Differences in underlying cardiac substrate among S-ICD recipients and its impact on long-term device-related outcomes: Real-world insights from the iSUSI registry

Outcome comparisons among subcutaneous implantable cardioverter-defibrillator (S-ICD) recipients with nonischemic cardiomyopathies are scarce. The aim of this study was to evaluate differences in device-related outcomes among S-ICD recipients with different structural substrates. Patients enrolled i...

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Published in:	Heart rhythm Vol. 21; no. 4; pp. 410 - 418
Main Authors:	Gasperetti, Alessio, Schiavone, Marco, Milstein, Jenna, Compagnucci, Paolo, Vogler, Julia, Laredo, Mikael, Breitenstein, Alexander, Gulletta, Simone, Martinek, Martin, Casella, Michela, Kaiser, Lukas, Santini, Luca, Rovaris, Giovanni, Curnis, Antonio, Biffi, Mauro, Kuschyk, Jürgen, Di Biase, Luigi, Tilz, Roland, Tondo, Claudio, Forleo, Giovanni B., Gasperetti, A., Arosio, R., Viecca, M., Forleo, G.B., Schiavone, M., Tondo, C., Ziacchi, M., Diemberger, I., Angeletti, A., Biffi, M., Fierro, N., Gulletta, S., Della Bella, P., Curnis, G. Mitacchione.A., Compagnucci, P., Casella, M., Russo, A. Dello, Santini, L., Pignalberi, C., Magnocavallo, M., Piro, A., Lavalle, C., Picarelli, F., Ricciardi, D., Bressi, E., Calò, L., Montemerlo, E., Rovaris, G., De Bonis, S., Bisignani, A., Bisignani, G., Russo, G., Pisanò, E., Palmisano, P., Guarracini, F., Vitali, F., Bertini, M., Vogler, J., Fink, T., Tilz, R., Fastenrath, F., Kuschyk, J., Kaiser, L., Hakmi, S., Laredo, M., Waintraub, X., Gandjbakhch, E., Badenco, N., Breitenstein, A., Saguner, A.M., Martine, M., Seidl, S., Di Biase, L.
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-04-2024
Subjects:	Arrhythmogenic Right Ventricular Dysplasia - complications ARVC Cardiomyopathies Cardiomyopathy, Dilated - complications Cardiomyopathy, Dilated - therapy Death, Sudden, Cardiac - epidemiology Death, Sudden, Cardiac - etiology Death, Sudden, Cardiac - prevention & control Defibrillators, Implantable - adverse effects Electric Countershock - adverse effects Humans Inappropriate shocks Registries S-ICD Sudden cardiac death Treatment Outcome ARVC BrS TV CMP LQTS VA Sudden cardiac death DCM Inappropriate shocks HCM S-ICD Cardiomyopathies ATP
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Summary:	Outcome comparisons among subcutaneous implantable cardioverter-defibrillator (S-ICD) recipients with nonischemic cardiomyopathies are scarce. The aim of this study was to evaluate differences in device-related outcomes among S-ICD recipients with different structural substrates. Patients enrolled in the i-SUSI (International SUbcutaneouS Implantable cardioverter defibrillator registry) project were grouped according to the underlying substrate (ischemic vs nonischemic) and subgrouped into dilated cardiomyopathy, hypertrophic cardiomyopathy, Brugada syndrome (BrS), arrhythmogenic right ventricular cardiomyopathy (ARVC). The main outcome of our study was to compare the rates of appropriate and inappropriate shocks and device-related complications. Among 1698 patients, the most common underlying substrate was ischemic (31.7%), followed by dilated cardiomyopathy (20.5%), BrS (10.8%), hypertrophic cardiomyopathy (8.5%), and ARVC (4.4%). S-ICD for primary prevention was more common in the nonischemic cohort (70.9% vs 65.4%; P = .037). Over a median (interquartile range) follow-up of 26.5 (12.6–42.8) months, no differences were observed in appropriate shocks between ischemic and nonischemic patients (4.8%/y vs 3.9%/y; log-rank, P = .282). ARVC (9.0%/y; hazard ratio [HR] 2.492; P = .001) and BrS (1.8%/y; HR 0.396; P = .008) constituted the groups with the highest and lowest rates of appropriate shocks, respectively. Device-related complications did not differ between groups (ischemic: 6.4%/y vs nonischemic: 6.1%/y; log-rank, P = .666), nor among underlying substrates (log-rank, P = .089). Nonischemic patients experienced higher rates of inappropriate shocks than did ischemic S-ICD recipients (4.4%/y vs 3.0%/y; log-rank, P = .043), with patients with ARVC (9.9%/y; P = .001) having the highest risk, even after controlling for confounders (adjusted HR 2.243; confidence interval 1.338–4.267; P = .002). Most S-ICD recipients were primary prevention nonischemic cardiomyopathy patients. Among those, patients with ARVC tend to receive the most frequent appropriate and inappropriate shocks and patients with BrS the least frequent appropriate shocks.
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ISSN:	1547-5271 1556-3871 1556-3871
DOI:	10.1016/j.hrthm.2023.12.007