Subcutaneous implantable cardioverter-defibrillator and defibrillation testing: A propensity-matched pilot study.

Comparative Effectiveness Research Death, Sudden, Cardiac / epidemiology Defibrillators, Implantable / adverse effects Electric Countershock / statistics & numerical data Equipment Failure / statistics & numerical data Equipment Failure Analysis / methods Europe / epidemiology Female Humans Male Materials Testing / methods Middle Aged Propensity Score Risk Assessment / methods Tachycardia, Ventricular / mortality

Defibrillation testing PRAETORIAN score Propensity matching Subcutaneous implantable cardioverter-defibrillator Sudden cardiac death

Journal

Heart rhythm

ISSN: 1556-3871

Titre abrégé: Heart Rhythm

Pays: United States

ID NLM: 101200317

Informations de publication

Date de publication:
12 2021

Historique:

received: 10 05 2021

revised: 22 06 2021

accepted: 27 06 2021

pubmed: 3 7 2021

medline: 4 3 2022

entrez: 2 7 2021

Statut: ppublish

Résumé

To date, only a few comparisons between subcutaneous implantable cardioverter-defibrillator (S-ICD) patients undergoing and those not undergoing defibrillation testing (DT) at implantation (DT+ vs DT-) have been reported. The purpose of this study was to compare long-term clinical outcomes of 2 propensity-matched cohorts of DT+ and DT- patients. Among consecutive S-ICD patients implanted across 17 centers from January 2015 to October 2020, DT- patients were 1:1 propensity-matched for baseline characteristics with DT+ patients. The primary outcome was a composite of ineffective shocks and cardiovascular mortality. Appropriate and inappropriate shock rates were deemed secondary outcomes. Among 1290 patients, a total of 566 propensity-matched patients (283 DT+; 283 DT-) served as study population. Over median follow-up of 25.3 months, no significant differences in primary outcome event rates were found (10 DT+ vs 14 DT-; P = .404) as well as for ineffective shocks (5 DT- vs 3 DT+; P = .725). At multivariable Cox regression analysis, DT performance was associated with a reduction of neither the primary combined outcome nor ineffective shocks at follow-up. A high PRAETORIAN score was positively associated with both the primary outcome (hazard ratio 3.976; confidence interval 1.339-11.802; P = .013) and ineffective shocks alone at follow-up (hazard ratio 19.030; confidence interval 4.752-76.203; P = .003). In 2 cohorts of strictly propensity-matched patients, DT performance was not associated with significant differences in cardiovascular mortality and ineffective shocks. The PRAETORIAN score is capable of correctly identifying a large percentage of patients at risk for ineffective shock conversion in both cohorts.

Sections du résumé

BACKGROUND

OBJECTIVE

The purpose of this study was to compare long-term clinical outcomes of 2 propensity-matched cohorts of DT+ and DT- patients.

METHODS

Among consecutive S-ICD patients implanted across 17 centers from January 2015 to October 2020, DT- patients were 1:1 propensity-matched for baseline characteristics with DT+ patients. The primary outcome was a composite of ineffective shocks and cardiovascular mortality. Appropriate and inappropriate shock rates were deemed secondary outcomes.

RESULTS

Among 1290 patients, a total of 566 propensity-matched patients (283 DT+; 283 DT-) served as study population. Over median follow-up of 25.3 months, no significant differences in primary outcome event rates were found (10 DT+ vs 14 DT-; P = .404) as well as for ineffective shocks (5 DT- vs 3 DT+; P = .725). At multivariable Cox regression analysis, DT performance was associated with a reduction of neither the primary combined outcome nor ineffective shocks at follow-up. A high PRAETORIAN score was positively associated with both the primary outcome (hazard ratio 3.976; confidence interval 1.339-11.802; P = .013) and ineffective shocks alone at follow-up (hazard ratio 19.030; confidence interval 4.752-76.203; P = .003).

CONCLUSION

In 2 cohorts of strictly propensity-matched patients, DT performance was not associated with significant differences in cardiovascular mortality and ineffective shocks. The PRAETORIAN score is capable of correctly identifying a large percentage of patients at risk for ineffective shock conversion in both cohorts.

Identifiants

DOI: 10.1016/j.hrthm.2021.06.1201 PMID: 34214647

pubmed: 34214647

pii: S1547-5271(21)01814-2

doi: 10.1016/j.hrthm.2021.06.1201

pii:

doi:

Banques de données

ClinicalTrials.gov

['NCT04373876']

Types de publication

Clinical Trial Journal Article Multicenter Study Observational Study

Langues

eng

Sous-ensembles de citation

Pagination

2072-2079