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. 2025 Mar;18(3):e013365.
doi: 10.1161/CIRCEP.124.013365. Epub 2025 Feb 24.

Subcutaneous Implantable Defibrillators in Young Patients: Arrhythmias, Complications, and Physical Activity

Pietro Francia  1 , Matteo Ziacchi  2 , Federico Migliore  3 , Paolo De Filippo  4 , Antonio Dello Russo  5 , Stefano Viani  6 , Antonio Rapacciuolo  7 , Giulio Falasconi  8   9 , Carmen Adduci  1 , Giovanni Bisignani  10 , Luca Checchi  11 , Giuseppe Busacca  12 , Luca Santini  13 , Carlo Lavalle  14 , Valeria Ilia Calvi  15 , Antonio Curcio  16 , Massimo Silvetti  17 , Antonio Pangallo  18 , Marco Carbonaro  19 , Davide Giorgi  20 , Raimondo Pittorru  3 , Mariolina Lovecchio  21 , Sergio Valsecchi  21 , Mauro Biffi  2 , Antonio D'Onofrio  22 , Antonio Pelliccia  23 ; S-ICD Rhythm Detect Investigators
Collaborators, Affiliations

Subcutaneous Implantable Defibrillators in Young Patients: Arrhythmias, Complications, and Physical Activity

Pietro Francia et al. Circ Arrhythm Electrophysiol. 2025 Mar.

Abstract

Background: The safety of subcutaneous implantable cardioverter defibrillator (S-ICD) recipients who lead active lifestyles and engage in recreational sports is unknown. We aimed to evaluate the association between lifestyle and recreational sports and the occurrence of arrhythmia- and device-related complications, appropriate and inappropriate shocks in S-ICD recipients.

Methods: We assessed a cohort of young-adult (15-65 years) S-ICD patients, evaluated their physical activity with IPAQ (International Physical Activity Questionnaire), and assessed the association between lifestyle and recreational sports on S-ICD safety and shocks.

Results: We enrolled 602 S-ICD recipients (77% men; age, 46±14 years). According to the IPAQ, patients were categorized as inactive subjects (26.4%), moderately active subjects (45.2%), or highly active subjects (28.4%). Among moderately/highly active subjects, 163 (27.1%) were recreational athletes. During follow-up (47.3 [interquartile range, 27.0-67.6] months), 23 patients (3.8%) reached the safety end point of arrhythmia- or device-related complications, with moderately and highly active subjects showing in multivariate analysis similar incidence compared with inactive subjects (P=0.59 and P=0.83, respectively). Forty-four patients had 87 appropriate shocks. In multivariate analysis, moderately and highly active subjects showed a nonsignificantly lower incidence of appropriate shocks compared with inactive subjects (P=0.12 and P=0.11, respectively). Consistently, there was a nonsignificant lower incidence of appropriate shocks in athletes versus nonathletes (P=0.06). Thirty-nine patients had 46 inappropriate shocks. Moderately and highly active subjects had similar incidence of inappropriate shocks compared with inactive subjects (P=0.92 and P=0.88, respectively).

Conclusions: Young S-ICD patients often lead active lifestyles and participate in sports. Higher activity levels were not associated with increased implantable cardioverter defibrillator-related complications or increased risk of implantable cardioverter defibrillator shocks.

Keywords: arrhythmias, cardiac; defibrillators; follow-up studies; incidence; life style; sports.

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Conflict of interest statement

This was an independent study. No external funding was received for this project. Dr Francia received speaker fees from Boston Scientific and research or educational grants from Abbott and Boston Scientific. Dr Ziacchi received speaker fees from Abbott, Biotronik, Boston Scientific. Dr De Filippo received speaker fees from Abbott, BS, and Medtronic. Dr Santini is a consultant for Abbott, Boston Scientific, Medtronic, and Biotronik and received speaker fee from Medtronic, Boston Scientific, Abbott, Microport, and Biotronik. M. Lovecchio and S. Valsecchi are employees of Boston Scientific. The other authors report no conflicts.

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