Long-Term Experience With the Subcutaneous Implantable Cardioverter-Defibrillator in Teenagers and Young Adults

Markus Bettin, Robert Larbig, Benjamin Rath, Alicia Fischer, Gerrit Frommeyer, Florian Reinke, Julia Köbe, Lars Eckardt

This study sought to examine the use of the subcutaneous implantable cardioverter-defibrillator (S-ICD) in teenagers and young adults. The S-ICD is an important advance in device therapy for the prevention of sudden cardiac death. Although guidelines recommend S-ICD use, long-term data are still limited, especially in subgroups. Therefore, this study analyzed teenagers and young adults <26 years of age with S-ICD in our large single-center S-ICD registry. Between July 2010 and December 2016, 147 S-ICD systems were inserted at our institution. Thirty-one patients were included in the study; 13 were teenagers (<20 years of age), and 18 were young adults (20 to 26 years of age). The patients were compared with an age-matched control group with transvenous ICDs. Primary prevention of sudden cardiac death was the indication in 13 patients (41.9%). Ventricular arrhythmias were adequately terminated in 8 patients (25.8%). In 5 patients (16.1%), oversensing resulting in at least 1 inappropriate shock was observed. All inappropriate shocks occurred in teenagers. Younger age was an independent predictor of inappropriate shocks in S-ICD (hazard ratio: 0.56; 95% confidence interval: 0.34 to 0.92; p < 0.05). No ineffective shocks were observed in a median follow-up of 25.7 ± 20.2 months. Young patients may be suitable candidates for S-ICD because of the high number of lead failures with transvenous systems expected in these patients during their lifetime. In the present study, S-ICD therapy was safe and feasible in teenagers and young adults. However, episodes of inappropriate shocks may occur, but rates of inappropriate shocks were comparable to those in patients with transvenous ICDs.