Long-Term Experience With the Subcutaneous Implantable Cardioverter-Defibrillator in Teenagersand YoungAdults.

Abstract

This study sought to examine the use of the subcutaneous implantable cardioverter-defibrillator (S-ICD)in teenagers and young adults. The S-ICD is an important advance in device therapy for the prevention of sudden cardiac death. Although guidelines recommend S-ICD use, long-term data are still limited, especially in subgroups. Therefore, this study analyzed teenagers and young adults<26 years of age with S-ICD in our large single-center S-ICD registry. Between July 2010 and December 2016, 147 S-ICD systems were inserted at our institution. Thirty-one patients were included in the study; 13 were teenagers (<20 years of age), and 18 were young adults (20 to 26 years of age). The patients were compared with an age-matched control group with transvenous ICDs. Primary prevention of sudden cardiac death was the indication in 13 patients (41.9%). Ventricular arrhythmias were adequately terminated in 8 patients (25.8%). In 5 patients (16.1%), oversensing resulting in at least 1 inappropriate shock was observed. All inappropriate shocks occurred in teenagers. Younger age was an independent predictor of inappropriate shocks in S-ICD (hazard ratio: 0.56; 95% confidence interval: 0.34 to 0.92; p< 0.05). No ineffective shocks were observed in a median follow-up of 25.7 ± 20.2 months. Young patients may be suitable candidates for S-ICD because of the high number of lead failures withtransvenous systems expected in these patients during their lifetime. In the present study, S-ICD therapy wassafeand feasible in teenagers and young adults. However, episodes of inappropriate shocks may occur, butratesofinappropriate shocks were comparable to those in patients with transvenous ICDs.