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Published on: February 28, 2012
Subcutaneous Implantable Cardioverter-Defibrillators in Patients With Congenital Heart Disease
Victor Waldmann1, Christelle Marquié2, Francis Bessière3
1Université de Paris, INSERM, Paris Cardiovascular Research Centre, Paris, France; Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France; Pediatric and Congenital Medico-Surgical Unit, Necker Hospital, Paris, France; Cardiac Electrophysiology Unit, European Georges Pompidou Hospital, Paris, France.
Insights
Subcutaneous implantable cardioverter-defibrillators (S-ICDs) are effective and safe for patients with congenital heart disease (CHD). This study found similar complication rates between CHD and non-CHD patients receiving S-ICDs.
Area of Science:
- Cardiology
- Medical Devices
- Congenital Heart Disease
Background:
- Limited data exist on subcutaneous implantable cardioverter-defibrillator (S-ICD) use in congenital heart disease (CHD) patients.
- S-ICDs are crucial for preventing sudden cardiac death in high-risk individuals.
Purpose of the Study:
- To analyze the outcomes of S-ICD implantation in patients diagnosed with congenital heart disease (CHD).
- To assess the safety and effectiveness of S-ICDs in this specific patient population.
Main Methods:
- A nationwide French cohort study analyzed data from 4,924 S-ICD recipients between 2012 and 2019.
- Included 101 patients (2.1%) with CHD, comparing their characteristics and outcomes to non-CHD patients.
- Propensity matching was used to adjust for potential confounding factors.
Main Results:
- Patients with CHD were younger, more frequently female, and more likely to receive S-ICDs for secondary prevention.
- Crude risk of appropriate S-ICD shocks was higher in CHD patients, but this difference diminished after propensity matching.
- The incidence of all complications and inappropriate shocks was comparable between CHD and non-CHD groups.
Conclusions:
- S-ICDs demonstrate effectiveness and safety in patients with congenital heart disease (CHD), a population often considered high-risk.
- Findings support the use of S-ICDs for arrhythmia management in CHD patients.
- The HONEST study (NCT05302115) provides valuable insights into S-ICD outcomes in CHD.
Background:
Very few data have been published on the use of subcutaneous implantable cardioverter-defibrillators (S-ICDs) in patients with congenital heart disease (CHD).
Objectives:
The aim of this study was to analyze outcomes associated with S-ICDs in patients with CHD.
Methods:
This nationwide French cohort including all patients with an S-ICD was initiated in 2020 by the French Institute of Health and Medical Research. Characteristics at implantation and outcomes were analyzed in patients with CHD.
Results:
From October 12, 2012, to December 31, 2019, among 4,924 patients receiving an S-ICD implant in 150 centers, 101 (2.1%) had CHD. Tetralogy of Fallot, univentricular heart, and dextro-transposition of the great arteries represented almost one-half of the population. Patients with CHD were significantly younger (age 37.1 ± 15.4 years vs 50.1 ± 14.9 years; P < 0.001), more frequently female (37.6% vs 23.0%; P < 0.001), more likely to receive an S-ICD for secondary prevention (72.3% vs 35.9%; P < 0.001), and less likely to have severe systolic dysfunction of the systemic ventricle (28.1% vs 53.1%; P < 0.001). Over a mean follow-up period of 1.9 years, 16 (15.8%) patients with CHD received at least 1 appropriate shock, with all shocks successfully terminating the ventricular arrhythmia. The crude risk of appropriate S-ICD shock was twice as high in patients with CHD compared with non-CHD patients (annual incidences of 9.0% vs 4.4%; HR: 2.1; 95% CI: 1.3-3.4); however, this association was no longer significant after propensity matching (especially considering S-ICD indication, P = 0.12). The burden of all complications (HR: 1.2; 95% CI: 0.7-2.1; P = 0.4) and inappropriate shocks (HR: 0.9; 95% CI: 0.4-2.0; P = 0.9) was comparable in both groups.
Conclusions:
In this nationwide study, patients with CHD represented 2% of all S-ICD implantations. Our findings emphasize the effectiveness and safety of S-ICD in this particularly high-risk population. (S-ICD French Cohort Study [HONEST]; NCT05302115).
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