Background: To date, only a few comparisons between subcutaneous implantable cardioverter-defibrillator (S-ICD) patients undergoing and those not undergoing defibrillation testing (DT) at implantation (DT+ vs DT–) have been reported. Objective: The purpose of this study was to compare long-term clinical outcomes of 2 propensity-matched cohorts of DT+ and DT– patients. Methods: Among consecutive S-ICD patients implanted across 17 centers from January 2015 to October 2020, DT– patients were 1:1 propensity-matched for baseline characteristics with DT+ patients. The primary outcome was a composite of ineffective shocks and cardiovascular mortality. Appropriate and inappropriate shock rates were deemed secondary outcomes. Results: Among 1290 patients, a total of 566 propensity-matched patients (283 DT+; 283 DT–) served as study population. Over median follow-up of 25.3 months, no significant differences in primary outcome event rates were found (10 DT+ vs 14 DT–; P =.404) as well as for ineffective shocks (5 DT– vs 3 DT+; P =.725). At multivariable Cox regression analysis, DT performance was associated with a reduction of neither the primary combined outcome nor ineffective shocks at follow-up. A high PRAETORIAN score was positively associated with both the primary outcome (hazard ratio 3.976; confidence interval 1.339–11.802; P =.013) and ineffective shocks alone at follow-up (hazard ratio 19.030; confidence interval 4.752–76.203; P =.003). Conclusion: In 2 cohorts of strictly propensity-matched patients, DT performance was not associated with significant differences in cardiovascular mortality and ineffective shocks. The PRAETORIAN score is capable of correctly identifying a large percentage of patients at risk for ineffective shock conversion in both cohorts.

Subcutaneous implantable cardioverter-defibrillator and defibrillation testing: A propensity-matched pilot study / Forleo G.B.; Gasperetti A.; Breitenstein A.; Laredo M.; Schiavone M.; Ziacchi M.; Vogler J.; Ricciardi D.; Palmisano P.; Piro A.; Compagnucci P.; Waintraub X.; Mitacchione G.; Carrassa G.; Russo G.; De Bonis S.; Angeletti A.; Bisignani A.; Picarelli F.; Casella M.; Bressi E.; Rovaris G.; Calo L.; Santini L.; Pignalberi C.; Lavalle C.; Viecca M.; Pisano E.; Olivotto I.; Curnis A.; Dello Russo A.; Tondo C.; Love C.J.; Di Biase L.; Steffel J.; Tilz R.; Badenco N.; Biffi M.. - In: HEART RHYTHM. - ISSN 1547-5271. - STAMPA. - 18:(2021), pp. 2072-2079. [10.1016/j.hrthm.2021.06.1201]

Subcutaneous implantable cardioverter-defibrillator and defibrillation testing: A propensity-matched pilot study

Carrassa G.;Olivotto I.;
2021

Abstract

Background: To date, only a few comparisons between subcutaneous implantable cardioverter-defibrillator (S-ICD) patients undergoing and those not undergoing defibrillation testing (DT) at implantation (DT+ vs DT–) have been reported. Objective: The purpose of this study was to compare long-term clinical outcomes of 2 propensity-matched cohorts of DT+ and DT– patients. Methods: Among consecutive S-ICD patients implanted across 17 centers from January 2015 to October 2020, DT– patients were 1:1 propensity-matched for baseline characteristics with DT+ patients. The primary outcome was a composite of ineffective shocks and cardiovascular mortality. Appropriate and inappropriate shock rates were deemed secondary outcomes. Results: Among 1290 patients, a total of 566 propensity-matched patients (283 DT+; 283 DT–) served as study population. Over median follow-up of 25.3 months, no significant differences in primary outcome event rates were found (10 DT+ vs 14 DT–; P =.404) as well as for ineffective shocks (5 DT– vs 3 DT+; P =.725). At multivariable Cox regression analysis, DT performance was associated with a reduction of neither the primary combined outcome nor ineffective shocks at follow-up. A high PRAETORIAN score was positively associated with both the primary outcome (hazard ratio 3.976; confidence interval 1.339–11.802; P =.013) and ineffective shocks alone at follow-up (hazard ratio 19.030; confidence interval 4.752–76.203; P =.003). Conclusion: In 2 cohorts of strictly propensity-matched patients, DT performance was not associated with significant differences in cardiovascular mortality and ineffective shocks. The PRAETORIAN score is capable of correctly identifying a large percentage of patients at risk for ineffective shock conversion in both cohorts.
2021
18
2072
2079
Forleo G.B.; Gasperetti A.; Breitenstein A.; Laredo M.; Schiavone M.; Ziacchi M.; Vogler J.; Ricciardi D.; Palmisano P.; Piro A.; Compagnucci P.; Waintraub X.; Mitacchione G.; Carrassa G.; Russo G.; De Bonis S.; Angeletti A.; Bisignani A.; Picarelli F.; Casella M.; Bressi E.; Rovaris G.; Calo L.; Santini L.; Pignalberi C.; Lavalle C.; Viecca M.; Pisano E.; Olivotto I.; Curnis A.; Dello Russo A.; Tondo C.; Love C.J.; Di Biase L.; Steffel J.; Tilz R.; Badenco N.; Biffi M.
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Utilizza questo identificatore per citare o creare un link a questa risorsa: https://hdl.handle.net/2158/1261124
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