AUTHOR=Schiedat Fabian , Meuterodt Benjamin , Prull Magnus , Aweimer Assem , Gotzmann Michael , O’Connor Stephen , Perings Christian , Korth Johannes , Lawo Thomas , El-Battrawy Ibrahim , Hanefeld Christoph , Mügge Andreas , Kloppe Axel 

TITLE=Comparison of infection and complication rates associated with transvenous vs. subcutaneous defibrillators in patients with stage 4 chronic kidney disease: a multicenter long-term retrospective follow-up

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=11

YEAR=2024

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2024.1397138

DOI=10.3389/fcvm.2024.1397138

ISSN=2297-055X

ABSTRACT=<sec><title>Background</title><p>Patients with progressive chronic kidney disease (CKD) are at higher risk of infections and complications from cardiac implantable electronic devices (CIED). In patients with a primary or secondary prophylactic indication, implantable cardiac defibrillators (ICD) can prevent sudden cardiac deaths (SCD). We retrospectively compared transvenous-ICD (TV-ICD) and intermuscularly implanted subcutaneous-ICD (S-ICD) associated infections and complication rates together with hospitalizations in recipients with stage 4 kidney disease.</p></sec><sec><title>Methods</title><p>We retrospectively analyzed 70 patients from six German centers with stage 4 CKD who received either a prophylactic TV-ICD with a single right ventricular lead, 49 patients, or a S-ICD, 21 patients. Follow-Ups (FU) were performed bi-annually.</p></sec><sec><title>Results</title><p>The TV-ICD patients were significantly older. This group had more patients with a history of atrial arrhythmias and more were prescribed anti-arrhythmic medication compared with the S-ICD group. There were no significant differences for other baseline characteristics. The median and interquartile range of FU durations were 55.2 (57.6–69.3) months. During FU, patients with a TV-ICD system experienced significantly more device associated infections (<italic>n</italic> = 8, 16.3% vs. <italic>n</italic> = 0; <italic>p</italic> &lt; 0.05), device-associated complications (<italic>n</italic> = 13, 26.5% vs. <italic>n</italic> = 1, 4.8%; <italic>p</italic> &lt; 0.05) and device associated hospitalizations (<italic>n</italic> = 10, 20.4% vs. <italic>n</italic> = 1, 4.8%; <italic>p</italic> &lt; 0.05).</p></sec><sec><title>Conclusion</title><p>In this long-term FU of patients with stage 4 CKD and an indication for a prophylactic ICD, the S-ICD was associated with significantly fewer device associated infections, complications and hospitalizations compared with TV-ICDs.</p></sec>