Prévention de la mort subite rythmique par un système entièrement sous-cutané comparé au défibrillateur trans-veineux : étude rétrospective au CHU de Caen

Abstract : Introduction. Implantable cardioverter-defibrillator (ICD) prevents from sudden cardiac death but it requires the use of intra-cardiac leads which are associated with the majority of the ICD’s complications. Recently, a new type of subcutaneous ICD (S-ICD) with no intravascular lead was developed and constitutes an alternative to the standard transvenous ICD (TV-ICD). Aim. We studied the safety and efficacy of the S-ICD device compared to (TV-ICD) in Caen University Hospital. Methods. One-hundred-and-seven patients were retrospectively included from April 2015 and October 2017: 28 in the S-ICD group and 79 in the TV-ICD group. The primary safety end-point was the rate of complications (local, infectious, electronic or lead failure inappropriate device therapy). The secondary end-points were the effectiveness of the device and the mortality rate. Results. There were significantly more inappropriate therapies in the S-ICD group (14% versus 3%, p = 0,039), and more local discomfort (p = 0,05). There was neither difference between the two groups regarding the remaining local complications, especially hemorrhagic complications, nor difference in lead or electronic failure. None of our patients experienced device infection. No difference was observedin appropriate device therapies and in mortality rates between the S-ICD and the TV-ICD groups. Conclusion. In our population, complications are different between TV-ICD and S-ICD patients. Latter experienced more inappropriate device therapies. However, Our study confirms safety and effectiveness of S-ICD compared to Tv-ICD with no difference regarding efficacy of the device and mortality.
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Camille Cloix. Prévention de la mort subite rythmique par un système entièrement sous-cutané comparé au défibrillateur trans-veineux : étude rétrospective au CHU de Caen. Médecine humaine et pathologie. 2018. ⟨dumas-02043521⟩

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