Subcutaneous Implantable Cardioverter Defibrillator Explantation -- A
Single Tertiary Center Experience
Abstract
Background: The subcutaneous implantable-cardioverter defibrillator
(S-ICD) is an appealing alternative to transvenous ICD systems. However,
data on indications for S-ICD explantations are sparse. Objectives: To
assess incidence and indications for S-ICD explantation at a large
tertiary referral center. Methods: We conducted a retrospective study of
all S-ICD explantations performed from 2014 to 2020. Data on
demographics, comorbidities, implantation characteristics, and
indications for explantation, were collected. Results: A total of 64
patients underwent S-ICD explantation during the study period. During
that time, there were 410 S-ICD implantations at our institution of
which 53 (12.9%) were explanted with a mean duration from implant to
explant of 19.7±20.1 months. The mean age of the patients at
explantation was 44.8±15.3 years, and 42% (n=27) were female. The
indication for S-ICD implantation was primary prevention in 58% and
secondary prevention in 42% of the patients. The most common reason for
explantation was infection (32.8%) followed by abnormal sensing (25%)
and need for pacing (18.8%). Those who underwent S-ICD explantation for
pacing indications were significantly older (55.7±13.6 vs 42.3± 14.6
years, p = 0.005) with a wider QRS duration (111±19 ms vs 98±19 ms, p =
0.03) at device implantation compared to patients who underwent
explantation for other indications. Conclusion: Incidence of S-ICD
explantation in a large tertiary practice was 12.9%. While infection
was the indication for a third of the explantations, a significant
number were due to sensing abnormalities and need for pacing. These data
may have implications for patient selection for S-ICD implantation.