Use and outcomes of subcutaneous implantable cardioverter-defibrillator (ICD) after transvenous ICD extraction: An analysis of current clinical practice and a comparison with transvenous ICD reimplantation

Stefano Viani, Federico Migliore, Gianfranco Tola, Ennio C L Pisanò, Antonio Dello Russo, Giovanni Luzzi, Paolo Sartori, Agostino Piro, Roberto Rordorf, Giovanni Battista Forleo, Anna Rago, Luca Segreti, Emanuele Bertaglia, Mauro Biffi, Mariolina Lovecchio, Sergio Valsecchi, Igor Diemberger, Maria Grazia Bongiorni

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The subcutaneous implantable cardioverter-defibrillator (S-ICD) does not require the insertion of any leads into the cardiovascular system.

OBJECTIVE: The aims of the study were to describe current practice and to measure outcomes associated with S-ICD or standard single-chamber transvenous ICD (TV-ICD) use after TV-ICD explantation.

METHODS: We analyzed all consecutive patients who underwent transvenous extraction of an ICD and subsequent implantation of an S-ICD or a single-chamber TV-ICD at 12 Italian centers from 2011 to 2017.

RESULTS: A total of 229 patients were extracted and subsequently reimplanted with an S-ICD (90; 39%) or a single-chamber TV-ICD (139; 61%). S-ICD implantation increased from 9% in 2011 to 85% in 2017 (P < .001). Patients reimplanted with an S-ICD were younger (53 ± 13 years vs 60 ± 18 years; P = .011) and more frequently had undergone extraction owing to infection (73% vs 52%; P < .001). The rates of complications at follow-up were comparable between groups (hazard ratio 0.97; 95% confidence interval 0.49-1.92; P = .940). No lead failures, systemic infections, or system-related deaths occurred in the S-ICD group. In the TV-ICD group, 1 lead fracture occurred and 2 systemic infections were reported, resulting in death in 1 case. In the S-ICD group, the rate of complications was lower when the generator was positioned in a sub- or intermuscular pocket (hazard ratio 0.21; 95% confidence interval 0.05-0.87; P = .048).

CONCLUSION: Our results show an increasing use of S-ICD over the years in patients undergoing TV-ICD explantation. An S-ICD is preferably adopted in young patients, mostly in the case of infection. The complication rate was comparable between groups and decreased when a sub- or intermuscular S-ICD generator position was adopted.

Original languageEnglish
JournalHeart Rhythm
DOIs
Publication statusE-pub ahead of print - Oct 24 2018

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    Viani, S., Migliore, F., Tola, G., Pisanò, E. C. L., Russo, A. D., Luzzi, G., Sartori, P., Piro, A., Rordorf, R., Forleo, G. B., Rago, A., Segreti, L., Bertaglia, E., Biffi, M., Lovecchio, M., Valsecchi, S., Diemberger, I., & Bongiorni, M. G. (2018). Use and outcomes of subcutaneous implantable cardioverter-defibrillator (ICD) after transvenous ICD extraction: An analysis of current clinical practice and a comparison with transvenous ICD reimplantation. Heart Rhythm. https://doi.org/10.1016/j.hrthm.2018.10.026