Outcomes of subcutaneous implantable cardioverter-defibrillator in dialysis patients: Results from the S-ICD post-approval study.
Outcomes of subcutaneous implantable cardioverter-defibrillator in dialysis patients: Results from the S-ICD post-approval study.
- 2020
Available online through MWHC library: 2004 - present
BACKGROUND: Patients with chronic renal disease on hemodialysis (HD) have limited vascular access and are at high-risk for bacteremia. The subcutaneous implantable cardioverter defibrillator (S-ICD) avoids vascular access, so it may be advantageous in this patient population. CONCLUSION: S-ICD is associated with similar adverse event rates but higher risk of inappropriate and appropriate therapy in dialysis patients compared to non-dialysis patients. Copyright (c) 2020. Published by Elsevier Inc. METHODS: S-ICD PAS patients were stratified based on presence (Group 1) or absence (Group 2) of HD at time of implant. Baseline demographic and clinical characteristics were collected. Perioperative and intermediate-term outcomes 365 days post-implant were compared between the two groups. OBJECTIVE: To report outcomes of patients with ESRD enrolled in the multicenter S-ICD post approval study (PAS). RESULTS: There were 220 (13.4%) patients on HD at implant of 1637 patients enrolled in S-ICD PAS. Patients on HD (Group 1) were older (57.4 +/- 13.2 vs. 52.5 +/- 15.2 years; p <0.0001), more likely to be of African descent (48.6% vs. 25.1%; p<0.0001) and had lower ejection fraction (28.6 +/- 11.3 vs. 32.6 +/- 14.9; p< 0.0001) compared to patients not on HD (Group 2). Group 1 patients had more comorbidities and mortality was higher (17.4% vs 3.7%) than Group 2. The rate of complications by KM estimate did not differ between groups (overall p=0.9169), with 1-year rates of 7.9% vs 7.7%, for Groups 1 and 2, respectively. The rate of appropriate shocks was significantly higher in Group 1 (p=0.0003 by K-M analysis), as was inappropriate shocks (p=0.0137).
English
1547-5271
10.1016/j.hrthm.2020.04.036 [doi] S1547-5271(20)30412-4 [pii]
*Arrhythmias, Cardiac/th [Therapy]
*Death, Sudden, Cardiac/pc [Prevention & Control]
*Defibrillators, Implantable
*Electric Countershock/mt [Methods]
*Kidney Failure, Chronic/th [Therapy]
*Renal Dialysis
*Risk Assessment/mt [Methods]
Arrhythmias, Cardiac/ep [Epidemiology]
Comorbidity
Female
Follow-Up Studies
Humans
Kidney Failure, Chronic/ep [Epidemiology]
Male
Middle Aged
Prospective Studies
Risk Factors
Survival Rate/td [Trends]
Time Factors
Treatment Outcome
United States/ep [Epidemiology]
MedStar Heart & Vascular Institute
Journal Article
Available online through MWHC library: 2004 - present
BACKGROUND: Patients with chronic renal disease on hemodialysis (HD) have limited vascular access and are at high-risk for bacteremia. The subcutaneous implantable cardioverter defibrillator (S-ICD) avoids vascular access, so it may be advantageous in this patient population. CONCLUSION: S-ICD is associated with similar adverse event rates but higher risk of inappropriate and appropriate therapy in dialysis patients compared to non-dialysis patients. Copyright (c) 2020. Published by Elsevier Inc. METHODS: S-ICD PAS patients were stratified based on presence (Group 1) or absence (Group 2) of HD at time of implant. Baseline demographic and clinical characteristics were collected. Perioperative and intermediate-term outcomes 365 days post-implant were compared between the two groups. OBJECTIVE: To report outcomes of patients with ESRD enrolled in the multicenter S-ICD post approval study (PAS). RESULTS: There were 220 (13.4%) patients on HD at implant of 1637 patients enrolled in S-ICD PAS. Patients on HD (Group 1) were older (57.4 +/- 13.2 vs. 52.5 +/- 15.2 years; p <0.0001), more likely to be of African descent (48.6% vs. 25.1%; p<0.0001) and had lower ejection fraction (28.6 +/- 11.3 vs. 32.6 +/- 14.9; p< 0.0001) compared to patients not on HD (Group 2). Group 1 patients had more comorbidities and mortality was higher (17.4% vs 3.7%) than Group 2. The rate of complications by KM estimate did not differ between groups (overall p=0.9169), with 1-year rates of 7.9% vs 7.7%, for Groups 1 and 2, respectively. The rate of appropriate shocks was significantly higher in Group 1 (p=0.0003 by K-M analysis), as was inappropriate shocks (p=0.0137).
English
1547-5271
10.1016/j.hrthm.2020.04.036 [doi] S1547-5271(20)30412-4 [pii]
*Arrhythmias, Cardiac/th [Therapy]
*Death, Sudden, Cardiac/pc [Prevention & Control]
*Defibrillators, Implantable
*Electric Countershock/mt [Methods]
*Kidney Failure, Chronic/th [Therapy]
*Renal Dialysis
*Risk Assessment/mt [Methods]
Arrhythmias, Cardiac/ep [Epidemiology]
Comorbidity
Female
Follow-Up Studies
Humans
Kidney Failure, Chronic/ep [Epidemiology]
Male
Middle Aged
Prospective Studies
Risk Factors
Survival Rate/td [Trends]
Time Factors
Treatment Outcome
United States/ep [Epidemiology]
MedStar Heart & Vascular Institute
Journal Article