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.

Subcutaneous implantable cardioverter defibrillator and defibrillation testing: a propensity-matched pilot study / G.B. Forleo, A. Gasperetti, A. Breitenstein, M. Laredo, M. Schiavone, M. Ziacchi, J. Vogler, D. Ricciardi, P. Palmisano, A. Piro, P. Compagnucci, X. Waintraub, G. Mitacchione, G. Carrassa, G. Russo, S.D. Bonis, A. Angeletti, A. Bisignani, F. Picarelli, M. Casella, E. Bressi, G. Rovaris, L. Calò, L. Santini, C. Pignalberi, C. Lavalle, M. Viecca, E. Pisanò, I. Olivotto, A. Curnis, A.D. Russo, C. Tondo, C.J. Love, L.D. Biase, J. Steffel, R. Tilz, N. Badenco, M. Biffi. - In: HEART RHYTHM. - ISSN 1547-5271. - (2021), pp. 1-8. [Epub ahead of print] [10.1016/j.hrthm.2021.06.1201]

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

Gasperetti, Alessio;Schiavone, Marco;Tondo, Claudio;
2021

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.
S-ICD; defibrillation testing; praetorian score; propensity matching; sudden cardiac death;
Settore MED/11 - Malattie dell'Apparato Cardiovascolare
30-giu-2021
HEART RHYTHM
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/858919
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