Current clinical practice of subcutaneous implantable cardioverter-defibrillator: Analysis using the JROAD-DPC database

• Published in: Heart rhythm Vol. 19; no. 6; pp. 909 - 916
• Main Authors: Tonegawa-Kuji, Reina, Inoue, Yuko Y., Nakai, Michikazu, Kanaoka, Koshiro, Sumita, Yoko, Miyazaki, Yuichiro, Wakamiya, Akinori, Shimamoto, Keiko, Ueda, Nobuhiko, Wada, Mitsuru, Yamagata, Kenichiro, Ishibashi, Kohei, Miyamoto, Koji, Nagase, Satoshi, Aiba, Takeshi, Iwanaga, Yoshitaka, Miyamoto, Yoshihiro, Kusano, Kengo
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2022
• Subjects: Nationwide database; Perioperative outcomes; Propensity-matched analysis; S-ICD; Subcutaneous implantable cardioverter-defibrillator; Perioperative outcomes; Nationwide database; Propensity-matched analysis; Subcutaneous implantable cardioverter-defibrillator; S-ICD
• ISSN: 1547-5271; 1556-3871
• DOI: 10.1016/j.hrthm.2022.02.006

Current evidence describing the characteristics of subcutaneous implantable cardioverter-defibrillator (S-ICD) therapy, its trend, and perioperative outcomes compared with transvenous implantable cardioverter-defibrillator (TV-ICD) based on a real-world, large-scale database is scarce. The purpose of this study was to identify the characteristics of current S-ICD therapy using a nationwide database. A retrospective analysis of ICD implantation was performed using a nationwide database obtained between 2016 and 2020. A total of 8690 patients implanted with ICD (median age 65 [52–72] year; 6902 men; 2021 S-ICD recipients) were analyzed. Younger patients were more prone to have S-ICD (P <.001). A history of ventricular fibrillation (VF) (odds ratio [OR] 2.45; 95% confidence interval [CI] 2.04–2.93), nonsustained ventricular tachycardia (VT) (OR 1.73; 95% CI 1.36–2.21), Brugada syndrome (BrS) (OR 3.14; 95% CI 2.48–4.00), and dialysis treatment (OR 2.02; 95% CI 1.44–2.82) were independent predictors of S-ICD selection on mixed-model logistic analysis. The proportion of S-ICD implantations has been increasing (P <.001), especially in patients with BrS (P <.001) and dialysis (P = .04). The proportion of combined complications after S-ICD implantation was low (1.3%) in the unmatched cohort and was comparable to TV-ICD in the 1:1 propensity-matched cohort of 3354 patients (1.5% vs 2.3%; OR 0.65; 95% CI 0.38–1.10). S-ICD was more likely to be implanted in younger patients and those with a history of VF, nonsustained VT, BrS, and dialysis treatment. The proportion of S-ICD implantation increased, especially in patients with BrS. The incidence of in-hospital complications was low in S-ICD recipients.