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. 2017 Nov 1;19(11):1826-1832.
doi: 10.1093/europace/euw337.

The Italian subcutaneous implantable cardioverter-defibrillator survey: S-ICD, why not?

Giovanni Luca Botto  1 , Giovanni B Forleo  2 , Alessandro Capucci  3 , Francesco Solimene  4 , Antonello Vado  5 , Giovanni Bertero  6 , Pietro Palmisano  7 , Ennio Pisanò  8 , Antonio Rapacciuolo  9 , Tommaso Infusino  10 , Alessandro Vicentini  11 , Miguel Viscusi  12 , Paola Ferrari  13 , Antonello Talarico  14 , Giovanni Russo  1 , Giuseppe Boriani  15 , Luigi Padeletti  16 , Mariolina Lovecchio  17 , Sergio Valsecchi  17 , Antonio D'Onofrio  18 ; ‘AIAC S-ICD Why Not’ Survey Investigators
Affiliations

The Italian subcutaneous implantable cardioverter-defibrillator survey: S-ICD, why not?

Giovanni Luca Botto et al. Europace. .

Abstract

Aims: A recommendation for a subcutaneous-implantable cardioverter-defibrillator (S-ICD) has been added to recent European Society of Cardiology Guidelines. However, the S-ICD is not ideally suitable for patients who need pacing. The aim of this survey was to analyse the current practice of ICD implantation and to evaluate the actual suitability of S-ICD.

Methods and results: The survey 'S-ICD Why Not?' was an independent initiative taken by the Italian Heart Rhythm Society (AIAC). Clinical characteristics, selection criteria, and factors guiding the choice of ICD type were collected in consecutive patients who underwent ICD implantation in 33 Italian centres from September to December 2015. A cardiac resynchronization therapy (CRT) device was implanted in 39% (369 of 947) of patients undergoing de novo ICD implantation. An S-ICD was implanted in 12% of patients with no CRT indication (62 of 510 with available data). S-ICD patients were younger than patients who received transvenous ICD, more often had channelopathies, and more frequently received their device for secondary prevention of sudden death. More frequently, the clinical reason for preferring a transvenous ICD over an S-ICD was the need for pacing (45%) or for antitachycardia pacing (36%). Nonetheless, only 7% of patients fulfilled conditions for recommending permanent pacing, and 4% of patients had a history of monomorphic ventricular tachycardia that might have been treatable with antitachycardia pacing.

Conclusion: The vast majority of patients needing ICD therapy are suitable candidates for S-ICD implantation. Nevertheless, it currently seems to be preferentially adopted for secondary prevention of sudden death in young patients with channelopathies.

Keywords: Implantable cardioverter-defibrillator; Indication; Pacing; Subcutaneous; Sudden death; Survey; Ventricular arrhythmias.

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Figures

Figure 1
Figure 1
Diagram of the study: number of cases in analysis.
Figure 2
Figure 2
Factors for preferring a transvenous ICD over an S-ICD (n = 448). Multiple factors were reported per patient.
Figure 3
Figure 3
Factors for preferring an S-ICD over a transvenous ICD (n = 62). Multiple factors were reported per patient.
See this image and copyright information in PMC

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