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Meta-Analysis
. 2022;18(3):e081221198647.
doi: 10.2174/1573403X17666211208100151.

Efficacy and Complications of Subcutaneous versus Conventional Cardioverter Defibrillators: A Systematic Review and Meta-analysis

Camilla Silva Araújo  1 , Carla Liz Barbosa Silva  1 , Antônio da Silva Menezes Júnior  1   2 , Vinícius Araújo Barbosa  1 , Tiago de Almeida Laranjeira  1 , Joaquim Ferreira Fernandes  1 , Lucas Cândido Gonçalves  2 , Antonio Márcio Cordeiro Silva  1
Affiliations
Meta-Analysis

Efficacy and Complications of Subcutaneous versus Conventional Cardioverter Defibrillators: A Systematic Review and Meta-analysis

Camilla Silva Araújo et al. Curr Cardiol Rev. 2022.

Abstract

Background/objectives: Implantable cardioverter defibrillators are used to prevent sudden cardiac death. The subcutaneous implantable cardioverter-defibrillator was newly developed to overcome the limitations of the conventional implantable cardioverter defibrillator-transvenous device. The subcutaneous implantable cardioverter defibrillator is indicated for young patients with heart disease, congenital heart defects, and poor venous access, who have an indication for implantable cardioverter defibrillator without the need for anti-bradycardic stimulation. We aimed to compare the efficacy and complications of subcutaneous with transvenous implantable cardioverter- defibrillator devices.

Methodology: A systematic review was conducted using different databases. The inclusion criteria were observational and clinical randomized trials with no language limits and no publication date limit that compared subcutaneous with transvenous implantable cardioverter-defibrillators. The selected patients were aged > 18 years with complex ventricular arrhythmia.

Results: Five studies involving 2111 patients who underwent implantable cardioverter defibrillator implantation were included. The most frequent complication in the subcutaneous device group was infection, followed by hematoma formation and electrode migration. For the transvenous device, the most frequent complications were electrode migration and infection. Regarding efficacy, the total rates of appropriate shocks were 9.04% and 20.47% in the subcutaneous and transvenous device groups, respectively, whereas inappropriate shocks to the subcutaneous and transvenous device groups were 11,3% and 10,7%, respectively.

Conclusion: When compared to the transvenous device, the subcutaneous device had lower complication rates owing to lead migration and less inappropriate shocks due to supraventricular tachycardia; nevertheless, infection rates and improper shocks due to T wave oversensing were comparable for both devices CRD42021251569.

Keywords: Subcutaneous implantable cardioverter defibrillator; bruise; complications; efficacy; infection; supraventricular tachycardia; transvenous implantable cardioverter defibrillator.

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Figures

Fig. (1)
Fig. (1)
The location of the subcutaneous implantable cardioverter-defibrillator (ICD-S) components is shown below. (A higher resolution / colour version of this figure is available in the electronic copy of the article).
Fig. (2)
Fig. (2)
Flowchart of selected studies.
Fig. (3)
Fig. (3)
Risk difference between the groups with subcutaneous implantable cardioverter defibrillators and implantable cardioverter defibrillators-transvenous for appropriate shock. (A higher resolution / colour version of this figure is available in the electronic copy of the article).
Fig. (4)
Fig. (4)
Risk difference between the groups with subcutaneous implantable cardioverter defibrillators and implantable cardioverter defibrillators-transvenous for electrode migration. (A higher resolution / colour version of this figure is available in the electronic copy of the article).
Fig. (5)
Fig. (5)
Risk difference between the groups with subcutaneous implantable cardioverter defibrillators and implantable cardioverter defibrillators-transvenous for infection. (A higher resolution / colour version of this figure is available in the electronic copy of the article).
Fig. (6)
Fig. (6)
Risk difference between the groups with subcutaneous implantable cardioverter defibrillators and implantable cardioverter defibrillators-transvenous for inappropriate shock. (A higher resolution / colour version of this figure is available in the electronic copy of the article).
Fig. (7)
Fig. (7)
Risk of bias. (A higher resolution / colour version of this figure is available in the electronic copy of the article).
See this image and copyright information in PMC

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