TY - JOUR
T1 - Subcutaneous implantable cardioverter-defibrillator and defibrillation testing
T2 - A propensity-matched pilot study
AU - Forleo, Giovanni B.
AU - Gasperetti, Alessio
AU - Breitenstein, Alexander
AU - Laredo, Mikael
AU - Schiavone, Marco
AU - Ziacchi, Matteo
AU - Vogler, Julia
AU - Ricciardi, Danilo
AU - Palmisano, Pietro
AU - Piro, Agostino
AU - Compagnucci, Paolo
AU - Waintraub, Xavier
AU - Mitacchione, Gianfranco
AU - Carrassa, Gianmarco
AU - Russo, Giulia
AU - De Bonis, Silvana
AU - Angeletti, Andrea
AU - Bisignani, Antonio
AU - Picarelli, Francesco
AU - Casella, Michela
AU - Bressi, Edoardo
AU - Rovaris, Giovanni
AU - Calò, Leonardo
AU - Santini, Luca
AU - Pignalberi, Carlo
AU - Lavalle, Carlo
AU - Viecca, Maurizio
AU - Pisanò, Ennio
AU - Olivotto, Iacopo
AU - Curnis, Antonio
AU - Dello Russo, Antonio
AU - Tondo, Claudio
AU - Love, Charles J.
AU - Di Biase, Luigi
AU - Steffel, Jan
AU - Tilz, Roland
AU - Badenco, Nicolas
AU - Biffi, Mauro
N1 - Funding Information:
Funding sources: The authors have no funding sources to disclose. Disclosures: Dr Santini is a consultant/speaker for Boston Scientific. Dr Tondo is a member of the Boston Scientific Advisory Board. Dr Steffel has received consultant and/or speaker fees Boston Scientific; and has received grant support through his institution from Boston Scientific. Dr Luigi Di Biase is a consultant for Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2021 Heart Rhythm Society
PY - 2021/12
Y1 - 2021/12
N2 - 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.
AB - 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.
KW - Defibrillation testing
KW - PRAETORIAN score
KW - Propensity matching
KW - Subcutaneous implantable cardioverter-defibrillator
KW - Sudden cardiac death
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U2 - 10.1016/j.hrthm.2021.06.1201
DO - 10.1016/j.hrthm.2021.06.1201
M3 - Article
C2 - 34214647
AN - SCOPUS:85111280090
VL - 18
SP - 2072
EP - 2079
JO - Heart Rhythm
JF - Heart Rhythm
SN - 1547-5271
IS - 12
ER -