Roberto Rordorf1, Matteo Casula2, Laura Pezza2, Federico Fortuni3, Antonio Sanzo4, Simone Savastano4, Alessandro Vicentini4. 1. Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy. Electronic address: r.rordorf@smatteo.pv.it. 2. Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy; Department of Molecular Medicine, Unit of Cardiology, University of Pavia, Pavia, Italy. 3. Department of Molecular Medicine, Unit of Cardiology, University of Pavia, Pavia, Italy. 4. Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy.
Abstract
BACKGROUND: Implantable cardioverter-defibrillator (ICD) placement is a well-established therapy for prevention of sudden cardiac death. The subcutaneous implantable cardioverter-defibrillator (S-ICD) was specifically designed to overcome some of the complications related to the transvenous implantable cardioverter-defibrillator (TV-ICD), such as lead complications and systemic infections. Evidence on the comparison of S-ICD vs TV-ICD are limited. OBJECTIVE: The purpose of this study was to conduct an updated meta-analysis comparing S-ICD vs TV-ICD. METHODS: Electronic databases were searched for studies directly comparing clinical outcomes and complications between S-ICD and TV-ICD. The primary outcome was the composite of clinically relevant complications (lead, pocket, major procedural complications; device-related infections) and inappropriate shocks. Secondary outcomes included death and the individual components of the primary outcome. RESULTS: Thirteen studies comprising 9073 patients were included in the analysis. Mean left ventricular ejection fraction was 40% ± 10%; 30% of patients were female; and 73% had an ICD implanted for primary prevention. There was no statistically significant difference in the risk of the primary outcome between S-ICD and TV-ICD (odds ratio [OR] 0.80; 95% confidence interval [CI] 0.53-1.19). Patients with S-ICD had lower risk of lead complications (OR 0.14; 95% CI 0.06-0.29; P <.00001) and major procedural complications (OR 0.18; 95% CI 0.06-0.57; P = .003) but higher risk of pocket complications (OR 2.18; 95% CI 1.30-3.66; P = .003) compared to those with TV-ICD. No significant differences were found for the other outcomes. CONCLUSION: In patients with an indication for ICD without the need for pacing, TV-ICD and S-ICD are overall comparable in terms of the composite of clinically relevant device-related complications and inappropriate shock.
BACKGROUND: Implantable cardioverter-defibrillator (ICD) placement is a well-established therapy for prevention of sudden cardiac death. The subcutaneous implantable cardioverter-defibrillator (S-ICD) was specifically designed to overcome some of the complications related to the transvenous implantable cardioverter-defibrillator (TV-ICD), such as lead complications and systemic infections. Evidence on the comparison of S-ICD vs TV-ICD are limited. OBJECTIVE: The purpose of this study was to conduct an updated meta-analysis comparing S-ICD vs TV-ICD. METHODS: Electronic databases were searched for studies directly comparing clinical outcomes and complications between S-ICD and TV-ICD. The primary outcome was the composite of clinically relevant complications (lead, pocket, major procedural complications; device-related infections) and inappropriate shocks. Secondary outcomes included death and the individual components of the primary outcome. RESULTS: Thirteen studies comprising 9073 patients were included in the analysis. Mean left ventricular ejection fraction was 40% ± 10%; 30% of patients were female; and 73% had an ICD implanted for primary prevention. There was no statistically significant difference in the risk of the primary outcome between S-ICD and TV-ICD (odds ratio [OR] 0.80; 95% confidence interval [CI] 0.53-1.19). Patients with S-ICD had lower risk of lead complications (OR 0.14; 95% CI 0.06-0.29; P <.00001) and major procedural complications (OR 0.18; 95% CI 0.06-0.57; P = .003) but higher risk of pocket complications (OR 2.18; 95% CI 1.30-3.66; P = .003) compared to those with TV-ICD. No significant differences were found for the other outcomes. CONCLUSION: In patients with an indication for ICD without the need for pacing, TV-ICD and S-ICD are overall comparable in terms of the composite of clinically relevant device-related complications and inappropriate shock.
Authors: Vincenzo Russo; Anna Rago; Vincenzo Ruggiero; Francesca Cavaliere; Valter Bianchi; Ernesto Ammendola; Andrea Antonio Papa; Vincenzo Tavoletta; Stefano De Vivo; Paolo Golino; Antonio D'Onofrio; Gerardo Nigro Journal: Front Cardiovasc Med Date: 2022-05-16
Authors: Maciej Kempa; Andrzej Przybylski; Szymon Budrejko; Tomasz Fabiszak; Michał Lewandowski; Krzysztof Kaczmarek; Mateusz Tajstra; Marcin Grabowski; Przemysław Mitkowski; Stanisław Tubek; Ewa Jędrzejczyk-Patej; Radosław Lenarczyk; Dariusz Jagielski; Janusz Romanek; Anna Rydlewska; Zbigniew Orski; Joanna Zakrzewska-Koperska; Artur Filipecki; Marcin Janowski; Tatjana Potpara; Serge Boveda Journal: Int J Environ Res Public Health Date: 2021-07-05 Impact factor: 3.390