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Inappropriate Shocks From Subcutaneous vs Transvenous Implantable Cardioverter-Defibrillators: Individual Participant

Alexander P Benz1, Louise R A Olde Nordkamp2, William F McIntyre1

  • 1Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.

Journal of the American College of Cardiology
|December 10, 2025
PubMed
Summary
This summary is machine-generated.

Subcutaneous implantable cardioverter-defibrillators (ICDs) showed a higher rate of inappropriate shocks, primarily due to oversensing and electromagnetic interference. Transvenous ICDs had more inappropriate shocks from atrial arrhythmias, despite overall infrequent events.

Keywords:
S-ICDTV-ICDcardiac implantable electronic devicecardioversiondefibrillationsudden cardiac death

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Area of Science:

  • Cardiology
  • Medical Devices
  • Clinical Trials

Background:

  • Subcutaneous implantable cardioverter-defibrillators (ICDs) reduce lead complications compared to transvenous ICDs.
  • Previous trials (PRAETORIAN, ATLAS) were not powered to compare inappropriate shock rates.
  • This study addresses the need for comparative data on inappropriate shocks between ICD types.

Purpose of the Study:

  • To compare the incidence of first inappropriate shocks between subcutaneous and transvenous ICDs.
  • To investigate the specific causes of inappropriate shocks in each ICD group.
  • To provide evidence for optimizing ICD selection and programming.

Main Methods:

  • Individual participant data meta-analysis of the PRAETORIAN and ATLAS trials.
  • Utilized Cox regression models, stratified by trial, to analyze time to first inappropriate shock.
  • Pooled data from 1,342 patients randomized to either subcutaneous or transvenous ICDs.

Main Results:

  • Subcutaneous ICDs had a higher rate of first inappropriate shocks (2.5 vs. 1.5 per 100 patient-years; HR: 1.61).
  • Increased risk of inappropriate shocks in subcutaneous ICDs was linked to cardiac oversensing and electromagnetic interference.
  • Transvenous ICDs showed a higher risk of inappropriate shocks attributed to atrial arrhythmias.

Conclusions:

  • First inappropriate shocks, while infrequent, occurred more often with subcutaneous ICDs.
  • Cardiac oversensing and electromagnetic interference were key drivers of inappropriate shocks in subcutaneous ICD patients.
  • Atrial arrhythmias were a more common cause of inappropriate shocks in transvenous ICD recipients.