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10-year experience of Subcutaneous Implantable Cardioverter Defibrillator implantation in a tertiary care center
Session:
Sessão de Posters 29 - Pacing sem elétrodos e inovação em dispositivos
Speaker:
Miguel Abrantes De Figueiredo
Congress:
CPC 2026
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.2 Implantable Cardioverter / Defibrillator
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Miguel Abrantes de Figueiredo; Fernando Nascimento Ferreira; Margarida Figueiredo; Sofia Jacinto; Hélder Santos; Madalena Cruz; Guilherme Portugal; Paulo Osório; Pedro Silva Cunha; Ana Lousinha; Bruno Valente; Mário Oliveira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction:</strong> Subcutaneous implantable cardioverter defibrillators (S-ICD) have emerged as an alternative to transvenous ICD, mainly in young patients, in those where there is limited venous access or if the risk of cardiac implantable device infection is deemed significant.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose:</strong> To analyze the complication rates and clinically significant outcomes for patients who have undergone S-ICD implantation in a tertiary care center.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> A retrospective analysis of all patients who underwent S-ICD implantation until November 2025 was performed. Data on mortality and clinically significant events (ventricular arrhythmias, inappropriate therapy, loss of sensing vectors, oversensing or undersensing and lead-related complications) were retrieved and time-to-event analysis was also performed.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> The first S-ICD implantation was performed in June 2015, with a total of 76 S-ICD implantations and a median follow-up time of 2.03 years. The S-ICD was the first cardiac implantable device in 86.8% of cases, with 2 patients already having a previous S-ICD. In 75.0% of cases the device was implanted as a primary prevention strategy, predominantly in a background of a pre-existing cardiomyopathy (in 57.9% of cases). There were no immediate procedural complications recorded; however, early loss of sensing vectors occurred in 2 cases. Late complications including lead displacement or fracture (2.6%) and device infection (1.3%) were infrequent. Clinically significant events occurred in 28.9% of patients (mainly regarding non-lead-related events, such as sustained ventricular arrhythmias and inappropriate therapy), while the mortality rate during follow-up was 13.2% (Figure 1). The sensing vector screening profile was fully obtained in 52.6% of cases (26.3% of patients had passed in all 3 sensing vectors, 23.7% in 2 and 2.6% in 1). However, there were no meaningful differences in mortality or clinically significant events in spite of the variances in the number of adequate screening sensing vectors obtained. The defibrillation threshold (DFT) test was not performed in 9.2% of cases due to clinical pre-procedural contraindications. The non-DFT group showed a greater proportion of clinically significant events (p= 0.040), particularly global mortality (p = 0.015) and cardiovascular mortality (p = 0.004), but not inappropriate therapy (p = 0.376). Time-to-event analysis also showed an increase in overall mortality (log-rank test, p = 0.048) and cardiovascular mortality (log-rank test, p = 0.035) in the non-DFT cohort.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion:</strong> S-ICD implantation is safe with a low complication rate. Nonetheless, there is a need for an adequate follow-up to treat the possible complications and clinically significant events. Finally, the absence of the DFT test after the S-ICD implantation may serve as a marker of adverse clinical outcomes, mainly increased mortality.</span></span></p>
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