Subcutaneous Implantable Cardioverter-Defibrillators in Patients With Congenital Heart Disease.

BACKGROUND

Very few data have been published on the use of subcutaneous implantable cardioverter-defibrillators (S-ICDs) in patients with congenital heart disease (CHD).

OBJECTIVES

The aim of this study was to analyze outcomes associated with S-ICDs in patients with CHD.

METHODS

This nationwide French cohort including all patients with an S-ICD was initiated in 2020 by the French Institute of Health and Medical Research. Characteristics at implantation and outcomes were analyzed in patients with CHD.

RESULTS

From October 12, 2012, to December 31, 2019, among 4,924 patients receiving an S-ICD implant in 150 centers, 101 (2.1%) had CHD. Tetralogy of Fallot, univentricular heart, and dextro-transposition of the great arteries represented almost one-half of the population. Patients with CHD were significantly younger (age 37.1 ± 15.4 years vs 50.1 ± 14.9 years; P < 0.001), more frequently female (37.6% vs 23.0%; P < 0.001), more likely to receive an S-ICD for secondary prevention (72.3% vs 35.9%; P < 0.001), and less likely to have severe systolic dysfunction of the systemic ventricle (28.1% vs 53.1%; P < 0.001). Over a mean follow-up period of 1.9 years, 16 (15.8%) patients with CHD received at least 1 appropriate shock, with all shocks successfully terminating the ventricular arrhythmia. The crude risk of appropriate S-ICD shock was twice as high in patients with CHD compared with non-CHD patients (annual incidences of 9.0% vs 4.4%; HR: 2.1; 95% CI: 1.3-3.4); however, this association was no longer significant after propensity matching (especially considering S-ICD indication, P = 0.12). The burden of all complications (HR: 1.2; 95% CI: 0.7-2.1; P = 0.4) and inappropriate shocks (HR: 0.9; 95% CI: 0.4-2.0; P = 0.9) was comparable in both groups.

CONCLUSIONS

In this nationwide study, patients with CHD represented 2% of all S-ICD implantations. Our findings emphasize the effectiveness and safety of S-ICD in this particularly high-risk population. (S-ICD French Cohort Study [HONEST]; NCT05302115).

Informations de copyright

Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Funding Support and Author Disclosures This study was supported by the French Institute of Health and Medical Research and Paris-Sudden Death Expertise Center, the French Society of Cardiology (Electrophysiology Working Group), and the French Federation of Cardiology. The Paris Sudden Death Expertise Center activities are supported by the Institut National de la Santé et de la Recherche Médicale (INSERM), the University of Paris, Assistance Publique-Hôpitaux de Paris, Fondation Cœur et Artères, Global Heart Watch, Fédération Française de Cardiologie, Société Française de Cardiologie, and Fondation Recherche Medicale, as well as unrestricted grants from industrial partners (Abbott, Biotronik, Boston Scientific, Medtronic, MicroPort, ZOLL, and Schiller). Dr Waldmann has served as a consultant for Abbott and Medtronic. Dr Marijon has served as a consultant for Boston Scientific, Medtronic, ZOLL, and Abbott. Dr Ollitrault has received consulting fees from Abbott, Biotronik, Boston Scientific, and Medtronic. Dr Champ-Rigot has received consulting fees from Boston Scientific, Medtronic, and MicroPort CRM. Dr Garcia has received grants and honoraria from Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.