Subcutaneous Implantable Cardioverter-Defibrillator Therapy in Women

Area of Science:

• Cardiology
• Medical Devices
• Public Health

Background:

• The subcutaneous implantable cardioverter-defibrillator (S-ICD) is crucial for preventing sudden cardiac death.
• However, comprehensive data on sex-specific outcomes following S-ICD implantation is limited.

Purpose of the Study:

• To investigate sex-related differences in baseline characteristics among S-ICD recipients.
• To evaluate disparities in appropriate shocks, complications, reinterventions, and mortality between men and women.

Main Methods:

• Analysis of the nationwide HONEST cohort, including all S-ICD implants in France (2012-2019).
• Central adjudication of clinical endpoints.
• Propensity score-based inverse probability weighting was used to assess sex-specific outcome associations.

Main Results:

• Women (23.3%) were younger and had different baseline characteristics, including less primary prevention and coronary artery disease, but more electrical heart disease.
• Adjusted analysis revealed women had fewer appropriate shocks (HR: 0.85) and inappropriate shocks (HR: 0.64), but higher risks of chronic pain (HR: 2.63) and lead dislodgement (HR: 1.79).
• All-cause mortality was lower in women, with similar S-ICD-unresponsive sudden death and device-related mortality.

Conclusions:

• Women S-ICD recipients experienced fewer appropriate shocks and lower mortality, with a distinct complication profile.
• Overall complication and reintervention rates were similar between sexes.
• Findings emphasize the need for sex-informed S-ICD selection and patient follow-up strategies.