Outcomes of subcutaneous implantable cardioverter-defibrillator in dialysis patients: Results from the S-ICD post-approval study.

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Citation: Heart Rhythm. 17(9):1566-1574, 2020 09.PMID: 32376304Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *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]Year: 2020Local holdings: Available online through MWHC library: 2004 - presentISSN:
  • 1547-5271
Name of journal: Heart rhythmAbstract: 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).All authors: Burke MC, Carter N, El-Chami MF, Gold MR, Herre JM, Kutalek SP, Niebauer MJ, Sadhu A, Shah MHOriginally published: Heart Rhythm. 2020 May 03Fiscal year: FY2021Fiscal year of original publication: FY2020Digital Object Identifier: Date added to catalog: 2020-07-09
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Journal Article MedStar Authors Catalog Article 32376304 Available 32376304

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).

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