Abstract 9276: Subcutaneous and Transvenous Defibrillator in Arrhythmogenic Right Ventricular Cardiomyopathy

Abstract

Introduction: There is limited evidence guiding the selection between subcutaneous and transvenous ICD in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) at risk for sudden death.Hypothesis: We aimed to compare clinical and quality of life outcomes between transvenous and subcutaneous implantable defibrillators (ICD) among patients with ARVC. Methods: Patients with subcutaneous ICD (n=57) were matched to patients with transvenous ICD (n=88) based on sex, proband status, primary prevention or secondary prevention, monomorphic ventricular tachycardia before implant, and year of implant. Appropriate therapy for ventricular arrhythmia, inappropriate shocks, and complications were compared. Quality of life surveys were conducted annually. Results: The matched cohort (median age of 35 years, 43% male, 78% proband, and 37% secondary prevention device) were prospectively followed for 5.1 (+/-2.5) years. No significant difference was observed in the rate of appropriate ICD shocks. The subcutaneous group had more inappropriate shocks (23% versus 10%) and fewer procedure related complications (4% versus 14%) than the transvenous group (p <0.05). The association between ICD type and the composite of inappropriate shock and complication was not statistically significant (adjusted hazard ratio 1.43 subcutaneous vs. transvenous, 95% confidence interval 0.72-2.84). Subcutaneous ICD was associated with more body image concerns and range of motion than transvenous ICD (p <0.05). Conclusions: In patients with ARVC receiving an ICD, the risk of inappropriate shocks from subcutaneous ICD should be balanced against the significant vascular complication risk from transvenous ICD. Patients with subcutaneous ICD had more concerns for body image and range of motion.