3878Subcutaneous versus transvenous implantable defibrillator therapy: A meta-analysis of case-control studies

Ray, Indraneil; Liu, J.; Jia, Xiaoming; Lam, Wilson; Nazeri, Alireza; López, Ana Margarita Manso; Seger, John J.; Giorgberidzė, Irakli; Razavi, Mehdi; Mathuria, M.; Rasekh, Abdi; Afsar, H.; Saeed, Mohammed

doi:10.1093/eurheartj/ehx504.3878

Cited by 24 publications

(42 citation statements)

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“…Inappropriate shocks occurred in 9.9% of S‐ICD and in 7.9% of TV‐ICD patients. These rates are similar to those published by a previous systematic review (8.3% vs 9.4%) …”

Section: Discussionsupporting

confidence: 91%

“…When analyzing the causes of inappropriate shocks, it is observed that they were mainly due to oversensing in S‐ICD patients (especially of T waves) ( P = .0002), while in TV‐ICD patients they were mainly produced as a consequence of supraventricular tachycardia ( P = .0001). This result is in line with a previous systematic review . This difference is because of different detection systems in S‐ICD and TV‐ICD; the TV‐ICD uses intracavitary signals (lead in the right ventricle) while the S‐ICD uses subcutaneous signals.…”

Section: Discussionsupporting

confidence: 91%

“…No statistically significant differences were observed in any case between S‐ICD and TV‐ICD ( P = .08). The infection rate was low in both cases: 0.6% in S‐ICD patients and 0.3% in TV‐ICD patients, similar to a previous systematic review …”

Section: Discussionsupporting

confidence: 89%

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Subcutaneous implantable cardioverter‐defibrillator in primary and secondary prevention of sudden cardiac death: A meta‐analysis

León‐Salas

Trujillo‐Martín

Garcı́a

et al. 2019

Pacing Clinical Electrophis

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Background Subcutaneous implantable cardioverter‐defibrillator (S‐ICD) is gaining in popularity for primary and secondary prevention of sudden cardiac death. The objective was to evaluate the safety and clinical effectiveness of the S‐ICD for prevention of sudden cardiac death compared to transvenous cardioverter‐defibrillator (TV‐ICD). Methods A systematic review with meta‐analyses was performed. The electronic databases MEDLINE, EMBASE, SCI, and Cochrane Central Register of Controlled Trials were consulted in March 2018 with no restrictions on publication date. Predefined criteria were used to determine inclusion of studies and to assess their methodologic quality. Results Ten longitudinal‐observational studies with comparison group presenting moderate methodologic flaws were included (N = 7820). The combination of results indicates that health‐related quality of life is not significantly different between S‐ICD and TV‐ICD groups (Physical health: MD = 2.90; 95% CI = −3.88, 9.68/Mental health: MD = 0.13; 95% CI = −2.11, 2.37). Mortality occurred in 4.4% of S‐ICD patients and 5.9% of TV‐ICD patients died (OR = 0.79; 95% CI = 0.50, 1.24). The incidence of infections (OR = 1.79; 95% CI = 0.93, 3.43) and inappropriate shocks (OR = 1.28, 95% CI = 0.91, 1.78) is not significantly different between both groups. The S‐ICD reduces complications related to electrodes/leads (OR = 0.13, 95% CI = 0.05, 0.29) and has lower electrodes/leads movement compared with TV‐ICD (OR = 0.26; 95% CI 0.10, 0.67). In contrast, pneumothorax is more likely in TV‐ICD than S‐ICD (OR = 0.17; 95% CI = 0.03, 0.97). Conclusions S‐ICD reduces electrodes/leads movement, electrodes/leads related complications, and pneumothorax. Our study did not demonstrate a statistically significant difference in mortality, health‐related quality of life, and infection rate between S‐ICD and TV‐ICD.

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“…Inappropriate shocks occurred in 9.9% of S‐ICD and in 7.9% of TV‐ICD patients. These rates are similar to those published by a previous systematic review (8.3% vs 9.4%) …”

Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 91%

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Subcutaneous implantable cardioverter‐defibrillator in primary and secondary prevention of sudden cardiac death: A meta‐analysis

León‐Salas

Trujillo‐Martín

Garcı́a

et al. 2019

Pacing Clinical Electrophis

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“…The majority of ICD leads were implanted by subclavian puncture. Alternative accesses like cephalic or axillary vein access or implantation of subcutaneous ICDs might reduce ICD lead problems …”

Section: Discussionmentioning

confidence: 99%

Contemporary benefit‐harm profile over two decades in primary prophylactic ICD‐therapy

Kleemann

Strauss

Kouraki

et al. 2019

Clinical Cardiology

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Background Implantable cardioverter defibrillator (ICD) was implemented into clinical routine more than 20 years ago. Since then, ICD therapy became standard therapy for primary and secondary prevention of sudden cardiac death in clinical practice. Objectives Aim of the study was to evaluate the benefit‐harm profile of contemporary primary prophylactic ICD therapy. Methods A total of 1222 consecutive patients of a prospective single‐center ICD‐registry were analyzed who underwent primary prophylactic ICD implantation between 2000 and 2017. Patients were divided into two groups according to the implantation year: 2010‐2017 (group 1, n = 579) and 2000‐2009 (group 2, n = 643). Results The rate of estimated appropriate ICD therapy after 8 years was 51% in the 2000s and 42% in the 2010s (P < .001). The complication rate changed slightly from 53% to 47% (P = .005). This decline was mainly driven by the reduction of inappropriate ICD shocks (30% vs 14%, P < .001) whereas the rate of ICD shock lead malfunction and device/ lead infection remained unchanged over time. Nonischemic cardiomyopathy was an independent predictor for ICD complications without benefit of ICD therapy (HR 1.37, 95% CI 1.07‐1.77). Conclusion The ICD therapy rate for ventricular arrhythmias in patients with primary prophylactic ICD implantation is decreasing over the last two decades. Complication rate remains high due to an unchanged rate of ICD shock malfunctions and device infections. Nonischemic cardiomyopathy is an independent predictor for ICD complications without benefit of ICD therapy in primary prophylactic ICD‐therapy.

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“…A newer subcutaneous ICD system in which the entire electrode is placed subcutaneously in the patient’s chest was introduced a few years ago to limit these complications. Evidence has shown that the subcutaneous system is as effective in terminating life‐threatening arrhythmias compared to a conventional transvenous ICD . However, this system has a larger pocket device, a shorter battery life span and is unable to perform functions such as anti‐tachycardia or bradycardic pacing.…”

mentioning

confidence: 99%

Imaging appearance of an Extravascular Implantable Cardioverter Defibrillator

et al. 2019

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3878Subcutaneous versus transvenous implantable defibrillator therapy: A meta-analysis of case-control studies

Cited by 24 publications

References 0 publications

Subcutaneous implantable cardioverter‐defibrillator in primary and secondary prevention of sudden cardiac death: A meta‐analysis

Subcutaneous implantable cardioverter‐defibrillator in primary and secondary prevention of sudden cardiac death: A meta‐analysis

Contemporary benefit‐harm profile over two decades in primary prophylactic ICD‐therapy

Imaging appearance of an Extravascular Implantable Cardioverter Defibrillator

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