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. 2025 Dec 19:ehaf918.
doi: 10.1093/eurheartj/ehaf918. Online ahead of print.

Long-term outcomes of subcutaneous implantable cardioverter defibrillators: the French nationwide HONEST study

Fawzi Kerkouri  1   2   3   4 , Christelle Marquié  5 , Serge Boveda  2   6   7 , Frédéric Anselme  8 , Soraya Anys  9 , Nicolas Badenco  10 , Francis Bessiere  11 , Hugues Blangy  12 , Pierre Bordachar  13 , Laure Champ-Rigot  14 , Michel Chauvin  15 , Nicolas Clementy  16 , Gaël Clerici  17 , Antoine Da Costa  18 , Pascal Defaye  19 , Maxime De Guillebon  20 , Jean-Claude Deharo  21 , Romain Eschalier  22 , Fabrice Extramiana  23 , Laurent Fauchier  24 , Pierre Frey  25 , Estelle Gandjbakhch  10 , Charles Guenancia  26 , Benoit Guy-Moyat  27 , Alexis Hermida  28 , Jérôme Hourdain  21 , Peggy Jacon  19 , Laurence Jesel  29 , Jérôme Lacotte  30 , Christophe Leclercq  31 , Nicolas Lellouche  32 , Jacques Mansourati  3   4 , Philippe Maury  33 , Aymeric Menet  34 , Pierre Mondoly  33 , Mathieu Montoy  35 , Kumar Narayanan  2 , Jean-Luc Pasquié  36 , David Perrot  1   2 , Bertrand Pierre  24 , Frédéric Sacher  13 , Nicolas Sadoul  12 , Victor Waldmann  1   2 , Rodrigue Garcia  37 , Vincent Probst  38 , Eloi Marijon  1   2
Affiliations

Long-term outcomes of subcutaneous implantable cardioverter defibrillators: the French nationwide HONEST study

Fawzi Kerkouri et al. Eur Heart J. .

Abstract

Background and aims: Although use of the subcutaneous implantable cardioverter defibrillator (S-ICD) is increasing, evidence from industry-independent and unselected populations remains limited.

Methods: HONEST is a ongoing nationwide academic observational study enrolling 98.2% of patients implanted with an S-ICD across France (2012-2019). Five-year clinical endpoints were centrally adjudicated.

Results: Overall, 4924 patients were enrolled (mean age 49.9 ± 15 years, 76.7% male, 63.0% for primary prevention). Implants used general anaesthesia (78.9%), and defibrillation testing (82.6%). Perioperative complications (within 30 days) occurred in 4.4%. At 5 years, cumulative incidence rates were 13.8% for inappropriate shocks, 10.8% for early battery depletion, 2.4% for infections, 1.5% for lead dysfunction, and 1.4% for chronic discomfort. Reoperation was required in 16.9%, need for cardiac pacing in 3.1%, and definite S-ICD extraction in 8.4%. Inappropriate shocks were independently associated with male sex (hazard ratio [HR] 1.29, 95% confidence interval [CI] 1.14-1.46, P < .001), obesity (HR 1.35, 95% CI 1.02-1.79, P = .032), arrhythmogenic right ventricular cardiomyopathy (HR 1.70, 95% CI 1.03-2.81, P = .036), and the presence of a pacemaker (HR 2.20, 95% CI 1.16-4.17, P = .016). SMART Pass filtering significantly reduced inappropriate shocks (HR 0.67, 95% CI 0.50-0.89, P = .007). Among patients with inappropriate shocks, ∼1% developed induced ventricular fibrillation (one fatality), and 10% underwent device extraction. Ineffective shocks or undetected arrhythmias occurred in only 0.2%. Among 547 deaths (11.1%), 53.9% were cardiovascular, including 26 sudden deaths, and 8 were S-ICD/procedure-related, with none related to S-ICD extraction.

Conclusions: This nationwide study refines the long-term event profile of S-ICD therapy and may inform clinical practice and device selection.

Keywords: Cardiac arrhythmias; Complications; Early battery depletion; Inappropriate shocks; Mortality; Sudden death.

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