Comparison of transvenous vs subcutaneous defibrillator therapy in patients with cardiac arrhythmia syndromes and genetic cardiomyopathies

• Verfasst von: Kuschyk, Jürgen [VerfasserIn]
• Verfasst von: Müller-Leisse, Johanna [VerfasserIn]
• Verfasst von: Duncker, David [VerfasserIn]
• Verfasst von: Tueluemen, Erol [VerfasserIn]
• Verfasst von: Fastenrath, Fabian [VerfasserIn]
• Verfasst von: Fastner, Christian [VerfasserIn]
• Verfasst von: Kruska, Mathieu [VerfasserIn]
• Verfasst von: Akın, Ibrahim [VerfasserIn]
• Verfasst von: Liebe, Volker [VerfasserIn]
• Verfasst von: Borggrefe, Martin [VerfasserIn]
• Verfasst von: Veltmann, Christian [VerfasserIn]
• Verfasst von: Rudic, Boris [VerfasserIn]
• Titel: Comparison of transvenous vs subcutaneous defibrillator therapy in patients with cardiac arrhythmia syndromes and genetic cardiomyopathies
• Verf.angabe: Jürgen Kuschyk, Johanna Müller-Leisse, David Duncker, Erol Tülümen, Fabian Fastenrath, Christian Fastner, Mathieu Kruska, Ibrahim Akin, Volker Liebe, Martin Borggrefe, Christian Veltmann, Boris Rudic
• E-Jahr: 2021
• Jahr: January 2021
• Umfang: 6 S.
• Fussnoten: Gesehen am 17.05.2021
• Titel Quelle: Enthalten in: International journal of cardiology
• Ort Quelle: Amsterdam [u.a.] : Elsevier Science, 1981
• Jahr Quelle: 2021
• Band/Heft Quelle: 323(2021), Seite 100-105
• ISSN Quelle: 1874-1754
• DOI: doi:10.1016/j.ijcard.2020.08.089
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Appropriate shock
• Sach-SW: Inappropriate shock
• Sach-SW: Inherited arrhythmia syndromes
• Sach-SW: Lead failure
• Sach-SW: Lead fracture
• Sach-SW: Subcutaneous defibrillator
• Sach-SW: Sudden cardiac death
• Sach-SW: Transvenous defibrillator
• Sach-SW: Ventricular fibrillation
• Sach-SW: Ventricular tachycardia
• K10plus-PPN: 1757947388

Abstract

Background - Inherited arrhythmia syndromes and genetic cardiomyopathies attribute in a significant proportion to sudden cardiac death. Implantable cardioverter defibrillators (ICDs) are the cornerstone in the prevention of sudden death in high-risk patients. However, ICD therapy is also associated with high rates of inappropriate shocks and/or device-related complications especially in young patients. - Objective - To determine the outcome of high-risk patients with inherited arrhythmia syndromes and genetic cardiomyopathies comparing two defibrillator technologies. - Method - Between 2010 and 2018, 183 consecutive patients from two large German tertiary care centers were enrolled in the study. The majority of patients (83%) had either cardiac channelopathies or idiopathic ventricular fibrillation without cardiac structural abnormalities, while the remaining 17% had a genetic cardiomyopathy (HCM/ARVC). Eighty-six patients (47%) received a transvenous ICD (TV-ICD), while a subcutaneous ICD (S-ICD) was implanted in another 97 patients (53%). - Results - During a mean follow-up of 4.3 years, 30 patients had an appropriate ICD therapy (annual rate 3.8%). Fifteen patients experienced an inappropriate shock (annual rate 1.9%). Lead failure occurred in 17 (9%) patients and was less frequent in the S-ICD group (OR 0.48, 95%CI 0.38-0.62). Adverse defibrillator events, defined as a composite of inappropriate shocks and lead failure requiring surgical revision were significantly lower in the S-ICD group as compared to the TV-ICD group (OR 0.55, 95%CI 0.41-0.72). There was a non-significant trend towards lower appropriate shocks in the S-ICD group, that in combination with all-cause shocks yielded in a significantly higher freedom of any shock in the S-ICD group (RR 39%, p = 0.003). No deaths occurred during follow-up. - Conclusion - The present data favor the use of the subcutaneous ICD for patients with inherited arrhythmia syndromes and genetic cardiomyopathies who do not need anti-bradycardia pacing.