S-ICD in heart failure patients: real-world data from a multicenter, european analysis

• Published in: Europace (London, England) England), 2022-05, Vol.24 (Supplement_1)
• Main Authors: Schiavone, M, Gasperetti, A, Vogler, J, Breitenstein, A, Hakmi, S, Mitacchione, G, Gulletta, S, Laredo, M, Lavalle, C, Casella, M, Tondo, C, Kuschyk, J, Tilz, R, Biffi, M, Forleo, GB
• Format: Article
• Language: English
• ISSN: 1099-5129; 1532-2092
• DOI: 10.1093/europace/euac053.459

Abstract Funding Acknowledgements Type of funding sources: None. Background Data on patients with heart failure (HF) and subcutaneous implantable cardioverter defibrillator (S-ICD) are very scarce and limited to a single prospective analysis from the UNTOUCHED trial. Purpose Aim of this study was to assess clinical outcomes of the S-ICD in HF patients, comparing them with a no-HF population, in a real-world analysis from the largest European retrospective S-ICD registry (ELISIR registry). Methods All consecutive patients undergoing S-ICD implantation at 20 European institutions enrolled in the ELISIR registry were used for the current analysis. According to European Guidelines, the registry population was classified into two groups: the HF cohort (further classified as HF with reduced and mid-range ejection fraction – HFrEF and HFmrEF) vs the no-HF group. The primary outcome of the study was the inappropriate shock (IS) rate across the two cohorts. As secondary outcomes, appropriate shocks, cardiovascular mortality and device-related complications during follow-up were assessed. Results A total of 1409 patients from the ELISIR registry were included in this analysis; HF patients represented 57.3% of the entire cohort (n=701, 86.9% HFrEF; n=106,13.1% HFmrEF). As expected, the HF cohort showed significantly higher rates of cardiovascular risk factors and comorbidities when compared to the no-HF cohort. Over a median follow-up of approximately 2 years, a total of 133 inappropriate shocks were observed in the entire cohort, without significant differences among the two groups (9.2% vs 9.8%, p=0.689). 133 complex ventricular arrhythmias were adequately recognized and treated in the overall cohort, showing similar rates of appropriate shocks (9.2% vs 9.8%, p=0.689). Inappropriate and effective shocks-free survival has been represented in Figure 1, showing Kaplan-Meier estimates comparing HF vs no-HF patients, also stratified by left ventricular ejection fraction (LVEF). The impact of baseline and procedural characteristics on the primary outcome was tested through univariable and multivariable Cox regression analysis in HF patients; at multivariate analysis, only age (HR=0.974 [0.955–0.992], p=0.005), LVEF (HR=0.954 [0.926-0.984], p=0.003), ARVC (HR=3.364 [1.206-9.384], p=0.020) and smart pass algorithm "on" (HR=0.321 [0.184-0.560], p