Federico Migliore, Luca Ottaviano, Alberto Arestia, Gerardo Nigro, Antonio Dello Russo, Stefano Viani, Valter Bianchi, Antonio Bisignani, Paolo Pieragnoli, Gennaro Vitulano, Roberto Rordorf, Pietro Francia, Erika Taravelli, Ennio Pisanò, Carlo Lavalle, Roberta Brambilla, Matteo Ziacchi, Antonio Rapacciuolo, Miguel Viscusi, Paolo De Filippo, Carmelo La Greca, Patrizia Pepi, Pasquale Notarstefano, Antonio Curcio, Raimondo Pittorru, Nicolò Martini, Alessandro Seganti, Carlo Napolitano, Mariolina Lovecchio, Sergio Valsecchi, Gianluca Botto, Silvia G Priori
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引用次数: 0
Abstract
Background: The implantable cardioverter-defibrillator (ICD) is recognized as the most effective life-saving therapy in patients with Brugada syndrome (BrS). However, transvenous ICD is associated with a notable rate of complications over time. The subcutaneous implantable cardioverter-defibrillator (S-ICD) has emerged as a promising alternative to the transvenous ICD. Nevertheless, long-term data from large cohorts of BrS patients with S-ICDs are lacking.
Objectives: This multicenter study aimed to assess the long-term outcomes of S-ICD therapy in patients with BrS.
Methods: The study included 450 consecutive BrS patients (mean age 43 ± 12; 86% male) who underwent S-ICD implantation between 2014 and 2024.
Results: During a median follow-up of 52 months (25th-75th percentile: 29-72), appropriate shocks were delivered in 3% of patients (1.2%; 95% CI: 0.2-2.2, at 12 months), with a first-shock success rate of 90% (100% with 2 shocks). Inappropriate shocks occurred in 7% of patients (1.4%; 95% CI: 0.3-2.5, at 12 months). Shock zone programmed at 250 beats/min (HR: 0.40; 95% CI: 0.18-0.89; P = 0.025) and more than 1 suitable vector on screening (HR: 0.39; 95% CI: 0.17-0.87; P = 0.023) were independent protective factors against inappropriate shock. Device-related complications were reported in 4% of patients (2.5%; 95% CI: 1.0-3.9 at 12 months). The need for antibradycardia pacing was reported in 3 patients (0.7%). No device explantation because of the need for antitachycardia pacing was noted.
Conclusions: Our findings support the S-ICD as a viable alternative to the transvenous ICD for preventing sudden cardiac death in BrS patients without pacing indication (Arrhythmias Detection in a Real World Population [RHYTHM DETECT]; NCT02275637).
期刊介绍:
JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.