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Observational Study
. 2025 Sep;11(9):2049-2060.
doi: 10.1016/j.jacep.2025.04.020. Epub 2025 Apr 24.

S-ICD Implantation Following TV-ICD: Insights Into Patients With Infections and Abandoned Leads: The HONEST Cohort

Vasileios Sousonis  1 , Peggy Jacon  2 , Fawzi Kerkouri  3 , Rodrigue Garcia  4 , Christelle Marquié  5 , Walid Amara  6 , Fréderic Anselme  7 , Nicolas Badenco  8 , Nathalie Behar  9 , Mohamed Belhameche  10 , Abdeslam Bouzeman  11 , Samir Fareh  12 , Benoît Guy-Moyat  13 , Alexis Hermida  14 , Jérome Hourdain  15 , Laurence Jesel  16 , Pierre Khattar  17 , Ziad Khoueiry  18 , Gabriel Laurent  19 , Vladimir Manenti  20 , Alexis Mechulan  21 , Aymeric Menet  22 , Antoine Milhem  23 , Pierre Mondoly  24 , Pierre Ollitrault  25 , David Perrot  26 , Michael Peyrol  27 , Bertrand Pierre  28 , Nicolas Sadoul  29 , Didier Scarlatti  30 , Jerome Taieb  31 , Claire Vanesson  32 , Pierre Winum  33 , Vincent Probst  34 , Eloi Marijon  26 , Pascal Defaye  2 , Serge Boveda  35 ; HONEST Study Investigators
Affiliations
Observational Study

S-ICD Implantation Following TV-ICD: Insights Into Patients With Infections and Abandoned Leads: The HONEST Cohort

Vasileios Sousonis et al. JACC Clin Electrophysiol. 2025 Sep.

Abstract

Background: Subcutaneous implantable cardioverter-defibrillators (S-ICDs) can be a viable option for patients with transvenous ICDs experiencing complications (rescue S-ICD).

Objectives: This study sought to evaluate the outcomes of rescue S-ICD implantation using data from the HONEST French nationwide S-ICD cohort.

Methods: All rescue S-ICD patients were identified. Outcomes (complications, reinterventions, and mortality) were compared between rescue and de novo S-ICD patients. Subgroup analyses were performed based on the implantation indication (infective vs noninfective) and the presence of abandoned leads.

Results: Among 4,924 patients in the HONEST cohort, 651 underwent rescue S-ICD implantation (295 with infective indications, 244 with abandoned leads). Over a follow-up of 4.2 ± 2.2 years, complications and reinterventions were similar in rescue and de novo S-ICD patients (22.6% vs 21.0%; P = 0.35 and 8.7% vs 7.2%; P = 0.17, respectively), in infective and noninfective rescue S-ICD patients (21.6% vs 23.5%; P = 0.55 and 8.9% vs 8.6%; P = 0.90, respectively) and in patients with abandoned and extracted leads (24.3% vs 21.7%; P = 0.46 and 8.3% vs 9.0%; P = 0.77, respectively). Mortality was higher in rescue compared to de novo S-ICD patients (16.9% vs 10.2%; P < 0.001) and in rescue S-ICD patients with infective indications (29.2% vs 6.7%; P < 0.001) and extracted leads (21.9% vs 8.6%; P < 0.001), mainly due to a higher burden of comorbidities, as none of these parameters was independently associated with mortality in multivariate analyses. No S-ICD-related deaths were observed.

Conclusions: Rescue S-ICD implantation is an acceptable option for patients with device-related complications. Lead abandonment in the setting of a noninfective indication appears to be safe. (S-ICD French Cohort Study [HONEST]; NCT05302115).

Keywords: S-ICD; abandoned leads; device-related complications; infection; subcutaneous ICD.

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Conflict of interest statement

Funding Support and Author Disclosures The HONEST study was supported by the French National Institute of Health & Medical Research, the French Society of Cardiology and the French Federation of Cardiology. Dr Jacon has received honoraria and research grants from Boston Scientific. Dr Garcia has received grants and honoraria from Boston Scientific. Dr Ollitrault has received consulting fees from Abbott, Biotronik, Boston Scientific, and Medtronic. Dr Marijon is a consultant for Abbott, Boston Scientific, Medtronic, and Zoll; and has received research grants from Abbott, Boston Scientific, Medtronic, and Biotronik. Dr Defaye has received honoraria and research grants from Boston Scientific. Dr Boveda is a consultant for Medtronic, Boston Scientific, MicroPort, and Zoll. All other authors have no relationships relevant to the contents of this paper to disclose.

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