Efficacy and safety of the subcutaneous implantable cardioverter defibrillator: a systematic review

Colin Dominic Chue, Chun Shing Kwok, Chun Wai Wong, Ashish Patwala, Diane Barker, Amir Zaidi, Mamas A Mamas, Colin Cunnington, Fozia Z Ahmed
2017 Heart  
Subcutaneous implantable cardioverter defibrillators (S-ICD) are an alternative to conventional transvenous implantable cardioverter defibrillators (TV-ICD) in patients not requiring pacing. We sought to define the efficacy and safety of S-ICD through literature review. Methods: We searched MEDLINE and EMBASE for studies evaluating efficacy and safety outcomes among patients undergoing S-ICD implantation. We performed narrative synthesis and pooled efficacy and safety outcomes across studies.
more » ... sults: 16 studies were included with 5,380 participants (mean age range 33-56 years). Short-term follow-up data were available for 1670 subjects. The commonest complication was pocket infection, affecting 2.7% (range 0-19%). Other complications included delayed wound healing (0.6%), wound discomfort (0.8%), haematoma (0.4%) and lead migration (0.3%). A total of 3.8% (range 0-12%) of S-ICDs were explanted. The commonest reason for explant was pocket infection. Mortality rates in hospital (0.4%) and during follow-up (3.4% from 12 studies reporting, 2.1% per person-years) were low. The number of patients experiencing ventricular arrhythmia varied across studies from 0 to 12%. Overall shock efficacy for treatment of ventricular arrhythmias exceeded 96%. Inappropriate shocks affected 4.3% (range 0-15%) of patients and was most commonly caused by T-wave oversensing. Conclusions: Although long-term randomised data are lacking, observational data suggest shock efficacy, peri-procedural and short-term complication rates of the S-ICD are similar to TV-ICD, making the S-ICD a suitable alternative in patients without an indication for pacing.
doi:10.1136/heartjnl-2016-310852 pmid:28687562 fatcat:6aqxjm3yy5hhrdgjagfeoumvhi