Giovanni Luca Botto 1 , Giovanni B Forleo 2 , Alessandro Capucci 3 , Francesco Solimene 4 , Antonello Vado 5 , Giovanni Bertero 6 , Pietro Palmisano 7 , Ennio Pisanò 8 , Antonio Rapacciuolo 9 , Tommaso Infusino 10 , Alessandro Vicentini 11 , Miguel Viscusi 12 , Paola Ferrari 13 , Antonello Talarico 14 , Giovanni Russo 1 , Giuseppe Boriani 15 , Luigi Padeletti 16 , Mariolina Lovecchio 17 , Sergio Valsecchi 17 , Antonio D’Onofrio 18 , on behalf of ‘AIAC S-ICD Why Not’ Survey Investigators
23 December 2016
A recommendation for a subcutaneous-implantable cardioverter-defibrillator (S-ICD) has been added to recent European Society of Cardiology Guidelines. However, the S-ICD is not ideally suitable for patients who need pacing. The aim of this survey was to analyse the current practice of ICD implantation and to evaluate the actual suitability of S-ICD.
The survey ‘S-ICD Why Not?’ was an independent initiative taken by the Italian Heart Rhythm Society (AIAC). Clinical characteristics, selection criteria, and factors guiding the choice of ICD type were collected in consecutive patients who underwent ICD implantation in 33 Italian centres from September to December 2015. A cardiac resynchronization therapy (CRT) device was implanted in 39% (369 of 947) of patients undergoing de novo ICD implantation. An S-ICD was implanted in 12% of patients with no CRT indication (62 of 510 with available data). S-ICD patients were younger than patients who received transvenous ICD, more often had channelopathies, and more frequently received their device for secondary prevention of sudden death. More frequently, the clinical reason for preferring a transvenous ICD over an S-ICD was the need for pacing (45%) or for antitachycardia pacing (36%). Nonetheless, only 7% of patients fulfilled conditions for recommending permanent pacing, and 4% of patients had a history of monomorphic ventricular tachycardia that might have been treatable with antitachycardia pacing.