-ICD (OR 2.10; 95% CI 1.11-4.00).
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