Transvenous vs. subcutaneous ICDs after transvenous device complication

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: Private company. Main funding source(s): Boston Scientific BACKGROUND: During long-term follow-up of patients with implantable cardioverter defibrillators (ICD) numerous problems may occur. Apart from lead failure cardiac device related infectious endocarditis poses a serious threat to the patient. To date, there is no data on the question whether a re-implantation of a transvenous ICD (tv-ICD) or the implantation of a subcutaneous ICD (S-ICD) might be the better choice. METHODS AND RESULTS: The present study represents a single-center experience of matched patients with a complication of tv-ICDs which had to be revised. The patient either received a tv- or an S-ICD thereafter. 103 patients (53 patients in each group) were included, follow-up duration was about 3 years in both groups. Patients from the tv-ICD group were slightly older (58 vs 52 years). Infections as well as oversensing were equally responsible for revision in both groups (infection: tv 49%, S-ICD 45%, oversensing: tv 51%, S-ICD 45%). During follow-up unscheduled re-hospitalization (tv 60 %, S-ICD: 38%), re-infection (tv 9.4% vs. S-ICD 1.9%) and re-revision (tv: 18.9% vs S-ICD 5.7%) were all significantly more often in the tv-ICD group. CONCLUSION: ICD patients who experienced a prior complication of a tv-ICD are at a considerable risk for a repeated complication if a new tv-ICD is implanted. Complication rates of S-ICDs in these patients seem to be lower so that S-ICD implantation might be preferred. Larger trials and prospective data is mandatory.