Clinical impact of defibrillation testing in a real-world S-ICD population: Data from the ELISIR registry

Danilo Ricciardi, Matteo Ziacchi, Alessio Gasperetti, Marco Schiavone, Francesco Picarelli, Igor Diemberger, Luca Bontempi, Natale Di Belardino, Giovanni Bisignani, Silvia De Bonis, Gianfranco Mitacchione, Vito Calabrese, Carlo Lavalle, Agostino Piro, Carlo Pignalberi, Luca Santini, Francesco Grigioni, Claudio Tondo, Mauro Biffi, Giovanni Battista Forleo

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Current guidelines recommend defibrillation testing (DT) performance in patients with a subcutaneous implantable cardioverter defibrillator (S-ICD), theoretically to reduce the amount of ineffective shocks. DT, however, has been proven unnecessary in transvenous ICD and real-world data show a growing trend in avoidance of DT after S-ICD implantation. Methods: All patients undergoing S-ICD implant at nine associated Italian centers joining in the ELISIR registry (ClinicalTrials.gov Identifier: NCT04373876) were enrolled and classified upon DT performance. Long-term follow-up events were recorded and compared to report the long-term efficacy and safety of S-ICD implantations without DT in a real-world setting. Results: A total of 420 patients (54.0 ± 15.5 years, 80.0% male) were enrolled in the study. A DT was performed in 254 (60.5%) patients (DT+ group), while in 166 (39.5%) was avoided (DT− group). Over a median follow-up of 19 (11–31) months, a very low rate (0.7%) of ineffective shocks was observed, and no significant differences in the primary combined arrhythmic outcome were observed between the two groups (p =.656). At regression analysis, the only clinical predictor associated with the primary combined outcome was S-ICD placement for primary prevention (odds ratio: 0.42; p =.013); DT performance instead was not associated with a reduction in primary outcome (p =.375). Conclusion: Implanting an S-ICD without DT does not appear to impact the safety of defibrillation therapy and overall patients' survival.

Original languageEnglish
JournalJournal of Cardiovascular Electrophysiology
DOIs
Publication statusAccepted/In press - 2020

Keywords

  • defibrillation testing
  • DFT
  • subcutaneous device
  • subcutaneous implantable cardioverter defibrillator

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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