Details

Autor(en) / Beteiligte

• Healey, Jeff S
• Krahn, Andrew D
• Bashir, Jamil
• Amit, Guy
• Philippon, François
• McIntyre, William F
• Tsang, Bernice
• Joza, Jacqueline
• Exner, Derek V
• Birnie, David H
• Sadek, Mouhannad
• Leong, Darryl P
• Sikkel, Markus
• Korley, Victoria
• Sapp, John L
• Roux, Jean-Francois
• Lee, Shun Fu
• Wong, Gloria
• Djuric, Angie
• Spears, Danna
• Carroll, Sandra
• Crystal, Eugene
• Hruczkowski, Tom
• Connolly, Stuart J
• Mondesert, Blandine

Titel

Perioperative Safety and Early Patient and Device Outcomes Among Subcutaneous Versus Transvenous Implantable Cardioverter Defibrillator Implantations : A Randomized, Multicenter Trial

Ist Teil von

• Annals of internal medicine, 2022-12, Vol.175 (12), p.1658-1665

Ort / Verlag

United States

Erscheinungsjahr

2022

Quelle

MEDLINE

Beschreibungen/Notizen

• Implantable cardioverter defibrillators (ICDs) improve survival in patients at risk for cardiac arrest, but are associated with intravascular lead-related complications. The subcutaneous ICD (S-ICD), with no intravascular components, was developed to minimize lead-related complications. To assess key ICD performance measures related to delivery of ICD therapy, including inappropriate ICD shocks (delivered in absence of life-threatening arrhythmia) and failed ICD shocks (which did not terminate ventricular arrhythmia). Randomized, multicenter trial. (ClinicalTrials.gov: NCT02881255). The ATLAS trial. 544 eligible patients (141 female) with a primary or secondary prevention indication for an ICD who were younger than age 60 years, had a cardiogenetic phenotype, or had prespecified risk factors for lead complications were electrocardiographically screened and 503 randomly assigned to S-ICD (251 patients) or transvenous ICD (TV-ICD) (252 patients). Mean follow-up was 2.5 years (SD, 1.1). Mean age was 49.0 years (SD, 11.5). The primary outcome was perioperative major lead-related complications. There was a statistically significant reduction in perioperative, lead-related complications, which occurred in 1 patient (0.4%) with an S-ICD and in 12 patients (4.8%) with TV-ICD (-4.4%; 95% CI, -6.9 to -1.9;  = 0.001). There was a trend for more inappropriate shocks with the S-ICD (hazard ratio [HR], 2.37; 95% CI, 0.98 to 5.77), but no increase in failed appropriate ICD shocks (HR, 0.61 (0.15 to 2.57). Patients in the S-ICD group had more ICD site pain, measured on a 10-point numeric rating scale, on the day of implant (4.2 ± 2.8 vs. 2.9 ± 2.2;  < 0.001) and 1 month later (1.3 ± 1.8 vs. 0.9 ± 1.5; = 0.035). At present, the ATLAS trial is underpowered to detect differences in clinical shock outcomes; however, extended follow-up is ongoing. The S-ICD reduces perioperative, lead-related complications without significantly compromising the effectiveness of ICD shocks, but with more early postoperative pain and a trend for more inappropriate shocks. Boston Scientific.