Significantly less inappropriate shocks in ischemic patients compared to non‐ischemic patients: The S‐ICD experience of a high volume single‐center

Background The subcutaneous cardioverter‐defibrillator (S‐ICD) continues to be preferentially used in relatively young patients, with less advanced heart disease. Objective We, therefore, studied the short and long‐term efficacy and safety of the S‐ICD in subgroups of patients, which are underreported at present. Methods A total of 218 patients between November 2010 and February 2019 undergoing S‐ICD with a follow up of at least 6 months implantation were included in a prospective registry. Mean follow up was 38 months. Results The most common indication for S‐ICD implantation was ischemic cardiomyopathy (n = 106, 49%). Complication rate needing invasive intervention was 9% (n = 21). Appropriate shock rate in patients with an S‐ICD was 3.5%/year. A total of 30 inappropriate shocks (IAS) occurred in 19 patients (8.7%; 2.7%/year). The proportion of appropriate and inappropriate shock rates in patients with different cardiomyopathies shows remarkable variances. There were significant more IAS (3.6%/year vs. 1.7%/year, p = .048) in patients with non‐ischemic cardiomyopathy versus patients with ischemic cardiomyopathy. Multivariate analysis identified, besides type of cardiomyopathy, atrial fibrillation (AF) as predictor for IAS. Conclusion In this real‐world prospective registry we analyzed S‐ICD performance in the more traditional ICD patient. Patients with ischemic cardiomyopathy had significantly less inappropriate therapy compared to patients with non‐ischemic cardiomyopathy and appear to be appropriate patients for this type of device.