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., et al.. - 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.
