Subcutaneous implantable cardioverter-defibrillator and defibrillation testing: A propensity-matched pilot study

Giovanni B. Forleo, Alessio Gasperetti, Alexander Breitenstein, Mikael Laredo, Marco Schiavone, Matteo Ziacchi, Julia Vogler, Danilo Ricciardi, Pietro Palmisano, Agostino Piro, Paolo Compagnucci, Xavier Waintraub, Gianfranco Mitacchione, Gianmarco Carrassa, Giulia Russo, Silvana De Bonis, Andrea Angeletti, Antonio Bisignani, Francesco Picarelli, Michela CasellaEdoardo Bressi, Giovanni Rovaris, Leonardo Calò, Luca Santini, Carlo Pignalberi, Carlo Lavalle, Maurizio Viecca, Ennio Pisanò, Iacopo Olivotto, Antonio Curnis, Antonio Dello Russo, Claudio Tondo, Charles J. Love, Luigi Di Biase, Jan Steffel, Roland Tilz, Nicolas Badenco, Mauro Biffi

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: To date, only a few comparisons between subcutaneous implantable cardioverter-defibrillator (S-ICD) patients undergoing and those not undergoing defibrillation testing (DT) at implantation (DT+ vs DT–) have been reported. Objective: The purpose of this study was to compare long-term clinical outcomes of 2 propensity-matched cohorts of DT+ and DT– patients. Methods: Among consecutive S-ICD patients implanted across 17 centers from January 2015 to October 2020, DT– patients were 1:1 propensity-matched for baseline characteristics with DT+ patients. The primary outcome was a composite of ineffective shocks and cardiovascular mortality. Appropriate and inappropriate shock rates were deemed secondary outcomes. Results: Among 1290 patients, a total of 566 propensity-matched patients (283 DT+; 283 DT–) served as study population. Over median follow-up of 25.3 months, no significant differences in primary outcome event rates were found (10 DT+ vs 14 DT–; P = .404) as well as for ineffective shocks (5 DT– vs 3 DT+; P = .725). At multivariable Cox regression analysis, DT performance was associated with a reduction of neither the primary combined outcome nor ineffective shocks at follow-up. A high PRAETORIAN score was positively associated with both the primary outcome (hazard ratio 3.976; confidence interval 1.339–11.802; P = .013) and ineffective shocks alone at follow-up (hazard ratio 19.030; confidence interval 4.752–76.203; P = .003). Conclusion: In 2 cohorts of strictly propensity-matched patients, DT performance was not associated with significant differences in cardiovascular mortality and ineffective shocks. The PRAETORIAN score is capable of correctly identifying a large percentage of patients at risk for ineffective shock conversion in both cohorts.

Original languageEnglish (US)
JournalHeart Rhythm
DOIs
StateAccepted/In press - 2021

Keywords

  • Defibrillation testing
  • PRAETORIAN score
  • Propensity matching
  • Subcutaneous implantable cardioverter-defibrillator
  • Sudden cardiac death

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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