Modern subcutaneous implantable defibrillator therapy in patients with cardiomyopathies and channelopathies: data from a large multicentre registry

Abstract

Aims: Patients with cardiomyopathies and channelopathies are usually younger and have a predominantly arrhythmia-related prognosis; they have nearly normal life expectancy thanks to the protection against sudden cardiac death provided by the implantable cardioverter defibrillator (ICD). The subcutaneous ICD (S-ICD) is an effective alternative to the transvenous ICD and has evolved over the years. This study aimed to evaluate the rate of inappropriate shocks (IS), appropriate therapies, and device-related complications in patients with cardiomyopathies and channelopathies who underwent modern S-ICD implantation.

Methods and results: We enrolled consecutive patients with cardiomyopathies and channelopathies who had undergone implantation of a modern S-ICD from January 2016 to December 2020 and who were followed up until December 2022. A total of 1338 S-ICD implantations were performed within the observation period. Of these patients, 628 had cardiomyopathies or channelopathies. The rate of IS at 12 months was 4.6% [95% confidence interval (CI): 2.8-6.9] in patients with cardiomyopathies and 1.1% (95% CI: 0.1-3.8) in patients with channelopathies (P = 0.032). No significant differences were noted over a median follow-up of 43 months [hazard ratio (HR): 0.76; 95% CI: 0.45-1.31; P = 0.351]. The rate of appropriate shocks at 12 months was 2.3% (95% CI: 1.1-4.1) in patients with cardiomyopathies and 2.1% (95% CI: 0.6-5.3) in patients with channelopathies (P = 1.0). The rate of device-related complications was 0.9% (95% CI: 0.3-2.3) and 3.2% (95% CI: 1.2-6.8), respectively (P = 0.074). No significant differences were noted over the entire follow-up. The need for pacing was low, occurring in 0.8% of patients.

Conclusion: Modern S-ICDs may be a valuable alternative to transvenous ICDs in patients with cardiomyopathies and channelopathies. Our findings suggest that modern S-ICD therapy carries a low rate of IS.

Clinical trial registration: URL: http://clinicaltrials.gov/Identifier: NCT02275637.

Keywords: Cardiomyopathies; Channelopathies; Implantable defibrillator; Inappropriate shock; Subcutaneous.

Graphical Abstract

Figure 1

Kaplan–Meier estimates of time to first inappropriate shock, stratified by cardiomypathies and channelopathies (A) and type of disease (B). ACM, arrhythmogenic cardiomyopathy; HCM, hypertrophic cardiomyopathy; VF, ventricular fibrillation.

Figure 2

Causes of inappropriate shocks reported during follow-up and distribution according to the type of cardiomyopathy and channelopathy.

Figure 3

Kaplan–Meier estimates of time to first appropriate shock stratified by cardiomypathies and channelopathies (A) and type of disease (B). ACM, arrhythmogenic cardiomyopathy; HCM, hypertrophic cardiomyopathy; VF, ventricular fibrillation.

Figure 4

Kaplan–Meier estimates of time to first device-related complication stratified by cardiomypathies and channelopathies (A) and type of disease (B). ACM, arrhythmogenic cardiomyopathy; HCM, hypertrophic cardiomyopathy; VF, ventricular fibrillation.