Title:Efficacy and Complications of Subcutaneous versus Conventional Cardioverter
Defibrillators: A Systematic Review and Meta-analysis
Volume: 18
Issue: 3
Author(s): Camilla Silva Araújo, Carla Liz Barbosa Silva, Antônio da Silva Menezes Júnior*, Vinícius Araújo Barbosa, Tiago de Almeida Laranjeira, Joaquim Ferreira Fernandes, Lucas Cândido Gonçalves and Antonio Márcio Cordeiro Silva
Affiliation:
- Department of Medicine, Pontificial Catholic University of Goiás/Goiânia, Brazil
- Faculty of Medicine, Federal University
of Goiás/Goiânia, Brazil
Keywords:
Subcutaneous implantable cardioverter defibrillator, transvenous implantable cardioverter defibrillator, efficacy, complications, supraventricular tachycardia, bruise, infection.
Abstract:
Background/Objectives: Implantable cardioverter defibrillators are used to prevent sudden
cardiac death. The subcutaneous implantable cardioverter-defibrillator was newly developed to
overcome the limitations of the conventional implantable cardioverter defibrillator-transvenous device.
The subcutaneous implantable cardioverter defibrillator is indicated for young patients with
heart disease, congenital heart defects, and poor venous access, who have an indication for implantable
cardioverter defibrillator without the need for anti-bradycardic stimulation. We aimed to
compare the efficacy and complications of subcutaneous with transvenous implantable cardioverter-
defibrillator devices.
Methodology: A systematic review was conducted using different databases. The inclusion criteria
were observational and clinical randomized trials with no language limits and no publication date
limit that compared subcutaneous with transvenous implantable cardioverter-defibrillators. The selected
patients were aged > 18 years with complex ventricular arrhythmia.
Results: Five studies involving 2111 patients who underwent implantable cardioverter defibrillator
implantation were included. The most frequent complication in the subcutaneous device group was
infection, followed by hematoma formation and electrode migration. For the transvenous device,
the most frequent complications were electrode migration and infection. Regarding efficacy, the total
rates of appropriate shocks were 9.04% and 20.47% in the subcutaneous and transvenous device
groups, respectively, whereas inappropriate shocks to the subcutaneous and transvenous device
groups were 11,3% and 10,7%, respectively.
Conclusion: When compared to the transvenous device, the subcutaneous device had lower complication
rates owing to lead migration and less inappropriate shocks due to supraventricular tachycardia;
nevertheless, infection rates and improper shocks due to T wave oversensing were comparable
for both devices CRD42021251569.
