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Subcutaneous versus transvenous implantable cardioverter-defibrillator therapy: insights from real-word evidence
Session:
SESSÃO DE POSTERS 42 - DISPOSITIVOS CARDÍACOS IMPLANTÁVEIS: CDI E CRT
Speaker:
Helena Sofia Santos Moreira
Congress:
CPC 2025
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.2 Implantable Cardioverter / Defibrillator
Session Type:
Cartazes
FP Number:
---
Authors:
Helena Sofia Santos Moreira; Pedro Mangas Palma; Miguel Rocha; Ana Isabel Pinho; Cátia Oliveira; Luís Santos; Ricardo Pinto; Marta Madeira; Gonçalo Pestana; Luís Adão; Rui André Rodrigues; Ana Lebreiro
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:11.0pt"><strong>Introduction: </strong>Several studies have explored the safety and efficacy of the subcutaneous implantable cardioverter-defibrillator (S-ICD) as a potentially non-inferior alternative to transvenous ICD (TV-ICD) for preventing sudden cardiac death (SCD), suggesting it as a considerable alternative in selected cases. </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:11.0pt"><strong>Purpose: </strong>To compare baseline characteristics and clinical outcomes between S-ICD and TV-ICD patients (pts) at a Portuguese tertiary hospital. The primary individual endpoints included cardiovascular mortality or hospitalization, ineffective or inappropriate shocks, battery depletion and system-related infections.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:11.0pt"><strong>Methods: </strong>We conducted a retrospective analysis on pts who received ICDs between September 2014 and September 2023 at our centre. Medical records of 1646 pts were initially reviewed. Pts with presumable need for antitachycardia pacing or resynchronization therapies, including known ischemic cardiomyopathy or left ventricular systolic disfunction, were excluded.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:11.0pt"><strong>Results: </strong>A total of 93 pts were included: 28 (31.1%) with S-ICD and 65 (69.9%) with TV-ICD. Most devices (60.2%) were implanted for primary prevention. Primary diagnosis differed significantly (p=0.009): hypertrophic cardiomyopathy was the most common in TV-ICD pts (n=27, 41.5%), while Brugada syndrome and other primary electrical diseases were the most frequent entity in S-ICD pts (n=14, 50%). S-ICD pts were younger (28±10 vs 48±17 years, p<0.001), while TV-ICD pts had more comorbidities, including arterial hypertension (p=0.003), dyslipidemia (p=0.001), and obesity (p=0.037). No other baseline features were statistically different. </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:11.0pt">The follow-up time was similar, 44 ± 31 months (p=0.074), and no cardiovascular deaths were reported in both groups. Also, cardiovascular hospitalizations did not differ significantly (overall n=15, 16.1%; p=0.061). Device complications rate was low, with no statistically significant differences in inappropriate shocks (p=0.514), ineffective shocks (p=0.301), or battery depletion (p=0.159) – Table 1. No system-related infections were observed in either group.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:11.0pt"><strong>Conclusion:</strong> Consistent with prior studies, our S-ICD population tended to be younger and with fewer comorbidities. Our real-world data suggests potentially comparable performance between subcutaneous and transvenous devices on a short-term period. Further randomized controlled trials with long-term follow-up are needed to validate our confidence in S-ICD and possibly establish it as an equivalent therapy to TV-ICD in SCD prevention.</span></span></span></p>
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