Factors influencing the use of subcutaneous or transvenous implantable cardioverter-defibrillators: results of the European Heart Rhythm Association prospective survey

Abstract

The purpose of this European Heart Rhythm Association (EHRA) prospective snapshot survey is to provide an overview of the factors influencing patient selection for the implantation of a particular type of device: subcutaneous implantable cardioverter-defibrillator (S-ICD) or transvenous implantable cardioverter-defibrillator (TV-ICD), across a broad range of tertiary European centres. A specially designed electronic questionnaire was sent via the internet to tertiary reference centres routinely implanting both TV-ICDs and S-ICDs. These centres were asked to prospectively include and fill-in this questionnaire for all consecutive patients implanted with an implantable cardioverter-defibrillator (ICD) (both TV-ICD and S-ICD) during an 8-week period of time. Questions concerned standards of care and policies used for patient management, focusing particularly on the reasons for choosing one or the other type of ICD for each patient. In total 20 centres participated at the survey and entered individual data from a total of 429 consecutive patients (men 76.3%). Indication of implantation was primary prevention for 73% of the patients. Implanted devices were distributed between cardiac resynchronisation therapy (CRT) ones with back-up defibrillators (31.6%), single-chamber TV-ICD (29.5%), S-ICD (19.8%), and dual-chamber TV-ICD (19.1%).The rate of S-ICD shows the current penetration of this treatment in everyday practice. Main reasons favouring the use of an S-ICD were young age (66.7%), anticipated (38.9%) or previous (9.3%) lead-related complications, and elevated risk (18.5%) or previous device infection (7.4%). Importantly, the choice for this device was also based on patient preference (16.7%) or active lifestyle (13%). The three most frequent reasons for the use of a transvenous device were the option of antitachycardia pacing (43.2%), and logically, the current or expected need for CRT (40%) or for permanent pacing (39.6%). This snapshot survey with individual patient data provides a contemporary insight into ICD implantation and management in the European electrophysiology tertiary centres. It also helps to better understand the reasons which condition the choice between a S-ICD and a traditional TV-ICD. Finally, it gives a picture of the distribution of various types of ICD, few years after the introduction of the S-ICD in the Europe.

Factors determining the choice between subcutaneous or transvenous implantable cardioverter-defibrillators in Poland in comparison with other European countries: a sub-study of the European Heart Rhythm Association prospective survey

“…In Poland, the main reasons leading to S-ICD implantation were infections or electrode-related complications, such as previous device infections with removal, anticipated lead-related complications, high risk of infection, or inadequate venous access. This is in contrast with other European countries, where young age of patients was the most common reason for S-ICD use [12]. Problems with transvenous electrodes are the main drawbacks of TV-ICDs, and they were among the reasons to develop the S-ICD system.…”

“…This EHRA prospective multicentre snapshot survey was designed to recognise European practices in the management of TV-ICD and S-ICD patients and recently provided an up-to-date overview of indications for ICD, periprocedural routines, and complications in European tertiary centres [12,13]. Our sub-analysis provides an additional important contemporary view on Polish patients undergoing ICD implantation and examines the criteria that influence the choice between S-ICD and TV-ICD in Poland, in comparison to other European countries.…”

“…All consecutive patients implanted with an ICD in the participating centres during an eight-week survey period were prospectively included in the study. The questionnaire was anonymous and consisted of 30 multiple-choice questions regarding the referral of the patient to a particular type of ICD and to periprocedural proceedings [12].…”

Noli me tangere: how to defibrillate without touching the heart

“…Even if the 20 centres responding to the survey were located in only six countries, half of them in France and Poland, the results provided an interesting picture of the S-ICD selection strategy. The economic factor significantly favoured the use of TV-ICD (18.5%), while patient preference or aesthetical reasons had negligible impact [13].…”

Initial experience with the subcutaneous implantable cardioverter-defibrillator with the real costs of hospitalization analysis in a single Polish center

“…young age, lead-related complications, elevated risk or previous device infection, and also patient preference or active lifestyle [18]. In our population two patients with the history of cardiac devicerelated infective endocarditis (CDRIE), the S-ICD was implanted due to increased risk of infection related to the necessity of device re-implantation as well as increased levels of inflammatory parameters during the entire period of hospitalization.…”