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. 2023 Aug 15;82(7):590-599.
doi: 10.1016/j.jacc.2023.05.057.

Subcutaneous Implantable Cardioverter-Defibrillators in Patients With Congenital Heart Disease

Victor Waldmann  1 , Christelle Marquié  2 , Francis Bessière  3 , David Perrot  4 , Frédéric Anselme  5 , Nicolas Badenco  6 , Sergio Barra  7 , Géraldine Bertaux  8 , Hugues Blangy  9 , Pierre Bordachar  10 , Serge Boveda  11 , Michel Chauvin  12 , Nicolas Clémenty  13 , Gaël Clerici  14 , Nicolas Combes  11 , Pascal Defaye  15 , Jean-Claude Deharo  16 , Philippe Durand  17 , Guillaume Duthoit  6 , Romain Eschalier  18 , Laurent Fauchier  13 , Rodrigue Garcia  19 , Olivier Geoffroy  14 , Edouard Gitenay  20 , Jean-Baptiste Gourraud  21 , Charles Guenancia  8 , Laurence Iserin  22 , Peggy Jacon  15 , Laurence Jesel-Morel  23 , Fawzi Kerkouri  24 , Didier Klug  2 , Linda Koutbi  16 , Fabien Labombarda  25 , Magalie Ladouceur  26 , Gabriel Laurent  8 , Christophe Leclercq  27 , Baptiste Maille  16 , Alice Maltret  28 , Grégoire Massoulié  18 , Pierre Mondoly  29 , Sandro Ninni  2 , Pierre Ollitrault  25 , Jean-Luc Pasquié  30 , Bertrand Pierre  13 , Pénélope Pujadas  31 , Laure Champ-Rigot  25 , Frédéric Sacher  10 , Nicolas Sadoul  9 , Alexandre Schatz  23 , Pierre Winum  32 , Paul-Ursmar Milliez  25 , Vincent Probst  21 , Eloi Marijon  33
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Free article

Subcutaneous Implantable Cardioverter-Defibrillators in Patients With Congenital Heart Disease

Victor Waldmann et al. J Am Coll Cardiol. .
Free article

Abstract

Background: Very few data have been published on the use of subcutaneous implantable cardioverter-defibrillators (S-ICDs) in patients with congenital heart disease (CHD).

Objectives: The aim of this study was to analyze outcomes associated with S-ICDs in patients with CHD.

Methods: This nationwide French cohort including all patients with an S-ICD was initiated in 2020 by the French Institute of Health and Medical Research. Characteristics at implantation and outcomes were analyzed in patients with CHD.

Results: From October 12, 2012, to December 31, 2019, among 4,924 patients receiving an S-ICD implant in 150 centers, 101 (2.1%) had CHD. Tetralogy of Fallot, univentricular heart, and dextro-transposition of the great arteries represented almost one-half of the population. Patients with CHD were significantly younger (age 37.1 ± 15.4 years vs 50.1 ± 14.9 years; P < 0.001), more frequently female (37.6% vs 23.0%; P < 0.001), more likely to receive an S-ICD for secondary prevention (72.3% vs 35.9%; P < 0.001), and less likely to have severe systolic dysfunction of the systemic ventricle (28.1% vs 53.1%; P < 0.001). Over a mean follow-up period of 1.9 years, 16 (15.8%) patients with CHD received at least 1 appropriate shock, with all shocks successfully terminating the ventricular arrhythmia. The crude risk of appropriate S-ICD shock was twice as high in patients with CHD compared with non-CHD patients (annual incidences of 9.0% vs 4.4%; HR: 2.1; 95% CI: 1.3-3.4); however, this association was no longer significant after propensity matching (especially considering S-ICD indication, P = 0.12). The burden of all complications (HR: 1.2; 95% CI: 0.7-2.1; P = 0.4) and inappropriate shocks (HR: 0.9; 95% CI: 0.4-2.0; P = 0.9) was comparable in both groups.

Conclusions: In this nationwide study, patients with CHD represented 2% of all S-ICD implantations. Our findings emphasize the effectiveness and safety of S-ICD in this particularly high-risk population. (S-ICD French Cohort Study [HONEST]; NCT05302115).

Keywords: congenital heart disease; implantable cardioverter defibrillator; sudden death; ventricular arrhythmia.

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Conflict of interest statement

Funding Support and Author Disclosures This study was supported by the French Institute of Health and Medical Research and Paris-Sudden Death Expertise Center, the French Society of Cardiology (Electrophysiology Working Group), and the French Federation of Cardiology. The Paris Sudden Death Expertise Center activities are supported by the Institut National de la Santé et de la Recherche Médicale (INSERM), the University of Paris, Assistance Publique-Hôpitaux de Paris, Fondation Cœur et Artères, Global Heart Watch, Fédération Française de Cardiologie, Société Française de Cardiologie, and Fondation Recherche Medicale, as well as unrestricted grants from industrial partners (Abbott, Biotronik, Boston Scientific, Medtronic, MicroPort, ZOLL, and Schiller). Dr Waldmann has served as a consultant for Abbott and Medtronic. Dr Marijon has served as a consultant for Boston Scientific, Medtronic, ZOLL, and Abbott. Dr Ollitrault has received consulting fees from Abbott, Biotronik, Boston Scientific, and Medtronic. Dr Champ-Rigot has received consulting fees from Boston Scientific, Medtronic, and MicroPort CRM. Dr Garcia has received grants and honoraria from Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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