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S-ICD in Hypertrophic Cardiomyopathy: Fewer Complications Without Increased Inappropriate Shocks Versus Transvenous

Christopher Monkhouse1,2, James Malcolmson1,2, Edward Maclean1,2

  • 1Barts Heart Centre, West Smithfield, London, UK.

Pacing and Clinical Electrophysiology : PACE
|January 19, 2026
PubMed

Insights

Subcutaneous implantable cardioverter defibrillators (S-ICD) show fewer complications in hypertrophic cardiomyopathy (HCM) patients compared to transvenous ICDs (TV-ICD). Multi-event analysis confirms reduced cumulative complication risk with S-ICDs, offering a potentially better benefit/risk ratio.

Area of Science:

  • Cardiology
  • Medical Devices
  • Biomedical Engineering

Background:

  • Hypertrophic cardiomyopathy (HCM) patients face long-term risks with implantable cardioverter defibrillators (ICDs), including complications and inappropriate therapy (IT).
  • Subcutaneous ICDs (S-ICDs) eliminate vascular risks of transvenous ICDs (TV-ICDs), but IT rates remain a concern.
  • Assessing cumulative complication risk is crucial for optimizing ICD selection in HCM.

Purpose of the Study:

  • To compare complication rates and cumulative risk between S-ICDs and TV-ICDs in HCM patients.
  • To evaluate the impact of device type on therapy rates and mortality.
  • To provide a novel assessment of cumulative complication burden using multi-event analysis.

Main Methods:

  • Retrospective observational study of 611 HCM patients receiving ICDs (2006-2022).
  • Comparative outcome analysis using Cox proportional hazard models and multi-event statistical models.
  • Propensity score matching to adjust for baseline differences.

Main Results:

  • S-ICD recipients (n=141) experienced significantly fewer complications than TV-ICD recipients (HR 0.309, p=0.035).
  • Multi-event analysis revealed a cumulative increase in complications for TV-ICDs (HR 0.258, p=0.004), with no multiple complications in S-ICD patients.
  • No significant differences in therapy rates or mortality were observed between matched groups.

Conclusions:

  • S-ICDs are associated with fewer complications compared to TV-ICDs in HCM patients, a finding amplified by multi-event analysis.
  • Despite similar inappropriate therapy rates, S-ICDs may offer an improved benefit/risk ratio.
  • Shared decision-making regarding S-ICD use should be encouraged for HCM patients.
Abstract

Keywords:
device complicationshypertrophic cardiomyopathyinappropriate therapysubcutaneous ICDsudden cardiac deathtransvenous ICD

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