Age-related differences and associated mid-term outcomes of subcutaneous implantable cardioverter-defibrillators: A propensity-matched analysis from a multicenter European registry

Simone Gulletta, Alessio Gasperetti, Marco Schiavone*, Julia Vogler, Fabian Fastenrath, Alexander Breitenstein, Mikael Laredo, Pietro Palmisano, Gianfranco Mitacchione, Paolo Compagnucci, Lukas Kaiser, Samer Hakmi, Andrea Angeletti, Silvana De Bonis, Francesco Picarelli, Roberto Arosio, Michela Casella, Jan Steffel, Nicolai Fierro, Fabrizio GuarraciniLuca Santini, Carlo Pignalberi, Agostino Piro, Carlo Lavalle, Ennio Pisanò, Maurizio Viecca, Antonio Curnis, Nicolas Badenco, Danilo Ricciardi, Antonio Dello Russo, Claudio Tondo, Jürgen Kuschyk, Paolo Della Bella, Mauro Biffi, Giovanni B. Forleo, Roland Tilz

*Corresponding author for this work
16 Citations (Scopus)

Abstract

Background: A few limited case series have shown that the subcutaneous implantable cardioverter-defibrillator (S-ICD) system is safe for teenagers and young adults, but a large-scale analysis currently is lacking. Objectives: The purpose of this study was to compare mid-term device-associated outcomes in a large real-world cohort of S-ICD patients, stratified by age at implantation. Methods: Two propensity-matched cohorts of teenagers + young adults (≤30 years old) and adults (>30 years old) were retrieved from the ELISIR Registry. The primary outcome was the comparison of inappropriate shock rate. Complications, freedom from sustained ventricular arrhythmias, and overall and cardiovascular mortality were deemed secondary outcomes. Results: Teenagers + young adults represented 11.0% of the entire cohort. Two propensity-matched groups of 161 patients each were used for the analysis. Median follow-up was 23.1 (13.2–40.5) months. In total, 15.2% patients experienced inappropriate shocks, and 9.3% device-related complications were observed, with no age-related differences in inappropriate shocks (16.1% vs 14.3%; P = .642) and complication rates (9.9% vs 8.7%; P = .701). At univariate analysis, young age was not associated with increased rates of inappropriate shocks (hazard ratio [HR] 1.204 [0.675–2.148]: P = .529). At multivariate analysis, use of the SMART Pass algorithm was associated with a strong reduction in inappropriate shocks (adjusted HR 0.292 [0.161–0.525]; P <.001), whereas arrhythmogenic right ventricular cardiomyopathy (ARVC) was associated with higher rates of inappropriate shocks (adjusted HR 2.380 [1.205–4.697]; P = .012). Conclusion: In a large multicenter registry of propensity-matched patients, use of the S-ICD in teenagers/young adults was safe and effective. The rates of inappropriate shocks and complications between cohorts were not significantly different. The only predictor of increased inappropriate shocks was a diagnosis of ARVC.

Original languageEnglish
JournalHeart Rhythm
Volume19
Issue number7
Pages (from-to)1109-1115
Number of pages7
ISSN1547-5271
DOIs
Publication statusPublished - 07.2022

Research Areas and Centers

  • Centers: Cardiological Center Luebeck (UHZL)

DFG Research Classification Scheme

  • 205-12 Cardiology, Angiology

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