Worldwide experience with a totally subcutaneous implantable defibrillator: Early results from the EFFORTLESS S-ICD Registry

P. Lambiase, C. Barr, D.A.M.J. Theuns, R. Knops, P. Neuzil, J.B. Johansen, M. Hood, S.S. Pedersen, S. Kaab, F. Murgatroyd, H. Reeve, N. Carter, L.V.A. Boersma

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Abstract

Aims
The totally subcutaneous implantable-defibrillator (S-ICD) is a new alternative to the conventional transvenous ICD system to minimize intravascular lead complications. There are limited data describing the long-term performance of the S-ICD. This paper presents the first large international patient population collected as part of the EFFORTLESS S-ICD Registry.
Methods and results
The EFFORTLESS S-ICD Registry is a non-randomized, standard of care, multicentre Registry designed to collect long-term, system-related, clinical, and patient reported outcome data from S-ICD implanted patients since June 2009. Follow-up data are systematically collected over 60-month post-implant including Quality of Life. The study population of 472 patients of which 241 (51%) were enrolled prospectively has a mean follow-up duration of 558 days (range 13–1342 days, median 498 days), 72% male, mean age of 49 ± 18 years (range 9–88 years), 42% mean left ventricular ejection fraction. Complication-free rates were 97 and 94%, at 30 and 360 days, respectively. Three hundred and seventeen spontaneous episodes were recorded in 85 patients during the follow-up period. Of these episodes, 169 (53%) received therapy, 93 being for Ventricular Tachycardia/Fibrillation (VT/VF). One patient died of recurrent VF and severe bradycardia. Regarding discrete VT/VF episodes, first shock conversion efficacy was 88% with 100% overall successful clinical conversion after a maximum of five shocks. The 360-day inappropriate shock rate was 7% with the vast majority occurring for oversensing (62/73 episodes), primarily of cardiac signals (94% of oversensed episodes).
Conclusion
The first large cohort of real-world data from an International patient S-ICD population demonstrates appropriate system performance with clinical event rates and inappropriate shock rates comparable with those reported for conventional ICDs
Original languageEnglish
Pages (from-to)1657-1665
JournalEuropean Heart Journal: The Journal of the European Society of Cardiology
Volume35
Issue number25
DOIs
Publication statusPublished - 2014

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    Lambiase, P., Barr, C., Theuns, D. A. M. J., Knops, R., Neuzil, P., Johansen, J. B., Hood, M., Pedersen, S. S., Kaab, S., Murgatroyd, F., Reeve, H., Carter, N., & Boersma, L. V. A. (2014). Worldwide experience with a totally subcutaneous implantable defibrillator: Early results from the EFFORTLESS S-ICD Registry. European Heart Journal: The Journal of the European Society of Cardiology, 35(25), 1657-1665. https://doi.org/10.1093/eurheartj/ehu112