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Review
. 2018 Jul 10;20(9):72.
doi: 10.1007/s11886-018-1021-8.

An Overview of Clinical Outcomes in Transvenous and Subcutaneous ICD Patients

S W E Baalman  1 , A B E Quast  2 , T F Brouwer  2 , R E Knops  2
Affiliations
Review

An Overview of Clinical Outcomes in Transvenous and Subcutaneous ICD Patients

S W E Baalman et al. Curr Cardiol Rep. .

Abstract

Purpose of review: Clear guidelines on when to select a subcutaneous ICD (S-ICD) over a transvenous ICD (TV-ICD) are lacking. This review will provide an overview of the most recent clinical data on S-ICD and TV-ICD therapy by pooling comparison studies in order to aid clinical decision making.

Recent findings: Pooling of observational-matched studies demonstrated an incidence rate ratio (IRR) for device-related complication of 0.90 (95% CI 0.58-1.42) and IRR for lead-related complications of 0.15 (95% CI 0.06-0.39) in favor of S-ICD. The IRR for device infections was 2.00 (95% CI 0.95-4.22) in favor of TV-ICD. Both appropriate shocks (IRR 0.67 (95% CI 0.42-1.06)) and inappropriate shocks (IRR 1.17 (95% CI 0.77-1.79)) did not differ significantly between both groups. With randomized data underway, the observational data demonstrate that the S-ICD is associated with reduced lead complications, but this has not yet resulted in a significant reduction in total number of complications compared to TV-ICDs. New technologies are expected to make the S-ICD a more attractive alternative.

Keywords: Appropriate shocks; Complications; Inappropriate shocks; Infections; Subcutaneous implantable cardioverter defibrillator; Transvenous implantable cardioverter defibrillator.

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Conflict of interest statement

Conflict of Interest

S.W.E. Baalman and A.B.E. Quast declare that they have no conflict of interest.

T.F. Brouwer reports grants from Boston Scientific.

R.E. Knops reports grants from Boston Scientific, Abbott, and Medtronic.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Figures

Fig. 1
Fig. 1
a All-cause complications in the S-ICD group compared to the TV-ICD group. There is no difference between both groups. b Lead-related complications in the S-ICD group compared to the TV-ICD group. Fewer lead-related complications occurred in the S-ICD group. c Infection-related complications in the S-ICD group compared to the TV-ICD group. There is no significant difference between both groups. d + e inappropriate shocks (IAS) and appropriate shocks (AS) in the S-ICD group compared to the TV-ICD group. There is no significant difference in AS or IAS between both groups. IRR = incidence rate ratio; CI = confidence interval; S-ICD = subcutaneous implantable cardioverter defibrillator; TV-ICD = transvenous implantable cardioverter defibrillator.
See this image and copyright information in PMC

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