Efficacy and safety of the subcutaneous implantable cardioverter defibrillator: a systematic review. Issue 17 (7th July 2017)

• Record Type: Journal Article
• Authors: Chue, Colin Dominic; Kwok, Chun Shing; Wong, Chun Wai; Patwala, Ashish; Barker, Diane; Zaidi, Amir; Mamas, Mamas A; Cunnington, Colin; Ahmed, Fozia Z
• Is Part Of: Heart. Volume 103:Issue 17(2017)
• Page Start: 1315
• Page End: 1322
• Publication Date: 2017-07-07
• Subjects: implanted cardiac defibrillators -- ventricular fibrillation -- ventricular tachycardia -- systematic review; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2016-310852
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Background: Subcutaneous implantable cardioverter defibrillators (S-ICDs) are considered an alternative to conventional transvenous ICDs (TV-ICDs) in patients not requiring pacing. Methods: We searched MEDLINE and EMBASE for studies evaluating efficacy and safety outcomes in S-ICD patients. Outcomes were pooled across studies. Results: Sixteen studies were included with 5380 participants (mean age range 33–56 years). Short-term follow-up data were available for 1670 subjects. The most common complication was pocket infection, affecting 2.7%. Other complications included delayed wound healing (0.6%) and wound discomfort (0.8%). 3.8% of S-ICDs were explanted, most commonly for pocket infection. Mortality rates in hospital (0.4%) and during follow-up (3.4% from 12 studies reporting) were low. Incidence of ventricular arrhythmia varied from 0% to 12%. Overall shock efficacy exceeded 96%. Inappropriate shocks affected 4.3% and was most commonly caused by T-wave oversensing. Conclusions: Although long-term randomised data are lacking, observational data suggest similar shock efficacy and short-term complication rates between the S-ICD and TV-ICD.