Subcutaneous versus transvenous implantable defibrillator in patients with hypertrophic cardiomyopathy.
Heart Rhythm
; 19(5): 759-767, 2022 05.
Article
em En
| MEDLINE
| ID: mdl-35038570
ABSTRACT
BACKGROUND:
Hypertrophic cardiomyopathy (HCM) is the most prevalent inherited cardiomyopathy. The implantable cardioverter-defibrillator (ICD) is important for prevention of sudden cardiac death (SCD) in patients at high risk. In recent years, the subcutaneous implantable cardioverter-defibrillator (S-ICD) has emerged as a viable alternative to the transvenous implantable cardioverter-defibrillator (TV-ICD). The S-ICD does not require intravascular access; however, it cannot provide antitachycardia pacing (ATP) therapy.OBJECTIVE:
The purpose of this study was to assess the real-world incidence of ICD therapy in patients with HCM implanted with TV-ICD vs S-ICD.METHODS:
We compared the incidence of ATP and shock therapies among all HCM patients with S-ICD and TV-ICD enrolled in the Boston Scientific ALTITUDE database. Cumulative Kaplan-Meier incidence was used to compare therapy-free survival, and Cox proportional hazard ratios were calculated. We performed unmatched as well as propensity match analyses.RESULTS:
We included 2047 patients with TV-ICD and 626 patients with S-ICD, followed for an average of 1650.5 ± 1038.5 days and 933.4 ± 550.6 days, respectively. Patients with HCM and TV-ICD had a significantly higher rate of device therapy compared to those with S-ICD (32.7 vs 14.5 therapies per 100 patient-years, respectively; P <.001), driven by a high incidence of ATP therapy in the TV-ICD group, which accounted for >67% of therapies delivered. Shock incidence was similar between groups, both in the general and the matched cohorts.CONCLUSION:
Patients with HCM and S-ICD had a significantly lower therapy rate than patients with TV-ICD without difference in shock therapy, suggesting potentially unnecessary ATP therapy. Empirical ATP programming in patients with HCM may be unbeneficial.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Cardiomiopatia Hipertrófica
/
Desfibriladores Implantáveis
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
Limite:
Humans
Idioma:
En
Ano de publicação:
2022
Tipo de documento:
Article