Evaluation of subcutaneous implantable cardioverter-defibrillator performance in patients with ion channelopathies from the EFFORTLESS cohort and comparison with a meta-analysis of transvenous ICD outcomes
Background: The subcutaneous implantable cardioverter-defibrillator (S-ICD) is an alternative to conventional transvenous ICD (TV-ICD) therapy to reduce lead complications. Objective: To evaluate outcomes in channelopathy vs patients with structural heart disease in the EFFORTLESS-SICD Registry and...
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| Format: | Article |
| Language: | English |
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Elsevier
2020-12-01
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| Series: | Heart Rhythm O2 |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666501820301434 |
| _version_ | 1819028461626327040 |
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| author | Pier D. Lambiase, MBChB, PhD, FHRS Lars Eckardt, MD Dominic A. Theuns, PhD Timothy R. Betts, MD Andreas L. Kyriacou, MBChB, FRCP, PhD, CCDS Elizabeth Duffy, MS Reinoud Knops, MD, PhD, CCDS |
| author_facet | Pier D. Lambiase, MBChB, PhD, FHRS Lars Eckardt, MD Dominic A. Theuns, PhD Timothy R. Betts, MD Andreas L. Kyriacou, MBChB, FRCP, PhD, CCDS Elizabeth Duffy, MS Reinoud Knops, MD, PhD, CCDS |
| author_sort | Pier D. Lambiase, MBChB, PhD, FHRS |
| collection | DOAJ |
| description | Background: The subcutaneous implantable cardioverter-defibrillator (S-ICD) is an alternative to conventional transvenous ICD (TV-ICD) therapy to reduce lead complications. Objective: To evaluate outcomes in channelopathy vs patients with structural heart disease in the EFFORTLESS-SICD Registry and with a previously reported TV-ICD meta-analysis in channnelopathies. Methods: The EFFORTLESS registry includes 199 patients with channelopathies (Brugada syndrome 83, long QT syndrome 24, idiopathic ventricular fibrillation 78, others 14) and 786 patients with structural heart disease. Results: Channelopathy patients were younger (39 ± 14 years vs 51 ± 17 years; P < .001) with left ventricular ejection fraction 59% ± 9% vs 41% ± 18% (P < .001). The complication rate (follow-up: 3.2 ± 1.5 years vs 3.0 ± 1.5 years) was similar: 13.6% vs 11.2% (P = .42). Appropriate shocks rates were 9.5% vs 10.8% (P = .70), with shocks for monomorphic ventricular tachycardia being 2.0% vs 6.9% (P < .02) and for polymorphic ventricular tachycardia/ventricular fibrillation (VT/VF) 8.0% vs 5.7% (P = .30). Conversion effectiveness of VT/VF episodes was similar: 36 of 37 (97.3%) vs 151 of 155 (97.4%, P = .59). VT/VF storm event (2% vs 0.9%, P = .33) and lower inappropriate shock (IAS) (8.5% vs 12.5%, P = .12) rates were statistically similar between channelopathy and non-channelopathy patients, with 45.5% channelopathy vs 31.4% non-channelopathy patients managed with a conditional zone > 200 beats per minute (P = .0002). Annualized appropriate shock, IAS, and complication rates appear to be lower for the S-ICD vs meta-analysis TV-ICD patients, particularly lead complications. Conclusion: EFFORTLESS demonstrates similar S-ICD efficacy and a nonsignificant, lower rate of IAS in channelopathy patients as compared to structural heart disease. Comparable IAS rates were achieved with the device programmed to higher rates for channelopathy patients. |
| first_indexed | 2024-12-21T05:58:44Z |
| format | Article |
| id | doaj.art-a9c8ef274f614046b43c94999f3c908f |
| institution | Directory Open Access Journal |
| issn | 2666-5018 |
| language | English |
| last_indexed | 2024-12-21T05:58:44Z |
| publishDate | 2020-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Heart Rhythm O2 |
| spelling | doaj.art-a9c8ef274f614046b43c94999f3c908f2022-12-21T19:13:48ZengElsevierHeart Rhythm O22666-50182020-12-0115326335Evaluation of subcutaneous implantable cardioverter-defibrillator performance in patients with ion channelopathies from the EFFORTLESS cohort and comparison with a meta-analysis of transvenous ICD outcomesPier D. Lambiase, MBChB, PhD, FHRS0Lars Eckardt, MD1Dominic A. Theuns, PhD2Timothy R. Betts, MD3Andreas L. Kyriacou, MBChB, FRCP, PhD, CCDS4Elizabeth Duffy, MS5Reinoud Knops, MD, PhD, CCDS6Barts Heart Centre, London, Edgware, United Kingdom; Address reprint requests and correspondence: Prof Pier D. Lambiase, Institute of Cardiovascular Science, UCL, Barts Heart Centre, West Smithfield, London EC1A 7BE, UK.Department of Cardiology II, University Hospital, Muenster, GermanyErasmus