Sex differences in shocks and device-related complications in subcutaneous implantable-cardioverter defibrillator patients

Abstract Background The use of implantable cardioverter-defibrillators (ICDs) improves the life expectancy of patients at risk of sudden cardiac death. However, ICD treatment comes with the risk of device-related complications. As the lead is the Achilles heel of the transvenous ICD (TV-ICD), the subcutaneous ICD (S-ICD) was developed to overcome the risk of lead-related complications. It is reported for TV-ICDs that women receive less appropriate therapy, but are more likely to experience ICD-related complications than men. It is unclear whether these differences also exist among S-ICD recipients. Purpose This study investigates the differences in appropriate shocks (AS) and device-related complications in men and women implanted with an S-ICD. Methods Retrospective data was collected of all patients implanted with an S-ICD between 2009 and 2022 in our tertiary center. Propensity score matching was used to create two comparable groups that differed by sex. The numbers of patients with an AS and device related-complication requiring intervention were compared between men and women. Differences between the groups were tested using a Fisher’s exact or X2-test. Results A total of 108 men and 108 women were included in this analysis. The median age was 40 years in men and 41 years in women (p=0.747), 61% had a primary prevention indication, and the median follow-up duration was 8 years. AS were seen in 15 women versus 24 men (p=0.156). There were 6 women versus 12 men with a device-related complication requiring intervention (p=0.218) (figure). The most common complication in men was infection (4/12) whereas in women erosion of the pocket occurred most frequently (2/6). Conclusions In this study, there was no significant difference in the number of patients with AS or complication between men and women with an S-ICD. However, a trend was seen towards more shocks and complications in men. The S-ICD may be a more suitable device for women, but further research with a larger sample size is needed.sex differences in S-ICD recipients