The randomized multicenter ATLAS trial of more than 500 persons has found that subcutaneous implantable cardioverter defibrillators (S-ICDs) reduce perioperative, lead-related complications without significantly compromising the effectiveness of ICD shocks, but with more early postoperative pain and a trend for more inappropriate shocks. The study is published in Annals of Internal Medicine.
ICDs improve survival in patients at risk for cardiac arrest but are associated with intravascular lead-related complications. The S-ICD, with no intravascular components, was developed to minimize lead-related complications.
Researchers from McMaster University conducted a randomized multicenter trial of 544 persons with a primary or secondary prevention indication for an ICD. The authors found that S-ICD usage demonstrated a 92 percent reduction of lead-related complications and prevented most lead-related perioperative complications, including myocardial perforation, which can lead to death. They also reported a modest reduction in system reliability with the S-ICD, specifically a trend toward more inappropriate shocks.
After a mean follow-up of 2.5 years, there was a nonsignificant 22 percent reduction in the need for surgical ICD revision with the S-ICD and ongoing, longer-term follow-up of ATLAS participants will evaluate the effect that the S-ICD will have on chronic ICD performance and the need for ICD reoperation.
Jeff S. Healey et al, Perioperative Safety and Early Patient and Device Outcomes Among Subcutaneous Versus Transvenous Implantable Cardioverter Defibrillator Implantations, Annals of Internal Medicine (2022). DOI: 10.7326/M22-1566
Annals of Internal Medicine
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