Subcutaneous versus transvenous implantable cardioverter-defibrillator among drug-induced type-1 ECG pattern Brugada syndrome: a propensity score matching analysis from IBRYD study

IBRYD Study Group, Vincenzo Russo, Alfredo Caturano, Federico Guerra, Federico Migliore, Giuseppe Mascia, Andrea Rossi, Martina Nesti, Vincenzo Ezio Santobuono, Emilio Attena, Gianfranco Tola, Luigi Sciarra, Giulio Conte, Alessandro Paoletti Perini, Pietro Francia, Gregory Dendramis, Zefferino Palamà, Stefano Albani, Andrea Ottonelli Ghidini, Leonardo CalòAntonio D'Onofrio, Enrico Baldi

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Samenvatting

No real-world data are available about the complications rate in drug-induced type 1 Brugada Syndrome (BrS) patients with an implantable cardioverter-defibrillator (ICD). Aim of our study is to compare the device-related complications, infections, and inappropriate therapies among drug-induced type 1 BrS patients with transvenous- ICD (TV-ICD) versus subcutaneous-ICD (S-ICD). Data for this study were sourced from the IBRYD (Italian BRugada sYnDrome) registry which includes 619 drug-induced type-1 BrS patients followed at 20 Italian tertiary referral hospitals. For the present analysis, we selected 258 consecutive BrS patients implanted with ICD. 198 patients (76.7%) received a TV-ICD, while 60 a S-ICD (23.4%). And were followed-up for a median time of 84.3 [46.5-147] months. ICD inappropriate therapies were experienced by 16 patients (6.2%). 14 patients (7.1%) in the TVICD group and 2 patients (3.3%) in S-ICD group (log-rank P = 0.64). ICD-related complications occurred in 31 patients (12%); 29 (14.6%) in TV-ICD group and 2 (3.3%) in S-ICD group (log-rank P = 0.41). ICD-related infections occurred in 10 patients (3.88%); 9 (4.5%) in TV-ICD group and 1 (1.8%) in S-ICD group (log-rank P = 0.80). After balancing for potential confounders using the propensity score matching technique, no differences were found in terms of clinical outcomes between the two groups. In a real-world setting of drug-induced type-1 BrS patients with ICD, no significant differences in inappropriate ICD therapies, device-related complications, and infections were shown among S-ICD vs TV-ICD. However, a reduction in lead-related complications was observed in the S-ICD group. In conclusion, our evidence suggests that S-ICD is at least non-inferior to TV-ICD in this population and may also reduce the risk of lead-related complications which can expose the patients to the necessity of lead extractions.

Originele taal-2English
Pagina's (van-tot)680-688
Aantal pagina's9
TijdschriftHeart and Vessels
Volume38
Nummer van het tijdschrift5
Vroegere onlinedatum24 nov 2022
DOI's
StatusPublished - mei 2023

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Publisher Copyright:
© 2022, The Author(s).

Copyright:
Copyright 2022 Elsevier B.V., All rights reserved.

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