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Disclosures: Dr. Verma receives speaker honoraria from
Medtronic, Biotronik, Zoll and Boston Scientific and consulting fees
from Biosense Webster and AltaThera Pharmaceuticals. Dr. Knight receives
speaker honoraria and consulting fees for Abbott, Baylis Medical,
Biosense Webster, Boston Scientific, and Medtronic. Dr. Pfenniger
receives speaker honoraria from Medtronic and Abbott. Dr. Passman
receives research support from AHA (#18SFRN34250013), NIH
(UG3HL165065), research support and speaker fees from Medtronic,
research support from Abbott, and royalties from UpToDate. Dr. Lin
receives research support and consulting fees from Medtronic. Dr. Kim
receives speaker honoraria from Medtronic, Boston Scientific, and
Abbott, and is on the advisory board for Boston Scientific. Dr. Patil
receives consulting fees from Boston Scientific and speaker honoraria
from Zoll Medical. Dr. Arora is on the board of directors and has
ownership interest in Inomagen Therapeutics, receives royalties from
UpToDate, and is on the board of directors and receives honoraria from
the American Board of Internal Medicine. The remaining authors have
nothing to disclose.
Funding Statement: This research was not supported by external
funding.
Abstract
Introduction : The subcutaneous implantable cardioverter
defibrillator (S-ICD) is an alternative to a transvenous ICD in patients
who meet criteria for ICD implantation without concurrent need for
cardiac pacing. The objective of this study is to examine the rates of
and indications for S-ICD removal and extraction.
Methods : A retrospective analysis of all patients who underwent
S-ICD implantation between 2010 and 2022 at a single multihospital
healthcare system was performed. The primary endpoint was S-ICD removal
or extraction. Patient and device characteristics were abstracted from
the electronic medical record. Univariate and multivariate analyses
were completed to determine factors associated with S-ICD extraction.
Results : A total of 372 patients (69.5% male; 48.6 ± 14.4
years old) underwent S-ICD implantation during the study period. There
were 22 (5.9%) patients (81.8% male; 52.1 ± 13.2 years old) who
underwent S-ICD extraction over a median follow up period of 4.4
[2.0-6.5] years. The median length of time between implantation and
extraction was 39.6 [8.3-64.6] months. The most common indications
for S-ICD extraction were need for bradycardia pacing (incidence,
1.08%), infection (1.34%), and inappropriate shocks due to oversensing
(1.34%). A smoking history and higher body mass index were
independently associated with S-ICD extraction.
Conclusions : The overall rate of S-ICD extraction over 4.4
[2.0-6.5] years was 5.9%, with the most common indications for
extraction being need for bradycardia pacing, infection, and
inappropriate shocks due to oversensing. A smoking history and high body
mass index are associated with increased rates of S-ICD extraction. With
appropriate patient selection for the S-ICD, the need to remove the
device after implantation is low.
Key Words: subcutaneous, ICD, extraction, rate, indications