Subcutaneous versus Transvenous Implantable Cardioverter Defibrillator in Patients with End-Stage Renal Disease Requiring Dialysis: Extended Long-Term Retrospective Multicenter Follow-Up
Abstract
:1. Introduction
2. Methods
2.1. Implantation Procedure
2.2. Patient Follow-Up
2.3. Data Collection
2.4. Statistical Analysis
3. Results
3.1. Patient Population and Implant Procedure
3.2. Follow-Up
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
BMI | Body mass index |
CIED | Cardiac implantable electronic device |
CKD | Chronic kidney disease |
CRP | C-reactive proteins |
CRT | Cardiac resynchronization therapy |
ESRD | End-stage renal disease |
GFR | Glomerular filtration rate |
HD | Hemodialysis |
HF | Heart failure |
HFrEF | Heart failure with reduced ejection fraction |
ICD | Implantable cardioverter defibrillator |
LV-EF | Left ventricular ejection fraction |
Min | Minutes |
NYHA | New York Heart Association |
SCD | Sudden cardiac death |
S-ICD | Subcutaneous implantable cardioverter defibrillator |
TLE | Transvenous lead extraction |
TV-ICD | Transvenous implantable cardioverter defibrillator |
References
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TV-ICD (n = 17) | S-ICD (n = 26) | p-Value | |
---|---|---|---|
Age (years) | 65.1 (54.5–73.0) | 64.9 (56.5–79.0) | 0.967, ns |
BMI (kg/m2) | 27.0 (24.1–30.2) | 24.8 (22.0–28.3) | 0.177, ns |
Female gender, n (%) | 3 (17.6) | 5 (19.2) | 0.892, ns |
Primary prophylactic, n (%) | 10 (58.8) | 18 (69.2) | 0.386, ns |
Anemia, n (%) | 10 (58.8) | 5 (19.2) | 0.128, ns |
Hyperparathyroidism, n (%) | 5 (29.4) | 3 (11.5) | 0.148, ns |
Previous renal transplant, n (%) | 0 | 4 (15.4) | 0.087, ns |
Ischemic cardiomyopathy, n (%) | 10 (58.8) | 18 (69.2) | 0.108, ns |
NYHA class | 2.3 ± 1.3 | 2.5 ± 0.5 | 0.381, ns |
Coronary artery disease, n (%) | 12 (70.6) | 21 (80.8) | 0.301, ns |
Myocardial infarction, n (%) | 11 (64.7) | 11 (42.3) | 0.195, ns |
History of heart surgery, n (%) | 6 (35.3) | 8 (30.8) | 0.831, ns |
Atrial arrhythmia, n (%) | 8 (47.1) | 10 (38.5) | 0.387, ns |
Arterial hypertension, n (%) | 13 (76.5) | 20 (76.9) | 0.791, ns |
Diabetes, n (%) | 10 (58.8) | 10 (38.4) | 0.269, ns |
Hyperlipoproteinemia, n (%) | 11 (64.7) | 16 (61.5) | 0.964, ns |
Chronic obstructive lung disease, n (%) | 1 (5.9) | 1 (3.8) | 0.785, ns |
Stroke of ischemic and non-ischemic etiology, n (%) | 1 (5.9) | 4 (15.4) | 0.365, ns |
Liver disease, n (%) | 3 (17.6) | 0 | 0.083, ns |
Peripheral artery disease, n (%) | 3 (17.6) | 1 (3.8) | 0.146, ns |
History of vascular surgery, n (%) | 1 (5.9) | 1 (3.8) | 0.785, ns |
Potassium (mmol/L) | 4.8 ± 0.5 | 4.9 ± 0.6 | 0.515, ns |
Hemoglobin (g/dL) | 11.4 ± 1.4 | 11.6 ± 2.3 | 0.811, ns |
CRP (mg/dL) | 2.9 ± 2.9 | 2.1 ± 2.0 | 0.286, ns |
Betablocker, n (%) | 9 (52.9) | 5 (19.2) | <0.05 |
ACE inhibitor/ARB, n (%) | 4 (23.5) | 2 (11.5) | 0.216, ns |
MRA, n (%) | 1 (5.9) | 0 | 0.332, ns |
Diuretics, n (%) | 8 (47.1) | 4 (15.4) | <0.05 |
Anti-arrhythmic medication, n (%) | 6 (35.3) | 3 (11.5) | <0.05 |
Cardiac glycosides, n (%) | 1 (5.9) | 1 (0.4) | 0.785, ns |
ASS, n (%) | 7 (41.2) | 22 (84.6) | <0.05 |
DAPT, n (%) | 3 (17.6) | 12 (46.2) | <0.05 |
OAK, n (%) | 7 (41.2) | 6 (23.1) | 0.642, ns |
Corticosteroid, n (%) | 2 (11.8) | 4 (15.4) | 0.496, ns |
Immunosuppression medication, n (%) | 0 | 4 (15.4) | <0.05 |
Insulin, n (%) | 7 (41.2) | 5 (19.2) | 0.143, ns |
