Background: A few limited case series have shown that the S-ICD system is safe in teenagers and young adults, but a large-scale analysis is currently lacking. Objectives: To compare mid-term device-associated outcomes in a large real-world cohort of S-ICD patients, stratified by age at implantation. Methods: Two propensity-matched cohorts of teenagers + young adults (≤ 30-year-old) and adults (> 30-year-old) were retrieved from the ELISIR registry. The primary outcome was the comparison of the inappropriate shock rate; complications, freedom from sustained ventricular arrhythmias, overall and cardiovascular mortality were deemed secondary outcomes. Results: Teenagers + young adults represented 11.0% of the entire cohort. Two propensity-matched groups of 161 patients each were used for the analysis; median follow-up was 23.1 [13.2-40.5] months. 15.2% patients experienced inappropriate shocks and 9.3% device related complications were observed, with no age-related differences in inappropriate shocks (16.1% vs 14.3%; p=0.642) and complication rates (9.9% vs 8.7%; p=0.701). At univariate analysis, young age was not associated with increased rates of inappropriate shocks (HR 1.204 [0.675-2.148]: p=0.529). At multivariate analysis, the use of SMART pass algorithm was associated to a strong reduction in inappropriate shocks (aHR 0.292 [0.161-0.525]; p<0.001), while ARVC was associated with higher rates of inappropriate shocks (aHR 2.380 [1.205-4.697]; p=0.012). Conclusion: In a large multicentered registry of propensity-matched patients, the use of S-ICD in teenagers/young adults resulted safe and effective. The rates of inappropriate shocks and complications between cohorts were not significantly different. The only predictor of increased inappropriate shocks was a diagnosis of ARVC.
Age-related differences and associated mid-term outcomes of subcutaneous implantable cardioverter defibrillators: a propensity-matched analysis from a multicenter European registry / S. Gulletta, A. Gasperetti, M. Schiavone, J. Vogler, F. Fastenrath, A. Breitenstein, M. Laredo, P. Palmisano, G. Mitacchione, P. Compagnucci, L. Kaiser, S. Hakmi, A. Angeletti, S. De Bonis, F. Picarelli, R. Arosio, M. Casella, J. Steffel, N. Fierro, F. Guarracini, L. Santini, C. Pignalberi, A. Piro, C. Lavalle, E. Pisanò, M. Viecca, A. Curnis, N. Badenco, D. Ricciardi, A.D. Russo, C. Tondo, J. Kuschyk, P.D. Bella, M. Biffi, G.B. Forleo, R. Tilz. - In: HEART RHYTHM. - ISSN 1547-5271. - 19:7(2022 Jul), pp. 1109-1115. [10.1016/j.hrthm.2022.02.029]
Age-related differences and associated mid-term outcomes of subcutaneous implantable cardioverter defibrillators: a propensity-matched analysis from a multicenter European registry
A. Gasperetti;M. Schiavone
;R. ArosioMembro del Collaboration Group
;C. TondoMembro del Collaboration Group
;
2022
Abstract
Background: A few limited case series have shown that the S-ICD system is safe in teenagers and young adults, but a large-scale analysis is currently lacking. Objectives: To compare mid-term device-associated outcomes in a large real-world cohort of S-ICD patients, stratified by age at implantation. Methods: Two propensity-matched cohorts of teenagers + young adults (≤ 30-year-old) and adults (> 30-year-old) were retrieved from the ELISIR registry. The primary outcome was the comparison of the inappropriate shock rate; complications, freedom from sustained ventricular arrhythmias, overall and cardiovascular mortality were deemed secondary outcomes. Results: Teenagers + young adults represented 11.0% of the entire cohort. Two propensity-matched groups of 161 patients each were used for the analysis; median follow-up was 23.1 [13.2-40.5] months. 15.2% patients experienced inappropriate shocks and 9.3% device related complications were observed, with no age-related differences in inappropriate shocks (16.1% vs 14.3%; p=0.642) and complication rates (9.9% vs 8.7%; p=0.701). At univariate analysis, young age was not associated with increased rates of inappropriate shocks (HR 1.204 [0.675-2.148]: p=0.529). At multivariate analysis, the use of SMART pass algorithm was associated to a strong reduction in inappropriate shocks (aHR 0.292 [0.161-0.525]; p<0.001), while ARVC was associated with higher rates of inappropriate shocks (aHR 2.380 [1.205-4.697]; p=0.012). Conclusion: In a large multicentered registry of propensity-matched patients, the use of S-ICD in teenagers/young adults resulted safe and effective. The rates of inappropriate shocks and complications between cohorts were not significantly different. The only predictor of increased inappropriate shocks was a diagnosis of ARVC.File | Dimensione | Formato | |
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