S-ICD Implantation Following TV-ICD: Insights Into Patients With Infections and Abandoned Leads: The HONEST Cohort.

BACKGROUND

Subcutaneous implantable cardioverter-defibrillators (S-ICDs) can be a viable option for patients with transvenous ICDs experiencing complications (rescue S-ICD).

OBJECTIVES

This study sought to evaluate the outcomes of rescue S-ICD implantation using data from the HONEST French nationwide S-ICD cohort.

METHODS

All rescue S-ICD patients were identified. Outcomes (complications, reinterventions, and mortality) were compared between rescue and de novo S-ICD patients. Subgroup analyses were performed based on the implantation indication (infective vs noninfective) and the presence of abandoned leads.

RESULTS

Among 4,924 patients in the HONEST cohort, 651 underwent rescue S-ICD implantation (295 with infective indications, 244 with abandoned leads). Over a follow-up of 4.2 ± 2.2 years, complications and reinterventions were similar in rescue and de novo S-ICD patients (22.6% vs 21.0%; P = 0.35 and 8.7% vs 7.2%; P = 0.17, respectively), in infective and noninfective rescue S-ICD patients (21.6% vs 23.5%; P = 0.55 and 8.9% vs 8.6%; P = 0.90, respectively) and in patients with abandoned and extracted leads (24.3% vs 21.7%; P = 0.46 and 8.3% vs 9.0%; P = 0.77, respectively). Mortality was higher in rescue compared to de novo S-ICD patients (16.9% vs 10.2%; P < 0.001) and in rescue S-ICD patients with infective indications (29.2% vs 6.7%; P < 0.001) and extracted leads (21.9% vs 8.6%; P < 0.001), mainly due to a higher burden of comorbidities, as none of these parameters was independently associated with mortality in multivariate analyses. No S-ICD-related deaths were observed.

CONCLUSIONS

Rescue S-ICD implantation is an acceptable option for patients with device-related complications. Lead abandonment in the setting of a noninfective indication appears to be safe. (S-ICD French Cohort Study [HONEST]; NCT05302115).