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Subcutaneous versus transvenous implantable defibrillator: An updated meta-analysis

  • Author Footnotes
    1 Dr Roberto Rordorf and Dr Matteo Casula share joint first co-authorship.
    Roberto Rordorf
    Correspondence
    Address reprint requests and correspondence: Dr Roberto Rordorf, Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, IRCCS Fondazione Policlinico S. Matteo, P.le Golgi 19, 27100, Pavia, Italy.
    Footnotes
    1 Dr Roberto Rordorf and Dr Matteo Casula share joint first co-authorship.
    Affiliations
    Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy
    Search for articles by this author
  • Author Footnotes
    1 Dr Roberto Rordorf and Dr Matteo Casula share joint first co-authorship.
    Matteo Casula
    Footnotes
    1 Dr Roberto Rordorf and Dr Matteo Casula share joint first co-authorship.
    Affiliations
    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
    Search for articles by this author
  • Laura Pezza
    Affiliations
    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
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  • Federico Fortuni
    Affiliations
    Department of Molecular Medicine, Unit of Cardiology, University of Pavia, Pavia, Italy
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  • Antonio Sanzo
    Affiliations
    Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy
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  • Simone Savastano
    Affiliations
    Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy
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  • Alessandro Vicentini
    Affiliations
    Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy
    Search for articles by this author
  • Author Footnotes
    1 Dr Roberto Rordorf and Dr Matteo Casula share joint first co-authorship.
Published:November 15, 2020DOI:https://doi.org/10.1016/j.hrthm.2020.11.013

      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.

      Keywords

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