Sex-based outcomes of subcutaneous implantable cardioverter-defibrillator and impact of surgical technique

Because of differences in chest wall anatomy, female patients may have higher rates of subcutaneous implantable cardioverter-defibrillator (S-ICD) pocket-related complications. We sought to evaluate sex-based outcomes after S-ICD implantation. Patients implanted with an S-ICD at Emory Healthcare between 2010 and 2023 were included in the analysis. Patients’ clinical characteristics and post–S-ICD implantation complications were collected. There were 429 male patients (68%) and 199 female patients (32%) observed for a median duration of 2.3 years (0.6–4.4 years). Male and female patients had comparable rates of diabetes (28%), end-stage renal disease (29.5%), ejection fraction (30.2% ± 13.4%), and body mass index (29.1 ± 6.6 kg/m2). There was no statistical difference in the incidence of shocks between men and women (26.3% vs 20.1%; P = .09), including appropriate shocks (14.7% vs 12%; P = .98) and inappropriate shocks (11.7% vs 9.5%; P = .98). Pocket-related complications occurred in 21 patients; these included pocket infection (n = 12), wound dehiscence (n = 7), and hematoma requiring drainage (n = 2). Female patients had a significantly higher pocket-related complication rate compared with male patients (7.2% vs 2.5%; P = .016). In controlling for age, body mass index, diabetes, and end-stage renal disease, female patients had higher odds of pocket-related complications compared with male patients (odds ratio, 3.15; 95% confidence interval, 1.27–7.75). Pocket-related complications decreased after 2018 compared with before 2018 (6% vs 2.6%, P = .052), mainly driven by reduction in complications in women (12.3% vs 3.2%; P = .034) but not in men (2.8% vs 2.4%; P = 1). In this cohort of S-ICD patients, women had a higher rate of post–S-ICD pocket-related complications that could be explained by sex-based differences in anatomy.