Infection and mortality after implantation of a subcutaneous ICD after transvenous ICD extraction

BACKGROUND The subcutaneous implantable cardioverterdefibrillator (S-ICD) provides an alternative to the transvenous implantable cardioverter-defibrillator (TV-ICD). Patients undergoing TV-ICD explantation may be eligible for reimplantation with an S-ICD; however, information on safety outcomes in this complex population is limited.
OBJECTIVE This analysis was designed to provide outcome and safety data from S-ICD patients who received their device after TV-ICD explantation.
METHODS Patients in the S-ICD IDE Study and EFFORTLESS Registry with a prior TV-ICD explantation, as well as those with no prior implantable cardioverter-defibrillator (ICD), were included. Patients were divided into 3 groups: those implanted with the S-ICD after TV-ICD extraction for system-related infection; those implanted after TV-ICD extraction for reasons other than system-related infection; and patients with no prior ICD.
RESULTS Mean follow-up duration was 651 days, and all-cause mortality was low. Patients previously explanted for TV-ICD infection were older, were more likely to have received the ICD for secondary prevention and had higher percentages of comorbidities, including atrial fibrillation, congestive heart failure, diabetes mellitus, and hypertension, in line with the highest mortality rate. Major infection after S-ICD implantation was low in all groups, with no evidence that patients implanted with the S-ICD after TV-ICD explantation for infection were more likely to experience a subsequent reinfection.
CONCLUSION The S-ICD is a suitable alternative for TV-ICD patients whose devices are explanted for any reason. Postimplantation risk of infection remains low even in patients whose devices were explanted for prior TV-ICD infection.