TY - JOUR
T1 - Subcutaneous Versus Transvenous Implantable Defibrillator Therapy
T2 - A Meta-Analysis of Case-Control Studies
AU - Basu-Ray, Indranill
AU - Liu, Jing
AU - Jia, Xiaoming
AU - Gold, Michael
AU - Ellenbogen, Kenneth
AU - DiNicolantonio, James
AU - Komócsi, András
AU - Vorobcsuk, András
AU - Kim, Jitae
AU - Afshar, Hamid
AU - Lam, Wilson
AU - Mathuria, Nilesh
AU - Razavi, Mehdi
AU - Rasekh, Abdi
AU - Saeed, Mohammad
N1 - Publisher Copyright:
© 2017 The Authors
PY - 2017/12/26
Y1 - 2017/12/26
N2 - Objectives This study aims to conduct a meta-analysis comparing efficacy and safety outcomes between subcutaneous implantable cardioverter-defibrillator (S-ICD) and transvenous implantable cardioverter-defibrillator (TV-ICD). Background The S-ICD was developed to minimize complications related to the conventional TV-ICD. Direct comparison of clinical outcomes between the 2 devices has been limited by varying patient characteristics and definitions of complications with no randomized trials completed comparing these systems. Methods Studies in the PubMed and Embase databases and secondary referencing sources were systematically reviewed. Studies meeting criteria were included in the meta-analysis. Baseline characteristics and outcome data of the S-ICD and TV-ICD groups were appraised and analyzed. A random-effects model was used to derive odds ratio (OR) with 95% confidence interval (CI). Results Five studies met inclusion criteria. Baseline characteristics were similar between the S-ICD and TV-ICD groups. Fewer lead complications occurred in the S-ICD group compared to the TV-ICD group (OR: 0.13; 95% CI: 0.05 to 0.38). The infection rate was similar between the S-ICD and TV-ICD groups (OR: 0.75; 95% CI: 0.30 to 1.89). There were no differences in system or device failures between groups (OR: 1.13; 95% CI: 0.43 to 3.02). Overall, inappropriate therapy (T-wave oversensing, supraventricular tachycardia, episodes of inappropriate sensing) was similar between the 2 groups (OR: 0.87; 95% CI: 0.51 to 1.49). However, the nature of inappropriate therapy was different between the S-ICD and TV-ICD groups. Both devices appear to perform equally well with respect to appropriate shocks. Conclusions S-ICD reduced lead-related complications but was similar to TV-ICD with regard to non–lead-related complications, including inappropriate therapy. These results support the concept that S-ICD is a safe and effective alternative to TV-ICD in appropriate patients.
AB - Objectives This study aims to conduct a meta-analysis comparing efficacy and safety outcomes between subcutaneous implantable cardioverter-defibrillator (S-ICD) and transvenous implantable cardioverter-defibrillator (TV-ICD). Background The S-ICD was developed to minimize complications related to the conventional TV-ICD. Direct comparison of clinical outcomes between the 2 devices has been limited by varying patient characteristics and definitions of complications with no randomized trials completed comparing these systems. Methods Studies in the PubMed and Embase databases and secondary referencing sources were systematically reviewed. Studies meeting criteria were included in the meta-analysis. Baseline characteristics and outcome data of the S-ICD and TV-ICD groups were appraised and analyzed. A random-effects model was used to derive odds ratio (OR) with 95% confidence interval (CI). Results Five studies met inclusion criteria. Baseline characteristics were similar between the S-ICD and TV-ICD groups. Fewer lead complications occurred in the S-ICD group compared to the TV-ICD group (OR: 0.13; 95% CI: 0.05 to 0.38). The infection rate was similar between the S-ICD and TV-ICD groups (OR: 0.75; 95% CI: 0.30 to 1.89). There were no differences in system or device failures between groups (OR: 1.13; 95% CI: 0.43 to 3.02). Overall, inappropriate therapy (T-wave oversensing, supraventricular tachycardia, episodes of inappropriate sensing) was similar between the 2 groups (OR: 0.87; 95% CI: 0.51 to 1.49). However, the nature of inappropriate therapy was different between the S-ICD and TV-ICD groups. Both devices appear to perform equally well with respect to appropriate shocks. Conclusions S-ICD reduced lead-related complications but was similar to TV-ICD with regard to non–lead-related complications, including inappropriate therapy. These results support the concept that S-ICD is a safe and effective alternative to TV-ICD in appropriate patients.
KW - device infection
KW - implantable cardioverter-defibrillator shock
KW - inappropriate therapy
KW - subcutaneous implantable cardioverter defibrillator
KW - transvenous implantable cardioverter-defibrillator
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U2 - 10.1016/j.jacep.2017.07.017
DO - 10.1016/j.jacep.2017.07.017
M3 - Article
C2 - 29759827
AN - SCOPUS:85030713304
SN - 2405-500X
VL - 3
SP - 1475
EP - 1483
JO - JACC: Clinical Electrophysiology
JF - JACC: Clinical Electrophysiology
IS - 13
ER -