Heart rhythm · 2026
Subcutaneous ICD therapy in patients with monomorphic ventricular tachycardia: Arrhythmia recurrence, shock rate, and management strategies.
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Botto Giovanni Luca, Migliore Federico, Pieragnoli Paolo, Viani Stefano, Bisignani Antonio, Ziacchi Matteo, Silvetti Massimo Stefano, Nigro Gerardo, Bianchi Valter, Mariani Marco Valerio, Savarese Gianluca, Pittorru Raimondo, Bambagioni Gabriele, Lovecchio Mariolina, Valsecchi Sergio, Biffi Mauro, Casale Maria Carla, “S-ICD Rhythm Detect” investigators
Аннотация
BACKGROUND: The subcutaneous implantable cardioverter-defibrillator (S-ICD) is recommended for patients at risk of sudden cardiac death who do not require pacing or antitachycardia pacing (ATP). However, patients with a history of monomorphic ventricular tachycardia (MVT), which is often amenable to ATP, are underrepresented in clinical studies dealing with S-ICD.
OBJECTIVE: This study aimed to evaluate outcomes of S-ICD therapy in patients with previous MVT and describe subsequent management strategies in clinical practice.
METHODS: From 2164 consecutive de novo S-ICD implantations, we identified 210 patients (10%) with a history of sustained MVT. Clinical characteristics, procedural data, and outcomes were analyzed. The endpoints of the study included the rates of sustained MVT and S-ICD shocks for all ventricular arrhythmias.
RESULTS: During a median follow-up of 43 months (interquartile range 21-70), 21 patients (10%) experienced 66 MVT episodes (60 isolated, 6 storms) and a total of 98 ventricular arrhythmic episodes, all successfully terminated by shocks. The annualized rate of MVT was 2.8%/y, and the rate of appropriate shocks was 4.9%/y. First-shock efficacy was 93% for both MVT and polymorphic ventricular tachycardia/ventricular fibrillation. Approximately half of patients with recurrent MVT underwent ablation, with high procedural success. No patient required S-ICD explantation or conversion to a transvenous implantable cardioverter-defibrillator for ATP delivery. The complication rate was 2.3%/y and the inappropriate shock rate 2.8%/y.
CONCLUSION: In patients with previous MVT, the S-ICD provided safe and effective protection against ventricular arrhythmias. Ablation was the preferred management strategy, and no patients required conversion to a transvenous device. These findings support the use of the S-ICD as a viable option in this patient population.
CLINICAL TRIAL REGISTRATION: URL: http://clinicaltrials.gov/ identifier: NCT02275637.
OBJECTIVE: This study aimed to evaluate outcomes of S-ICD therapy in patients with previous MVT and describe subsequent management strategies in clinical practice.
METHODS: From 2164 consecutive de novo S-ICD implantations, we identified 210 patients (10%) with a history of sustained MVT. Clinical characteristics, procedural data, and outcomes were analyzed. The endpoints of the study included the rates of sustained MVT and S-ICD shocks for all ventricular arrhythmias.
RESULTS: During a median follow-up of 43 months (interquartile range 21-70), 21 patients (10%) experienced 66 MVT episodes (60 isolated, 6 storms) and a total of 98 ventricular arrhythmic episodes, all successfully terminated by shocks. The annualized rate of MVT was 2.8%/y, and the rate of appropriate shocks was 4.9%/y. First-shock efficacy was 93% for both MVT and polymorphic ventricular tachycardia/ventricular fibrillation. Approximately half of patients with recurrent MVT underwent ablation, with high procedural success. No patient required S-ICD explantation or conversion to a transvenous implantable cardioverter-defibrillator for ATP delivery. The complication rate was 2.3%/y and the inappropriate shock rate 2.8%/y.
CONCLUSION: In patients with previous MVT, the S-ICD provided safe and effective protection against ventricular arrhythmias. Ablation was the preferred management strategy, and no patients required conversion to a transvenous device. These findings support the use of the S-ICD as a viable option in this patient population.
CLINICAL TRIAL REGISTRATION: URL: http://clinicaltrials.gov/ identifier: NCT02275637.