Sex-based outcomes of subcutaneous implantable cardioverter-defibrillator and impact of surgical technique

• Published in: Heart rhythm Vol. 21; no. 10; pp. 1907 - 1911
• Main Authors: Vijayvargiya, Sonya, Mekary, Wissam, Jain, Vardhmaan, Rao, Birju R., Ibrahim, Rand, Patel, Anshul M., Shah, Anand D., DeLurgio, David B., Westerman, Stacy, Lloyd, Michael S., Bhatia, Neal, Merchant, Faisal M., El-Chami, Mikhael F.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2024
• Subjects: 2-incision technique; Intermuscular technique; Pocket-related complications; Sex-based outcomes; Subcutaneous ICD; 2-incision technique; ESRD; SCD; Subcutaneous ICD; S-ICD; TV-ICD; Pocket-related complications; Intermuscular technique; ICD; Sex-based outcomes
• ISSN: 1547-5271; 1556-3871; 1556-3871
• DOI: 10.1016/j.hrthm.2024.04.052

Because of differences in chest wall anatomy, female patients may have higher rates of subcutaneous implantable cardioverter-defibrillator (S-ICD) pocket-related complications. We sought to evaluate sex-based outcomes after S-ICD implantation. Patients implanted with an S-ICD at Emory Healthcare between 2010 and 2023 were included in the analysis. Patients’ clinical characteristics and post–S-ICD implantation complications were collected. There were 429 male patients (68%) and 199 female patients (32%) observed for a median duration of 2.3 years (0.6–4.4 years). Male and female patients had comparable rates of diabetes (28%), end-stage renal disease (29.5%), ejection fraction (30.2% ± 13.4%), and body mass index (29.1 ± 6.6 kg/m2). There was no statistical difference in the incidence of shocks between men and women (26.3% vs 20.1%; P = .09), including appropriate shocks (14.7% vs 12%; P = .98) and inappropriate shocks (11.7% vs 9.5%; P = .98). Pocket-related complications occurred in 21 patients; these included pocket infection (n = 12), wound dehiscence (n = 7), and hematoma requiring drainage (n = 2). Female patients had a significantly higher pocket-related complication rate compared with male patients (7.2% vs 2.5%; P = .016). In controlling for age, body mass index, diabetes, and end-stage renal disease, female patients had higher odds of pocket-related complications compared with male patients (odds ratio, 3.15; 95% confidence interval, 1.27–7.75). Pocket-related complications decreased after 2018 compared with before 2018 (6% vs 2.6%, P = .052), mainly driven by reduction in complications in women (12.3% vs 3.2%; P = .034) but not in men (2.8% vs 2.4%; P = 1). In this cohort of S-ICD patients, women had a higher rate of post–S-ICD pocket-related complications that could be explained by sex-based differences in anatomy.