Subcutaneous versus transvenous implantable cardioverter defibrillator in hypertrophic cardiomyopathy: a systematic review and meta-analysis.
| Autor: | da Silva Menezes Júnior A; Department of Medicine, Federal University of Goiás, Goiânia, GO, Brazil.; Internal Medicine Department, Pontifical Catholic University of Goiás, Goiânia, GO, Brazil., Oliveira IC; Department of Medicine, Federal University of Goiás, Goiânia, GO, Brazil., de Sousa AM; Department of Medicine, Federal University of Goiás, Goiânia, GO, Brazil., Paro Piai RF; Department of Medicine, Federal University of Goiás, Goiânia, GO, Brazil., Oliveira VMR; Department of Medicine, Federal University of Goiás, Goiânia, GO, Brazil. |
|---|---|
| Jazyk: | angličtina |
| Zdroj: | Cardiovascular diagnosis and therapy [Cardiovasc Diagn Ther] 2024 Jun 30; Vol. 14 (3), pp. 318-327. Date of Electronic Publication: 2024 Jun 27. |
| DOI: | 10.21037/cdt-24-15 |
| Abstrakt: | Background: A subcutaneous implantable cardioverter-defibrillator (S-ICD) is an alternative to a transvenous implantable cardio defibrillator (TV-ICD). An S-ICD reduces the risk of transvenous lead placement. However, further research is required to determine how S-ICDs affect patients with hypertrophic cardiomyopathy (HCM). In this study, we investigated the comparative efficacy and safety of S-ICDs versus TV-ICDs in HCM. Methods: On December 6 th , 2023, we performed a comprehensive search of the PubMed, Embase, Scopus, and Cochrane databases to identify randomized clinical trials (RCTs) and observational studies comparing S-ICDs with TV-ICDs in HCM patients published from 2004 until 2023. No language restrictions were applied. The primary outcome was appropriate shocks (AS), with inappropriate shocks (IAS), and device-related complications considered as secondary outcomes. Odds ratios (ORs) and 95% confidence intervals (CIs) were pooled using a random effects model. The ROBINS-I tool was used to assess the risk of bias of the studies. Results: The search yielded 1,114 records. Seven studies comprising 4,347 HCM patients were included, of whom 3,325 (76.0%) had TV-ICDs, and 1,022 (22.6%) had S-ICDs. There were 2,564 males (58.9%). The age range was from 39.1 to 49.4 years. Compared with the TV-ICD group, the S-ICD cohort had a significantly lower incidence of device-related complications (OR 0.52; 95% CI: 0.30-0.89; P=0.02; I 2 =4%). Contrastingly, there were no statistically significant differences in the occurrences of AS (OR 0.49; 95% CI: 0.22-1.08; P=0.08; I 2 =75%) and IAS (OR 1.03; 95% CI: 0.57-1.84; P=0.93; I 2 =65%) between the two device modalities. In the analysis of the overall risk of bias in the studies, we found 42% of them with several, 28% with moderate, and 14% with low risk of bias. Conclusions: In HCM patients, S-ICDs were associated with a lower incidence of device-associated problems than TV-ICDs. AS and IAS incidence rates were similar between groups. These findings may assist clinicians in determining the most suitable device for treating patients with HCM. Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://cdt.amegroups.com/article/view/10.21037/cdt-24-15/coif). The authors have no conflicts of interest to declare. (2024 Cardiovascular Diagnosis and Therapy. All rights reserved.) |
| Databáze: | MEDLINE |
| Externí odkaz: |
|