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. 2023;30(2):214-220.
doi: 10.5603/CJ.a2022.0073. Epub 2022 Aug 17.

A survey study of the use of a subcutaneous implantable cardioverter-defibrillator in various clinical scenarios by expert electrophysiologists in Poland

Maciej Kempa  1 , Barbara Opielowska-Nowak  1 , Szymon Budrejko  2 , Grzegorz Raczak  1
Affiliations

A survey study of the use of a subcutaneous implantable cardioverter-defibrillator in various clinical scenarios by expert electrophysiologists in Poland

Maciej Kempa et al. Cardiol J. 2023.

Abstract

Background: A subcutaneous implantable cardioverter-defibrillator (S-ICD) has become a recognized alternative to a traditional transvenous implantable cardioverter-defibrillator (T-ICD). Despite the growing evidence of non-inferiority of S-ICD, there are no clear clinical guidelines for selection of either of the two available systems. The aim of the study was to analyze the decisions made in predefined typical clinical scenarios by Polish cardiologists experienced in the use of both S-ICDs and T-ICDs.

Methods: A group of 30 experts of cardiac electrotherapy experienced in the use of S-ICDs was recruited and invited to participate in a web-based anonymous survey. The survey questions regarded the proposed therapy in various but typical clinical scenarios.

Results: From the invited 30 experts representing 18 clinical centers, 25 completed the survey. 72% of them declared that the number of S-ICDs implanted at their center during the preceding 12 months exceeded 10, and 40% - that it was over 20. Rates of responders preferring S-ICD or T-ICD in various clinical scenarios are reported and discussed in detail.

Conclusions: Significant divergence of opinion exists among Polish experts regarding the use of a subcutaneous cardioverter-defibrillator. It is especially pronounced on the issue of the use of the system in middle-age patients, in case of complications of the hitherto ICD therapy, or the need of upgrading the existing cardiac implantable electronic device.

Keywords: implantable cardioverter-defibrillator; subcutaneous implantable cardioverter-defibrillator; sudden cardiac death; ventricular fibrillation; ventricular tachycardia.

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Conflict of interest statement

Conflict of interest: None declared

Figures

Figure 1
Figure 1
The number of subcutaneous implantable cardioverter-defibrillator devices implanted in centers of responders over the preceeding 12 months.
Figure 2
Figure 2
The choice between subcutaneous implantable cardioverter-defibrillator (S-ICD) and transvenous implantable cardioverter-defibrillator (T-ICD) in patients with non-ischemic cardiomyopathy (NICM) and ischemic cardiomyopathy (ICM) with no history of arrhythmia and no indications for permanent pacing for different age groups.
Figure 3
Figure 3
The choice between subcutaneous implantable cardioverter-defibrillator (S-ICD) and transvenous implantable cardioverter-defibrillator (T-ICD) in patients with indications for an implantable cardioverter-defibrillator, with no history of arrhythmia and no indications for permanent pacing in various clinical scenarios; LQTS — long-QT syndrome.
Figure 4
Figure 4
The choice between subcutaneous implantable cardioverter-defibrillator (S-ICD) and transvenous implantable cardioverter-defibrillator (T-ICD) in patients wih congenital heart disease (not precluding transvenous implant) qualified for an implantable cardioverter-defibrillator, with no history of arrhythmia and no indications for permanent pacing, for different weight categories.
Figure 5
Figure 5
Main factors determining the preference of transvenous implantable cardioverter-defibrillator (T-ICD) over subcutaneous implantable cardioverter-defibrillator (S-ICD) in patients eligible for S-ICD (multiple choice question).
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