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Clinical course of hypertrophic cardiomyopathy patients implanted with a transvenous or subcutaneous defibrillator

Pietro Francia1, Matteo Ziacchi2, Carmen Adduci1

  • 1Cardiology, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, University Sapienza, Rome, Italy.

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|September 19, 2023
PubMed

Insights

Subcutaneous ICDs (S-ICDs) in hypertrophic cardiomyopathy (HCM) patients show a lower risk of ICD therapies and lead complications compared to transvenous ICDs (TV-ICDs). Long-term studies are needed to confirm survival benefits.

Area of Science:

  • Cardiology
  • Medical Devices
  • Sudden Cardiac Death Prevention

Background:

  • Implantable cardioverter-defibrillators (ICDs) are crucial for preventing sudden cardiac death in hypertrophic cardiomyopathy (HCM) patients.
  • Complications associated with transvenous ICDs (TV-ICDs) are a significant concern.
  • Subcutaneous ICDs (S-ICDs) offer a leadless alternative, potentially reducing complications.

Purpose of the Study:

  • To compare the efficacy and safety of S-ICDs versus TV-ICDs in HCM patients.
  • To evaluate differences in ICD interventions, complications, adverse events, and mortality between S-ICD and TV-ICD recipients.

Main Methods:

  • A comparative study of consecutive HCM patients implanted with either S-ICD (n=216) or TV-ICD (n=211).
  • Analysis using propensity-adjusted Kaplan-Meier curves and Cox proportional hazard ratios.
  • Comparison of 5-year event-free survival and risks of various adverse outcomes.

Main Results:

  • S-ICD patients demonstrated a significantly lower 5-year risk of both appropriate (HR: 0.32) and inappropriate (HR: 0.44) ICD interventions.
  • The risk of major lead-related complications was substantially lower in the S-ICD group (HR: 0.17).
  • Rates of device-related complications, disease-related complications, and mortality were similar between S-ICD and TV-ICD groups at 5 years.

Conclusions:

  • S-ICDs in HCM patients are associated with a reduced risk of ICD therapies and major lead-related complications compared to TV-ICDs.
  • Further long-term follow-up is necessary to determine if reduced lead complications translate to improved morbidity and survival benefits.
Abstract

Keywords:
Device-related complicationsHypertrophic cardiomyopathyImplantable cardioverter-defibrillatorSubcutaneous implantable cardioverter-defibrillator

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