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What is the mortality impact of subcutaneous implantable cardioverter-defibrillator inappropriate shocks?
Session:
CO 23 - Dispositivos
Speaker:
Luís Oliveira
Congress:
CPC 2021
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.2 Implantable Cardioverter / Defibrillator
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Luís Resendes De Oliveira; Diogo Cavaco; Gustavo Rodrigues; Daniel Matos; Maria Salomé Carvalho; João Carmo; Pedro Galvão Santos; Francisco Costa; Pedro Carmo; Isabel Santos; Francisco Morgado; Miguel Mendes; Pedro Adragão
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Background:</strong> Previous studies have shown an adverse prognosis for patients with transvenous implantable cardioverter-defibrillators (ICD) who receive both appropriate and inappropriate shocks. There is a paucity of data regarding the prognosis of inappropriate shocks in patients with a subcutaneous ICD (S-ICD).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose:</strong> To assess and characterize S-ICD inappropriate (IAS) and appropriate shocks (AS) and their impact on mortality. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> Single center observational registry of 162 consecutive patients who underwent S-ICD implantation for primary and secondary prevention between November 2009 and September 2020. Only follow-up data of at least 6 months was analysed to identify predictors of both IAS and AS and their mortality impact.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> A total of 144 patients were included in the analysis. Mean age was 42.2±16.6 years and 75% of the patients were male. One hundred and four patients (72.2%) implanted the S-ICD in primary prevention. The most common etiology was ischemic cardiomyopathy (22.9%) followed by hypertrophic cardiomyopathy (18.8%) and dilated idiopathic cardiomyopathy (14.6%). During a mean follow-up of 42.3±29.9 months a total of 48 patients (33.3%) experienced at least one S-ICD shock. Twenty-nine (20.1%) patients received AS due to VT/VF and 31 patients (21.5%) received IAS. Eighteen (58.1%) of the IAS were due to oversensing/noise/discrimination errors and the remaining due to supraventricular tachycardia. Overall, patients with AS (HR 4.93, 95% CI 1.58-15.36, <em>p</em>=0.006) and higher number of total AS (HR 1.10, 95% CI 1.00-1.20, <em>p</em>=0.044) were associated with higher mortality during follow-up. S-ICD IAS therapy did not affect overall mortality (HR 1.71, 95% CI 0.21-14.0, <em>p</em>=0.616).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions: </strong>In our sample of patients with S-ICD, receiving an IAS, in contrast to AS, did not correlate with a worse prognosis. Larger studies are needed to confirm this hypothesis and to explain this findings. </span></span></p>
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