Defibrillation Testing During Implantation of Subcutaneous Implantable Cardioverter Defibrillators

Journal of the American College of Cardiology2025Fawzi Kerkouri, Romain Eschalier, Samir Fareh, Christelle Marquié, Mina Ait Said, Walid Amara, Frédéric Anselme, Marc Badoz, Nathalie Behar, Pierre Bordachar, Rim El Bouazzaoui, Laure Champ Rigot, Michel Chauvin, Philippe Chevalier, Antoine da Costa, Pascal Defaye, Jean Claude Deharo, Laurent Fauchier, Estelle Gandjbakhch, Edouard Gitenay, Jean-Baptiste Gourraud, Charles Guenancia, Maxime de Guillebon, Benoît Guy-Moyat, Alexis Hermida, Jérôme Hourdain, Peggy Jacon, Pierre Khattar, Mikael Laredo, Laurence Jesel, Nicolas Lellouche, Christophe Leclercq, Vincent Mansourati, Philippe Maury, Pierre Mondoly, Jean Luc Pasquié, Michaël Peyrol, Bertrand Pierre, Sylvain Ploux, Charlotte Potelle, Nicolas Sadoul, Jean Marc Sellal, Emilie Varlet, Rodrigue Garcia, Vincent Probst, Serge Boveda, Eloi Marijon

Journal of the American College of Cardiology, 2025, 86 (1), pp.32-45. ⟨10.1016/j.jacc.2025.04.048⟩

Background: Defibrillation testing (DT) remains recommended during subcutaneous implantable cardioverter defibrillator (S-ICD) implantation due to limited supporting evidence. Objectives: The objective of this study was to evaluate the long-term impact of DT during S-ICD implantation. Methods: The HONEST (coHOrte fraNcaise des dEfibrillateurs Sous cuTanés) study is a nationwide, ongoing observational study, including all S-ICD recipients in France (2012-2019). Five-year endpoints were centrally adjudicated, and propensity score-weighted analyses compared outcomes by DT status. Results: Among 4,924 patients, DT was performed in 4,066 (82.6%), decreasing from 85.4% (2012-2014) to 66.9% in 2019 (P < 0.001). Nontested patients were older (51.2 vs 49.6 years; P = 0.007), had lower left ventricular ejection fraction (37.6% vs 43.3%; P < 0.001), and were more frequently implanted for primary prevention (68.0% vs 62.4%; P = 0.002) and structural heart disease (84.9% vs 76.8%; P < 0.001). DT-related complications occurred in 0.1%, including 2 deaths. Failure rate was 1.0%, with 87.8% undergoing corrective reinterventions. Independent predictors of DT failure were elevated shock impedance (≥89 Ω; OR: 4.60; 95% CI: 2.32-9.66; P < 0.001) and obesity (body mass index ≥30 kg/m2; OR: 2.17; 95% CI: 1.01-4.55; P = 0.007). After adjustment, DT omission was not associated with increased risks of overall mortality (HR: 1.17; 95% CI: 0.86-1.61; P = 0.313), cardiovascular mortality (HR: 1.04; 95% CI: 0.70-1.56; P = 0.846), sudden cardiac death (HR: 0.27; 95% CI: 0.04-1.72; P = 0.167), and appropriate (HR: 1.01; 95% CI: 0.78-1.30; P = 0.945) or inappropriate shocks (HR: 0.98; 95% CI: 0.78-1.23; P = 0.865). Combined rates of ineffective shocks or undetected ventricular arrhythmias were similar (0.05 vs 0.06 per 100 person-years). Conclusions: Our findings suggest that DT can be safely omitted in the majority of S-ICD recipients, whereas selective DT may be considered in higher-risk subgroups. (S-ICD French Cohort Study (HONEST); NCT05302115).

Fawzi Kerkouri, Romain Eschalier, Samir Fareh, Christelle Marquié, Mina Ait Said, et al.. Defibrillation Testing During Implantation of Subcutaneous Implantable Cardioverter Defibrillators. Journal of the American College of Cardiology, 2025, 86 (1), pp.32-45. ⟨10.1016/j.jacc.2025.04.048⟩ (lien externe). ⟨hal-05145080⟩ (lien externe)

Citations

APA

Kerkouri, F., Eschalier, R., Fareh, S., Marquié, C., Ait Said, M., Amara, W., Anselme, F., Badoz, M., Behar, N., Bordachar, P., El Bouazzaoui, R., Champ Rigot, L., Chauvin, M., Chevalier, P., da Costa, A., Defaye, P., Deharo, J. C., Fauchier, L., Gandjbakhch, E., … Marijon, E. (2025). Defibrillation Testing During Implantation of Subcutaneous Implantable Cardioverter Defibrillators. In Journal of the American College of Cardiology. https://dx.doi.org/10.1016/j.jacc.2025.04.048

MLA

Kerkouri, Fawzi, et al. “Defibrillation Testing During Implantation of Subcutaneous Implantable Cardioverter Defibrillators.” Journal of the American College of Cardiology, July 2025, https://dx.doi.org/10.1016/j.jacc.2025.04.048.

Chicago

Kerkouri, Fawzi, Romain Eschalier, Samir Fareh, Christelle Marquié, Mina Ait Said, Walid Amara, Frédéric Anselme, et al. 2025. “Defibrillation Testing During Implantation of Subcutaneous Implantable Cardioverter Defibrillators.” Journal of the American College of Cardiology. https://dx.doi.org/10.1016/j.jacc.2025.04.048.

Harvard

Kerkouri, F. et al. (2025) “Defibrillation Testing During Implantation of Subcutaneous Implantable Cardioverter Defibrillators,” Journal of the American College of Cardiology. Available at: https://dx.doi.org/10.1016/j.jacc.2025.04.048.

ISO 690

KERKOURI, Fawzi, ESCHALIER, Romain, FAREH, Samir, MARQUIÉ, Christelle, AIT SAID, Mina, AMARA, Walid, ANSELME, Frédéric, BADOZ, Marc, BEHAR, Nathalie, BORDACHAR, Pierre, EL BOUAZZAOUI, Rim, CHAMP RIGOT, Laure, CHAUVIN, Michel, CHEVALIER, Philippe, DA COSTA, Antoine, DEFAYE, Pascal, DEHARO, Jean Claude, FAUCHIER, Laurent, GANDJBAKHCH, Estelle, GITENAY, Edouard, GOURRAUD, Jean-Baptiste, GUENANCIA, Charles, DE GUILLEBON, Maxime, GUY-MOYAT, Benoît, HERMIDA, Alexis, HOURDAIN, Jérôme, JACON, Peggy, KHATTAR, Pierre, LAREDO, Mikael, JESEL, Laurence, LELLOUCHE, Nicolas, LECLERCQ, Christophe, MANSOURATI, Vincent, MAURY, Philippe, MONDOLY, Pierre, PASQUIÉ, Jean Luc, PEYROL, Michaël, PIERRE, Bertrand, PLOUX, Sylvain, POTELLE, Charlotte, SADOUL, Nicolas, SELLAL, Jean Marc, VARLET, Emilie, GARCIA, Rodrigue, PROBST, Vincent, BOVEDA, Serge and MARIJON, Eloi, 2025. Defibrillation Testing During Implantation of Subcutaneous Implantable Cardioverter Defibrillators [en ligne]. July 2025. Disponible à l'adresse : https://dx.doi.org/10.1016/j.jacc.2025.04.048

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