Long-term safety and efficacy of subcutaneous implantable cardioverter-defibrillator compared with transvenous implantable cardioverter-defibrillator in propensity score-matched patients from Japan

Abstract

Background

Subcutaneous implantable cardioverter-defibrillator (S-ICD) has been reported to be non-inferior to transvenous ICD (TV-ICD) in terms of device-related complications and inappropriate shock (IAS). We aimed to evaluate the long-term clinical outcomes of S-ICD compared with TV-ICD in Japanese patients.

Methods

We studied 315 consecutive patients (TV-ICD, 167; S-ICD, 148) who underwent ICD implantation. A propensity score matching analysis was performed to select patient subgroups for comparison (104 patients in each group). Clinical outcomes, including appropriate and inappropriate ICD therapy, procedure- and lead-related complications, and mortality, were compared between the two groups.

Results

During follow-up (median, 1458 [interquartile range, 1353–1572] days), the cumulative incidence of appropriate shock therapy was 9.6% and 8.7% in the S-ICD and TV-ICD groups, respectively (p = 0.94). Although the S-ICD group tended to have a higher IAS than the TV-ICD group (5.8% vs. 1.9%), the difference was not significant (p = 0.19). Conversely, the cumulative incidence of procedural and lead-related complications was significantly lower in the S-ICD group (2.9% vs. 9.6%, p = 0.02). Notably, lead-related complications were more common in the TV-ICD group (p = 0.05). There was no difference in all-cause mortality between the two groups (p = 0.75), and heart failure exacerbation was the most common cause of death in both groups.

Conclusions

In propensity score-matched Japanese patients with S-ICD, the cumulative incidence of appropriate shock and mortality was comparable to those with TV-ICD. There was no significant difference in the rate of IAS. Notably, patients with S-ICD had fewer lead-related complications than those with TV-ICD.