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Suitability for subcutaneous defibrillator implantation: results based on data from routine clinical practice
  1. Mihály K de Bie1,
  2. Joep Thijssen1,
  3. Johannes B van Rees1,
  4. Hein Putter2,
  5. Enno T van der Velde1,
  6. Martin J Schalij1,
  7. Lieselot van Erven1
  1. 1Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
  2. 2Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
  1. Correspondence to Lieselot van Erven, Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, The Netherlands; l.van_erven{at}lumc.nl

Abstract

Objective To assess the proportion of current implantable cardioverter defibrillator (ICD) recipients who would be suitable for a subcutaneous lead ICD (S-ICD).

Design A retrospective cohort study.

Setting Tertiary care facility in the Netherlands.

Patients All patients who received a single- or dual-chamber ICD in the Leiden University Medical Center between 2002 and 2011. Patients with a pre-existent indication for cardiac pacing were excluded.

Main outcome measure Suitability for an S-ICD defined as not reaching one of the following endpoints during follow-up: (1) an atrial and/or right ventricular pacing indication, (2) successful antitachycardia pacing without a subsequent shock or (3) an upgrade to a CRT-D device.

Results During a median follow-up of 3.4 years (IQR 1.7–5.7 years), 463 patients (34% of the total population of 1345 patients) reached an endpoint. The cumulative incidence of ICD recipients suitable for an initial S-ICD implantation was 55.5% (95% CI 52.0% to 59.0%) after 5 years. Significant predictors for the unsuitability of an S-ICD were: secondary prevention, severe heart failure and prolonged QRS duration.

Conclusions After 5 years of follow-up, approximately 55% of the patients would have been suitable for an S-ICD implantation. Several baseline clinical characteristics were demonstrated to be useful in the selection of patients suitable for an S-ICD implantation.

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