Background: The implantable cardioverter-defibrillator (ICD) is recognized as the most effective life-saving therapy in patients with Brugada syndrome (BrS). However, transvenous ICD is associated with a notable rate of complications over time. The subcutaneous implantable cardioverter-defibrillator (S-ICD) has emerged as a promising alternative to the transvenous ICD. Nevertheless, long-term data from large cohorts of BrS patients with S-ICDs are lacking. Objectives: This multicenter study aimed to assess the long-term outcomes of S-ICD therapy in patients with BrS. Methods: The study included 450 consecutive BrS patients (mean age 43 ± 12; 86% male) who underwent S-ICD implantation between 2014 and 2024. Results: During a median follow-up of 52 months (25th-75th percentile: 29-72), appropriate shocks were delivered in 3% of patients (1.2%; 95% CI: 0.2-2.2, at 12 months), with a first-shock success rate of 90% (100% with 2 shocks). Inappropriate shocks occurred in 7% of patients (1.4%; 95% CI: 0.3-2.5, at 12 months). Shock zone programmed at 250 beats/min (HR: 0.40; 95% CI: 0.18-0.89; P = 0.025) and more than 1 suitable vector on screening (HR: 0.39; 95% CI: 0.17–0.87; P = 0.023) were independent protective factors against inappropriate shock. Device-related complications were reported in 4% of patients (2.5%; 95% CI: 1.0-3.9 at 12 months). The need for antibradycardia pacing was reported in 3 patients (0.7%). No device explantation because of the need for antitachycardia pacing was noted. Conclusions: Our findings support the S-ICD as a viable alternative to the transvenous ICD for preventing sudden cardiac death in BrS patients without pacing indication (Arrhythmias Detection in a Real World Population [RHYTHM DETECT]; NCT02275637)
Subcutaneous Implantable Defibrillator Therapy in Patients With Brugada Syndrome: Data From a Large Multicenter Registry / Migliore, F.; Ottaviano, L.; Arestia, A.; Nigro, G.; Dello Russo, A.; Viani, S.; Bianchi, V.; Bisignani, A.; Pieragnoli, P.; Vitulano, G.; Rordorf, R.; Francia, P.; Taravelli, E.; Pisano, E.; Lavalle, C.; Brambilla, R.; Ziacchi, M.; Rapacciuolo, A.; Viscusi, M.; De Filippo, P.; La Greca, C.; Pepi, P.; Notarstefano, P.; Curcio, A.; Pittorru, R.; Martini, N.; Seganti, A.; Napolitano, C.; Lovecchio, M.; Valsecchi, S.; Botto, G.; Priori, S. G.. - In: JACC. CLINICAL ELECTROPHYSIOLOGY. - ISSN 2405-500X. - 11:7(2025), pp. 1572-1582. [10.1016/j.jacep.2025.03.003]
Subcutaneous Implantable Defibrillator Therapy in Patients With Brugada Syndrome: Data From a Large Multicenter Registry
Migliore F.;Ottaviano L.;Pisano E.;Rapacciuolo A.;La Greca C.;Curcio A.;
2025
Abstract
Background: The implantable cardioverter-defibrillator (ICD) is recognized as the most effective life-saving therapy in patients with Brugada syndrome (BrS). However, transvenous ICD is associated with a notable rate of complications over time. The subcutaneous implantable cardioverter-defibrillator (S-ICD) has emerged as a promising alternative to the transvenous ICD. Nevertheless, long-term data from large cohorts of BrS patients with S-ICDs are lacking. Objectives: This multicenter study aimed to assess the long-term outcomes of S-ICD therapy in patients with BrS. Methods: The study included 450 consecutive BrS patients (mean age 43 ± 12; 86% male) who underwent S-ICD implantation between 2014 and 2024. Results: During a median follow-up of 52 months (25th-75th percentile: 29-72), appropriate shocks were delivered in 3% of patients (1.2%; 95% CI: 0.2-2.2, at 12 months), with a first-shock success rate of 90% (100% with 2 shocks). Inappropriate shocks occurred in 7% of patients (1.4%; 95% CI: 0.3-2.5, at 12 months). Shock zone programmed at 250 beats/min (HR: 0.40; 95% CI: 0.18-0.89; P = 0.025) and more than 1 suitable vector on screening (HR: 0.39; 95% CI: 0.17–0.87; P = 0.023) were independent protective factors against inappropriate shock. Device-related complications were reported in 4% of patients (2.5%; 95% CI: 1.0-3.9 at 12 months). The need for antibradycardia pacing was reported in 3 patients (0.7%). No device explantation because of the need for antitachycardia pacing was noted. Conclusions: Our findings support the S-ICD as a viable alternative to the transvenous ICD for preventing sudden cardiac death in BrS patients without pacing indication (Arrhythmias Detection in a Real World Population [RHYTHM DETECT]; NCT02275637)I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
