Lambiase, Pier D; Theuns, Dominic A; Murgatroyd, Francis; Barr, Craig; Eckardt, Lars; Neuzil, Petr; Scholten, Marcoen; ... Boersma, Lucas VA; + view all Lambiase, Pier D; Theuns, Dominic A; Murgatroyd, Francis; Barr, Craig; Eckardt, Lars; Neuzil, Petr; Scholten, Marcoen; Hood, Margaret; Kuschyk, Jȕrgen; Brisben, Amy J; Carter, Nathan; Stivland, Timothy M; Knops, Reinoud; Boersma, Lucas VA; - view fewer (2022) Subcutaneous implantable cardioverter-defibrillators: long-term results of the EFFORTLESS study. European Heart Journal 10.1093/eurheartj/ehab921. (In press).

Preview

Text ehab921.pdf - Published Version Download (2MB) | Preview

Abstract

AIMS: To report 5-year outcomes of EFFORTLESS registry patients with early generation subcutaneous implantable cardioverter-defibrillator (S-ICD) devices. METHODS AND RESULTS: Kaplan-Meier, trend and multivariable analyses were performed for mortality and late (years 2-5) complications, appropriate shock (AS) and inappropriate shock (IAS) rates. Nine hundred and eighty-four of 994 enrolled patients with diverse diagnoses (28% female, 48 ± 17 years, body mass index 27 ± 6 kg/m2, ejection fraction 43 ± 18%) underwent S-ICD implantation. Median follow-up was 5.1 years (interquartile range 4.7-5.5 years). All-cause mortality was 9.3% (95% confidence interval 7.2-11.3%) at 5 years; 703 patients remained in follow-up on study completion, 171 withdrew including 87 (8.8%) with device explanted, and 65 (6.6%) lost to follow-up. Of the explants, only 20 (2.0%) patients needed a transvenous device for pacing indications. First and final shock efficacy for discrete ventricular arrhythmias was consistent at 90% and 98%, respectively, with storm episode final shock efficacy at 95.2%. Time to therapy remained unaltered. Overall 1- and 5-year complication rates were 8.9% and 15.2%, respectively. Early complications did not predict later complications. There were no structural lead failures. Inappropriate shock rates at 1 and 5 years were 8.7% and 16.9%, respectively. Self-terminating inappropriately sensed episodes predicted late IAS. Predictors of late AS included self-terminating appropriately sensed episodes and earlier AS. CONCLUSION: In this diverse S-ICD registry population, spontaneous shock efficacy was consistently high over 5 years. Very few patients underwent S-ICD replacement with a transvenous device for pacing indications. Treated and self-terminating arrhythmic episodes predict future shock events, which should encourage more personalized device optimization. KEY QUESTION: Is subcutaneous implantable cardioverter-defibrillator (S-ICD) shock efficacy maintained over time? KEY FINDING: Subcutaneous implantable cardioverter-defibrillator shock efficacy remains high for discrete and storm episodes. For discrete episodes first and final shock efficacy do not change over time or by rhythm type. TAKE-HOME MESSAGE: The EFFORTLESS study 5-year results provide the longest follow up of a large patient cohort implanted with the S-ICD. For 984 patients with a median follow-up of 5.1 years, the S-ICD maintains a high level of shock efficacy of 98%.

Download activity - last month

Export as JSONXMLCSV

Download activity - last 12 months

Export as JSONXMLCSV

Downloads by country - last 12 months

Export as XMLCSVJSON

Archive Staff Only

View Item