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Meta-Analysis
. 2017 Dec 26;3(13):1475-1483.
doi: 10.1016/j.jacep.2017.07.017. Epub 2017 Sep 27.

Subcutaneous Versus Transvenous Implantable Defibrillator Therapy: A Meta-Analysis of Case-Control Studies

Indranill Basu-Ray  1 , Jing Liu  2 , Xiaoming Jia  2 , Michael Gold  3 , Kenneth Ellenbogen  4 , James DiNicolantonio  5 , András Komócsi  6 , András Vorobcsuk  7 , Jitae Kim  8 , Hamid Afshar  9 , Wilson Lam  9 , Nilesh Mathuria  10 , Mehdi Razavi  10 , Abdi Rasekh  10 , Mohammad Saeed  10
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Free article
Meta-Analysis

Subcutaneous Versus Transvenous Implantable Defibrillator Therapy: A Meta-Analysis of Case-Control Studies

Indranill Basu-Ray et al. JACC Clin Electrophysiol. .
Free article

Abstract

Objectives: This study aims to conduct a meta-analysis comparing efficacy and safety outcomes between subcutaneous implantable cardioverter-defibrillator (S-ICD) and transvenous implantable cardioverter-defibrillator (TV-ICD).

Background: The S-ICD was developed to minimize complications related to the conventional TV-ICD. Direct comparison of clinical outcomes between the 2 devices has been limited by varying patient characteristics and definitions of complications with no randomized trials completed comparing these systems.

Methods: Studies in the PubMed and Embase databases and secondary referencing sources were systematically reviewed. Studies meeting criteria were included in the meta-analysis. Baseline characteristics and outcome data of the S-ICD and TV-ICD groups were appraised and analyzed. A random-effects model was used to derive odds ratio (OR) with 95% confidence interval (CI).

Results: Five studies met inclusion criteria. Baseline characteristics were similar between the S-ICD and TV-ICD groups. Fewer lead complications occurred in the S-ICD group compared to the TV-ICD group (OR: 0.13; 95% CI: 0.05 to 0.38). The infection rate was similar between the S-ICD and TV-ICD groups (OR: 0.75; 95% CI: 0.30 to 1.89). There were no differences in system or device failures between groups (OR: 1.13; 95% CI: 0.43 to 3.02). Overall, inappropriate therapy (T-wave oversensing, supraventricular tachycardia, episodes of inappropriate sensing) was similar between the 2 groups (OR: 0.87; 95% CI: 0.51 to 1.49). However, the nature of inappropriate therapy was different between the S-ICD and TV-ICD groups. Both devices appear to perform equally well with respect to appropriate shocks.

Conclusions: S-ICD reduced lead-related complications but was similar to TV-ICD with regard to non-lead-related complications, including inappropriate therapy. These results support the concept that S-ICD is a safe and effective alternative to TV-ICD in appropriate patients.

Keywords: device infection; implantable cardioverter-defibrillator shock; inappropriate therapy; subcutaneous implantable cardioverter defibrillator; transvenous implantable cardioverter-defibrillator.

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