Chue, CD, Kwok, CS, Wong, CW, Patwala, A, Barker, D, Zaidi, A, Mamas, MA ORCID: https://orcid.org/0000-0001-9241-8890, Cunnington, C and Ahmed, FZ (2017) Efficacy And Safety Of The Subcutaneous Implantable Cardioverter Defibrillator: A Systematic Review. Heart, 103 (17). pp. 1315-1322.

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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.

Item Type: Article
Additional Information: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via BMJ Publishing Group at : http://dx.doi.org/10.1136/heartjnl-2016-310852 - please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: implanted cardiac defibrillators, ventricular fibrillation, ventricular tachycardia, systematic review
Subjects: R Medicine > RC Internal medicine > RC666 Diseases of the circulatory (Cardiovascular) system
Divisions: Faculty of Medicine and Health Sciences > Institute for Science and Technology in Medicine
Depositing User: Symplectic
Date Deposited: 04 Apr 2017 08:27
Last Modified: 14 Mar 2019 12:25
URI: http://eprints.keele.ac.uk/id/eprint/3152

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