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Outcome of Subcutaneous Implantable Cardioverter Defibrillator Implantation in Patients with End‐Stage Renal Disease on Dialysis
Author(s) -
ELCHAMI MIKHAEL F.,
LEVY MATHEW,
KELLI HEVAL M.,
CASEY MARY,
HOSKINS MICHAEL H.,
GOYAL ABHINAV,
LANGBERG JONATHAN J.,
PATEL ANSHUL,
DELURGIO DAVID,
LLOYD MICHAEL S.,
LEON ANGEL R.,
MERCHANT FAISAL M.
Publication year - 2015
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.12705
Subject(s) - medicine , dialysis , cohort , clinical endpoint , incidence (geometry) , end stage renal disease , implantable cardioverter defibrillator , kidney disease , surgery , hemodialysis , randomized controlled trial , physics , optics
Subcutaneous ICD in Dialysis Patients Background Although the subcutaneous ICD (S‐ICD®) is an attractive alternative in patients with end‐stage renal disease (ESRD), data on S‐ICD outcomes in dialysis patients are lacking. Methods Patients with cardiomyopathy undergoing S‐ICD implantation in our center were stratified by need for chronic dialysis at the time of implant. The primary endpoint was incidence of death, heart failure hospitalization or appropriate S‐ICD shocks, and secondary endpoints were incidence of inappropriate shocks or implant related complications requiring surgical re‐intervention. Mean follow‐up was longer in the nondialysis cohort (514 ± 495 vs. 227 ± 233 days, P = 0.006), so all endpoints were analyzed using time‐dependent comparisons and reported as annual event rates. Results Out of 79 S‐ICD implants included in this analysis, 27 patients were on dialysis. Dialysis patients were older and more likely to be diabetic. Mean ejection fraction across the entire cohort was 26.9% without significant difference between dialysis and nondialysis groups. Although not significant, the incidence of the primary endpoint was higher in the dialysis cohort (23.8%/year vs. 10.9%/year, P = 0.317), driven primarily by a higher rate of appropriate shocks. The rate of inappropriate shocks was similar between groups (dialysis 6.0%/year vs. nondialysis 6.8%/year, P = 0.509). No patients in the dialysis cohort had complications requiring surgical re‐intervention versus 6 patients in the nondialysis cohort (P = 0.086). Conclusions Our data suggest that S‐ICD implantation in dialysis patients is not associated with an excess risk of implant related complications or inappropriate shocks.