MC, Rotterdam, NetherlandsOxford Biomedical Research Centre, Oxford, United KingdomSheffield Teaching Hospitals, Sheffield, United KingdomBoston Scientific, St Paul, MinnesotaAcademic Medical Center, Amsterdam, NetherlandsBackground: The subcutaneous implantable cardioverter-defibrillator (S-ICD) is an alternative to conventional transvenous ICD (TV-ICD) therapy to reduce lead complications. Objective: To evaluate outcomes in channelopathy vs patients with structural heart disease in the EFFORTLESS-SICD Registry and with a previously reported TV-ICD meta-analysis in channnelopathies. Methods: The EFFORTLESS registry includes 199 patients with channelopathies (Brugada syndrome 83, long QT syndrome 24, idiopathic ventricular fibrillation 78, others 14) and 786 patients with structural heart disease. Results: Channelopathy patients were younger (39 ± 14 years vs 51 ± 17 years; P < .001) with left ventricular ejection fraction 59% ± 9% vs 41% ± 18% (P < .001). The complication rate (follow-up: 3.2 ± 1.5 years vs 3.0 ± 1.5 years) was similar: 13.6% vs 11.2% (P = .42). Appropriate shocks rates were 9.5% vs 10.8% (P = .70), with shocks for monomorphic ventricular tachycardia being 2.0% vs 6.9% (P < .02) and for polymorphic ventricular tachycardia/ventricular fibrillation (VT/VF) 8.0% vs 5.7% (P = .30). Conversion effectiveness of VT/VF episodes was similar: 36 of 37 (97.3%) vs 151 of 155 (97.4%, P = .59). VT/VF storm event (2% vs 0.9%, P = .33) and lower inappropriate shock (IAS) (8.5% vs 12.5%, P = .12) rates were statistically similar between channelopathy and non-channelopathy patients, with 45.5% channelopathy vs 31.4% non-channelopathy patients managed with a conditional zone > 200 beats per minute (P = .0002). Annualized appropriate shock, IAS, and complication rates appear to be lower for the S-ICD vs meta-analysis TV-ICD patients, particularly lead complications. Conclusion: EFFORTLESS demonstrates similar S-ICD efficacy and a nonsignificant, lower rate of IAS in channelopathy patients as compared to structural heart disease. Comparable IAS rates were achieved with the device programmed to higher rates for channelopathy patients.http://www.sciencedirect.com/science/article/pii/S2666501820301434ArrhythmiaChannelopathyImplantable cardioverter-defibrillatorSudden cardiac deathSubcutaneous ICDVentricular arrhythmias |
| spellingShingle | Pier D. Lambiase, MBChB, PhD, FHRS Lars Eckardt, MD Dominic A. Theuns, PhD Timothy R. Betts, MD Andreas L. Kyriacou, MBChB, FRCP, PhD, CCDS Elizabeth Duffy, MS Reinoud Knops, MD, PhD, CCDS Evaluation of subcutaneous implantable cardioverter-defibrillator performance in patients with ion channelopathies from the EFFORTLESS cohort and comparison with a meta-analysis of transvenous ICD outcomes Heart Rhythm O2 Arrhythmia Channelopathy Implantable cardioverter-defibrillator Sudden cardiac death Subcutaneous ICD Ventricular arrhythmias |
| title | Evaluation of subcutaneous implantable cardioverter-defibrillator performance in patients with ion channelopathies from the EFFORTLESS cohort and comparison with a meta-analysis of transvenous ICD outcomes |
| title_full | Evaluation of subcutaneous implantable cardioverter-defibrillator performance in patients with ion channelopathies from the EFFORTLESS cohort and comparison with a meta-analysis of transvenous ICD outcomes |
| title_fullStr | Evaluation of subcutaneous implantable cardioverter-defibrillator performance in patients with ion channelopathies from the EFFORTLESS cohort and comparison with a meta-analysis of transvenous ICD outcomes |
| title_full_unstemmed | Evaluation of subcutaneous implantable cardioverter-defibrillator performance in patients with ion channelopathies from the EFFORTLESS cohort and comparison with a meta-analysis of transvenous ICD outcomes |
| title_short | Evaluation of subcutaneous implantable cardioverter-defibrillator performance in patients with ion channelopathies from the EFFORTLESS cohort and comparison with a meta-analysis of transvenous ICD outcomes |
| title_sort | evaluation of subcutaneous implantable cardioverter defibrillator performance in patients with ion channelopathies from the effortless cohort and comparison with a meta analysis of transvenous icd outcomes |
| topic | Arrhythmia Channelopathy Implantable cardioverter-defibrillator Sudden cardiac death Subcutaneous ICD Ventricular arrhythmias |
| url | http://www.sciencedirect.com/science/article/pii/S2666501820301434 |
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