Giovanni B Forleo1, Alessio Gasperetti2, Alexander Breitenstein3, Mikael Laredo4, Marco Schiavone5, Matteo Ziacchi6, Julia Vogler7, Danilo Ricciardi8, Pietro Palmisano9, Agostino Piro10, Paolo Compagnucci11, Xavier Waintraub4, Gianfranco Mitacchione12, Gianmarco Carrassa13, Giulia Russo14, Silvana De Bonis15, Andrea Angeletti6, Antonio Bisignani15, Francesco Picarelli8, Michela Casella11, Edoardo Bressi16, Giovanni Rovaris17, Leonardo Calò16, Luca Santini18, Carlo Pignalberi19, Carlo Lavalle10, Maurizio Viecca1, Ennio Pisanò14, Iacopo Olivotto13, Antonio Curnis12, Antonio Dello Russo11, Claudio Tondo20, Charles J Love21, Luigi Di Biase22, Jan Steffel3, Roland Tilz7, Nicolas Badenco4, Mauro Biffi6. 1. Cardiology Unit, Luigi Sacco University Hospital, Milan, Italy. 2. Cardiology Unit, Luigi Sacco University Hospital, Milan, Italy; Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Salesi-Lancisi", Ancona, Italy; Division of Cardiology, Johns Hopkins University, Baltimore, Maryland. 3. Cardiology Department, Zurich University Hospital, Zurich, Switzerland. 4. APHP, Hôpital Pitié Salpêtrière, Paris, France. 5. Cardiology Unit, Luigi Sacco University Hospital, Milan, Italy. Electronic address: marco.schiavone11@gmail.com. 6. Cardiology Unit, Sant'Orsola Hospital, University of Bologna, Bologna, Italy. 7. Cardiology Department, University Hospital of Lubeck, Lubeck, Germany. 8. Cardiology Department, Campus-Bio-Medico, Rome, Italy. 9. Cardiology Department, Tricase Hospital, Tricase, Italy. 10. Cardiology Department, Policlinico Umberto I, Rome, Italy. 11. Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Salesi-Lancisi", Ancona, Italy. 12. Cardiology Department, Spedali Civili Brescia, Brescia, Italy. 13. Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy. 14. Cardiology Department, Vito Fazzi Hospital, Lecce, Italy. 15. Cardiology Department, Ferrari Hospital, Castrovillari, Cosenza, Italy. 16. Cardiology Department, Policlinico Casilino, Rome, Italy. 17. Cardiology Department, San Gerardo Hospital, Monza, Italy. 18. Cardiology Department, Ospedale G.B. Grassi, Ostia, Italy. 19. Cardiology Department, Ospedale San Filippo Neri, Rome, Italy. 20. Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy; Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy. 21. Division of Cardiology, Johns Hopkins University, Baltimore, Maryland. 22. Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
Abstract
BACKGROUND: To date, only a few comparisons between subcutaneous implantable cardioverter-defibrillator (S-ICD) patients undergoing and those not undergoing defibrillation testing (DT) at implantation (DT+ vs DT-) have been reported. OBJECTIVE: The purpose of this study was to compare long-term clinical outcomes of 2 propensity-matched cohorts of DT+ and DT- patients. METHODS: Among consecutive S-ICD patients implanted across 17 centers from January 2015 to October 2020, DT- patients were 1:1 propensity-matched for baseline characteristics with DT+ patients. The primary outcome was a composite of ineffective shocks and cardiovascular mortality. Appropriate and inappropriate shock rates were deemed secondary outcomes. RESULTS: Among 1290 patients, a total of 566 propensity-matched patients (283 DT+; 283 DT-) served as study population. Over median follow-up of 25.3 months, no significant differences in primary outcome event rates were found (10 DT+ vs 14 DT-; P = .404) as well as for ineffective shocks (5 DT- vs 3 DT+; P = .725). At multivariable Cox regression analysis, DT performance was associated with a reduction of neither the primary combined outcome nor ineffective shocks at follow-up. A high PRAETORIAN score was positively associated with both the primary outcome (hazard ratio 3.976; confidence interval 1.339-11.802; P = .013) and ineffective shocks alone at follow-up (hazard ratio 19.030; confidence interval 4.752-76.203; P = .003). CONCLUSION: In 2 cohorts of strictly propensity-matched patients, DT performance was not associated with significant differences in cardiovascular mortality and ineffective shocks. The PRAETORIAN score is capable of correctly identifying a large percentage of patients at risk for ineffective shock conversion in both cohorts.
BACKGROUND: To date, only a few comparisons between subcutaneous implantable cardioverter-defibrillator (S-ICD) patients undergoing and those not undergoing defibrillation testing (DT) at implantation (DT+ vs DT-) have been reported. OBJECTIVE: The purpose of this study was to compare long-term clinical outcomes of 2 propensity-matched cohorts of DT+ and DT- patients. METHODS: Among consecutive S-ICD patients implanted across 17 centers from January 2015 to October 2020, DT- patients were 1:1 propensity-matched for baseline characteristics with DT+ patients. The primary outcome was a composite of ineffective shocks and cardiovascular mortality. Appropriate and inappropriate shock rates were deemed secondary outcomes. RESULTS: Among 1290 patients, a total of 566 propensity-matched patients (283 DT+; 283 DT-) served as study population. Over median follow-up of 25.3 months, no significant differences in primary outcome event rates were found (10 DT+ vs 14 DT-; P = .404) as well as for ineffective shocks (5 DT- vs 3 DT+; P = .725). At multivariable Cox regression analysis, DT performance was associated with a reduction of neither the primary combined outcome nor ineffective shocks at follow-up. A high PRAETORIAN score was positively associated with both the primary outcome (hazard ratio 3.976; confidence interval 1.339-11.802; P = .013) and ineffective shocks alone at follow-up (hazard ratio 19.030; confidence interval 4.752-76.203; P = .003). CONCLUSION: In 2 cohorts of strictly propensity-matched patients, DT performance was not associated with significant differences in cardiovascular mortality and ineffective shocks. The PRAETORIAN score is capable of correctly identifying a large percentage of patients at risk for ineffective shock conversion in both cohorts.
Authors: Szymon Budrejko; Maciej Kempa; Wojciech Krupa; Tomasz Królak; Tomasz Fabiszak; Grzegorz Raczak Journal: Int J Environ Res Public Health Date: 2022-08-06 Impact factor: 4.614