LVEF (%) | 31.3 (26.3–43.8) | 27.9 (25.0–30.5) | 0.243, ns |
Implant duration (min) | 54.8 (37.5–72.5) | 71.4 (55.4–87.4) | <0.05 |
Minor perioperative complications, n (%) | 5 (29.4) | 1 (3.8) | <0.05 |
Perioperative vascular complications | 0 | 0 | ns |
TV-ICD (n = 17) | S-ICD (n = 26) | Hazard Ratio (95% CI) | p | |
---|---|---|---|---|
Duration follow-up, months | 84.4 (25.0–165.5) | 103.3 (100.0–123.0) | 0.305, ns | |
Infection requiring whole system removal, n (%) | 5 (29.4) | 0 | <0.005 | |
Device-related infection, n (%) | 5 (29.4) | 1 (3.8) | 8.72 (1.18–12.85) | <0.01 |
Time to first device infection, (months) | 47.8 (7.5–89.5) | - | ||
Lead associated complication | 2 (11.7) | 0 | 0.188, ns | |
Overall mortality, n (%) | 6 (35.3) | 6 (23.1) | 1.92 (0.96–6.15) | 0.274, ns |
Cardiovascular mortality, n (%) | 4 (23.5) | 1 (3.8) | 9.17 (1.12–8.33) | <0.05 |
Patients experiencing ventricular arrhythmia | 3 (17.6) | 2 (7.7) | 0.355, ns | |
Mean number ventricular arrhythmia episodes | 0.7 ± 1.8 | 0.1 ± 0.3 | 0.150, ns | |
Average ATP | 0.2 ± 0.5 | 0 | ns | |
Patients receiving a shock, n (%) | 2 (11.7) | 4 (15.4) | 0.388, ns | |
Patients receiving appropriate shocks | 2 (11.7) | 2 (7.7) | 0.605, ns | |
Patients receiving inappropriate shocks, n (%) | 0 | 2 (7.7) | 0.242, ns | |
Patients receiving more than one shock | 0 | 0 | ||
Hospitalization rate, n (%) | 11 (64.7) | 8 (30.8) | 2.59 (1.12–6.41) | <0.05 |
Mean number hospitalizations per patients | 3.4 ± 2.9 | 0.8 ± 1.8 | <0.05 | |
Patients with cardiac hospitalization, n (%) | 7 (41.2) | 3 (11.5) | 5.99 (1.24–28.9) | <0.05 |
Mean cardiac hospitalizations | 1.3 ± 2.4 | 0.2 ± 0.9 | <0.05 | |
Patients with non-cardiac hospitalization, n (%) | 7 (41.2) | 4 (15.4) | 1.43 (0.86-1.73) | 0.158, ns |
Number of non-cardiac hospitalizations | 0.8 ± 1.5 | 0.4 ± 1.3 | 0.377, ns | |
Patients with device hospitalization, n (%) | 7 (41.2) | 1 (3.8) | 10.2 (1.22-84.61) | <0.001 |
Overall duration hospitalization (days) | 62.0 ± 22.6 | 24.0 ± 18.6 | <0.05 |
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Schiedat, F.; Meuterodt, B.; Winter, J.; Prull, M.; Aweimer, A.; Gotzmann, M.; O’Connor, S.; Perings, C.; Lawo, T.; El-Battrawy, I.; et al. Subcutaneous versus Transvenous Implantable Cardioverter Defibrillator in Patients with End-Stage Renal Disease Requiring Dialysis: Extended Long-Term Retrospective Multicenter Follow-Up. J. Pers. Med. 2024, 14, 870. https://doi.org/10.3390/jpm14080870
Schiedat F, Meuterodt B, Winter J, Prull M, Aweimer A, Gotzmann M, O’Connor S, Perings C, Lawo T, El-Battrawy I, et al. Subcutaneous versus Transvenous Implantable Cardioverter Defibrillator in Patients with End-Stage Renal Disease Requiring Dialysis: Extended Long-Term Retrospective Multicenter Follow-Up. Journal of Personalized Medicine. 2024; 14(8):870. https://doi.org/10.3390/jpm14080870
Chicago/Turabian StyleSchiedat, Fabian, Benjamin Meuterodt, Joachim Winter, Magnus Prull, Assem Aweimer, Michael Gotzmann, Stephen O’Connor, Christian Perings, Thomas Lawo, Ibrahim El-Battrawy, and et al. 2024. "Subcutaneous versus Transvenous Implantable Cardioverter Defibrillator in Patients with End-Stage Renal Disease Requiring Dialysis: Extended Long-Term Retrospective Multicenter Follow-Up" Journal of Personalized Medicine 14, no. 8: 870. https://doi.org/10.3390/jpm14080870