S-ICD Implantation Following TV-ICD: Insights Into Patients With Infections and Abandoned Leads: The HONEST Cohort

Subcutaneous implantable cardioverter-defibrillators (S-ICDs) can be a viable option for patients with transvenous ICDs experiencing complications (rescue S-ICD).

This study sought to evaluate the outcomes of rescue S-ICD implantation using data from the HONEST French nationwide S-ICD cohort.

All rescue S-ICD patients were identified. Outcomes (complications, reinterventions, and mortality) were compared between rescue and de novo S-ICD patients. Subgroup analyses were performed based on the implantation indication (infective vs noninfective) and the presence of abandoned leads.

Among 4,924 patients in the HONEST cohort, 651 underwent rescue S-ICD implantation (295 with infective indications, 244 with abandoned leads). Over a follow-up of 4.2 ± 2.2 years, complications and reinterventions were similar in rescue and de novo S-ICD patients (22.6% vs 21.0%; P = 0.35 and 8.7% vs 7.2%; P = 0.17, respectively), in infective and noninfective rescue S-ICD patients (21.6% vs 23.5%; P = 0.55 and 8.9% vs 8.6%; P = 0.90, respectively) and in patients with abandoned and extracted leads (24.3% vs 21.7%; P = 0.46 and 8.3% vs 9.0%; P = 0.77, respectively). Mortality was higher in rescue compared to de novo S-ICD patients (16.9% vs 10.2%; P < 0.001) and in rescue S-ICD patients with infective indications (29.2% vs 6.7%; P < 0.001) and extracted leads (21.9% vs 8.6%; P < 0.001), mainly due to a higher burden of comorbidities, as none of these parameters was independently associated with mortality in multivariate analyses. No S-ICD-related deaths were observed.

Rescue S-ICD implantation is an acceptable option for patients with device-related complications. Lead abandonment in the setting of a noninfective indication appears to be safe. (S-ICD French Cohort Study [HONEST]; NCT05302115).