作者
Alessio Gasperetti,Marco Schiavone,Jenna Milstein,Paolo Compagnucci,Julia Vogler,Mikaël Laredo,Alexander Berndt,Simone Gulletta,Martin Martinek,Michela Casella,Lukas Kaiser,Luca Santini,Giovanni Rovaris,Antonio Curnis,Mauro Biffi,Jürgen Kuschyk,Luigi Di Biase,Roland Richard Tilz,Claudio Tondo,Giovanni B. Forleo,Alessio Gasperetti,Roberto Arosio,Maurizio Viecca,Giovanni B. Forleo,Marco Schiavone,Claudio Tondo,Matteo Ziacchi,Igor Diemberger,Andrea Angeletti,Mauro Biffi,Nicolai Fierro,Simone Gulletta,Paolo Della Bella,G. Mitacchione.A. Curnis,Paolo Compagnucci,Michela Casella,Antonio Dello Russo,Luca Santini,Carlo Pignalberi,Michele Magnocavallo,Agostino Piro,Carlo Lavalle,Francesco Picarelli,Danilo Ricciardi,Edoardo Bressi,Leonardo Calò,Elisabetta Montemerlo,Giovanni Rovaris,Silvana De Bonis,Antonio Bisignani,Giovanni Bisignani,Giulia Russo,Ennio Pisanò,Pietro Palmisano,Fabrizio Guarracini,Francesco Vitali,Matteo Bertini,Julia Vogler,Thomas Fink,Roland Richard Tilz,F. Fastenrath,Jürgen Kuschyk,Lukas Kaiser,Samer Hakmi,Mikaël Laredo,Xavier Waintraub,Estelle Gandjbakhch,Nicolas Badenco,Alexander Berndt,Am. Saguner,Migaud Fressart Martine,Stefan Seidl,Luigi Di Biase
摘要
Background Outcome comparisons among subcutaneous implantable cardioverter-defibrillator (S-ICD) recipients with nonischemic cardiomyopathies are scarce. Objective The aim of this study was to evaluate differences in device-related outcomes among S-ICD recipients with different structural substrates. Methods Patients enrolled in the i-SUSI (International SUbcutaneouS Implantable cardioverter defibrillator registry) project were grouped according to the underlying substrate (ischemic vs nonischemic) and subgrouped into dilated cardiomyopathy, hypertrophic cardiomyopathy, Brugada syndrome (BrS), arrhythmogenic right ventricular cardiomyopathy (ARVC). The main outcome of our study was to compare the rates of appropriate and inappropriate shocks and device-related complications. Results Among 1698 patients, the most common underlying substrate was ischemic (31.7%), followed by dilated cardiomyopathy (20.5%), BrS (10.8%), hypertrophic cardiomyopathy (8.5%), and ARVC (4.4%). S-ICD for primary prevention was more common in the nonischemic cohort (70.9% vs 65.4%; P = .037). Over a median (interquartile range) follow-up of 26.5 (12.6–42.8) months, no differences were observed in appropriate shocks between ischemic and nonischemic patients (4.8%/y vs 3.9%/y; log-rank, P = .282). ARVC (9.0%/y; hazard ratio [HR] 2.492; P = .001) and BrS (1.8%/y; HR 0.396; P = .008) constituted the groups with the highest and lowest rates of appropriate shocks, respectively. Device-related complications did not differ between groups (ischemic: 6.4%/y vs nonischemic: 6.1%/y; log-rank, P = .666), nor among underlying substrates (log-rank, P = .089). Nonischemic patients experienced higher rates of inappropriate shocks than did ischemic S-ICD recipients (4.4%/y vs 3.0%/y; log-rank, P = .043), with ARVC patients (9.9%/y; P = .001) having the highest risk, even after controlling for confounders (adjusted HR 2.243; confidence interval 1.338–4.267; P = .002). Conclusion Most S-ICD recipients were primary prevention nonischemic cardiomyopathy patients. Among those, ARVC patients tend to receive the most frequent appropriate and inappropriate shocks and BrS patients the least frequent appropriate shocks. ClinicalTrials.gov Identifier NCT0473876.