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Efficacy And Safety Of The Subcutaneous Implantable Cardioverter Defibrillator: A Systematic Review

Mamas

Efficacy And Safety Of The Subcutaneous Implantable Cardioverter Defibrillator: A Systematic Review Thumbnail


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Abstract

Background:
Subcutaneous implantable cardioverter defibrillators (S-ICD) are an alternative to conventional transvenous implantable cardioverter defibrillators (TV-ICD) in patients not requiring pacing. We sought to define the efficacy and safety of S-ICD through literature review.

Methods:
We searched MEDLINE and EMBASE for studies evaluating efficacy and safety outcomes among patients undergoing S-ICD implantation. We performed narrative synthesis and pooled efficacy and safety outcomes across studies.

Results:
16 studies were included with 5,380 participants (mean age range 33–56 years). Short-term follow-up data were available for 1670 subjects. The commonest complication was pocket infection, affecting 2.7% (range 0–19%). Other complications included delayed wound healing (0.6%), wound discomfort (0.8%), haematoma (0.4%) and lead migration (0.3%). A total of 3.8% (range 0–12%) of S-ICDs were explanted. The commonest reason for explant was pocket infection. Mortality rates in hospital (0.4%) and during follow-up (3.4% from 12 studies reporting, 2.1% per person-years) were low. The number of patients experiencing ventricular arrhythmia varied across studies from 0 to 12%. Overall shock efficacy for treatment of ventricular arrhythmias exceeded 96%. Inappropriate shocks affected 4.3% (range 0–15%) of patients and was most commonly caused by T-wave oversensing.

Conclusions:
Although long-term randomised data are lacking, observational data suggest shock efficacy, peri-procedural and short-term complication rates of the S-ICD are similar to TV-ICD, making the S-ICD a suitable alternative in patients without an indication for pacing.

Acceptance Date Mar 31, 2017
Publication Date Sep 1, 2017
Publicly Available Date Mar 29, 2024
Journal Heart
Print ISSN 1355-6037
Publisher BMJ Publishing Group
Pages 1315-1322
DOI https://doi.org/10.1136/heartjnl-2016-310852
Keywords implanted cardiac defibrillators, ventricular fibrillation, ventricular tachycardia, systematic review
Publisher URL http://dx.doi.org/10.1136/heartjnl-2016-310852

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