Long-term outcomes of subcutaneous implantable cardioverter defibrillators: the French nationwide HONEST study

European Heart Journal2025Fawzi Kerkouri, Christelle Marquié, Serge Boveda, Frédéric Anselme, Soraya Anys, Nicolas Badenco, Francis Bessiere, Hugues Blangy, Pierre Bordachar, Laure Champ-Rigot, Michel Chauvin, Nicolas Clementy, Gaël Clerici, Antoine da Costa, Pascal Defaye, Maxime de Guillebon, Jean-Claude Deharo, Romain Eschalier, Fabrice Extramiana, Laurent Fauchier, Pierre Frey, Estelle Gandjbakhch, Charles Guenancia, Benoit Guy-Moyat, Alexis Hermida, Jérôme Hourdain, Peggy Jacon, Laurence Jesel, Jérôme Lacotte, Christophe Leclercq, Nicolas Lellouche, Jacques Mansourati, Philippe Maury, Aymeric Menet, Pierre Mondoly, Mathieu Montoy, Kumar Narayanan, Jean Luc Pasquié, David Perrot, Bertrand Pierre, Frédéric Sacher, Nicolas Sadoul, Victor Waldmann, Rodrigue Garcia, Vincent Probst, Eloi Marijon

European Heart Journal, 2025, ⟨10.1093/eurheartj/ehaf918⟩

Background and Aims Although use of the subcutaneous implantable cardioverter defibrillator (S-ICD) is increasing, evidence from industry-independent and unselected populations remains limited. Methods HONEST is a ongoing nationwide academic observational study enrolling 98.2% of patients implanted with an S-ICD across France (2012–2019). Five-year clinical endpoints were centrally adjudicated. Results Overall, 4924 patients were enrolled (mean age 49.9 ± 15 years, 76.7% male, 63.0% for primary prevention). Implants used general anaesthesia (78.9%), and defibrillation testing (82.6%). Perioperative complications (within 30 days) occurred in 4.4%. At 5 years, cumulative incidence rates were 13.8% for inappropriate shocks, 10.8% for early battery depletion, 2.4% for infections, 1.5% for lead dysfunction, and 1.4% for chronic discomfort. Reoperation was required in 16.9%, need for cardiac pacing in 3.1%, and definite S-ICD extraction in 8.4%. Inappropriate shocks were independently associated with male sex (hazard ratio [HR] 1.29, 95% confidence interval [CI] 1.14–1.46, P < .001), obesity (HR 1.35, 95% CI 1.02–1.79, P = .032), arrhythmogenic right ventricular cardiomyopathy (HR 1.70, 95% CI 1.03–2.81, P = .036), and the presence of a pacemaker (HR 2.20, 95% CI 1.16–4.17, P = .016). SMART Pass filtering significantly reduced inappropriate shocks (HR 0.67, 95% CI 0.50–0.89, P = .007). Among patients with inappropriate shocks, ∼1% developed induced ventricular fibrillation (one fatality), and 10% underwent device extraction. Ineffective shocks or undetected arrhythmias occurred in only 0.2%. Among 547 deaths (11.1%), 53.9% were cardiovascular, including 26 sudden deaths, and 8 were S-ICD/procedure-related, with none related to S-ICD extraction. Conclusions This nationwide study refines the long-term event profile of S-ICD therapy and may inform clinical practice and device selection.

Fawzi Kerkouri, Christelle Marquié, Serge Boveda, Frédéric Anselme, Soraya Anys, et al.. Long-term outcomes of subcutaneous implantable cardioverter defibrillators: the French nationwide HONEST study. European Heart Journal, 2025, ⟨10.1093/eurheartj/ehaf918⟩ (lien externe). ⟨hal-05428618⟩ (lien externe)

Citations

APA

Kerkouri, F., Marquié, C., Boveda, S., Anselme, F., Anys, S., Badenco, N., Bessiere, F., Blangy, H., Bordachar, P., Champ-Rigot, L., Chauvin, M., Clementy, N., Clerici, G., da Costa, A., Defaye, P., de Guillebon, M., Deharo, J.-C., Eschalier, R., Extramiana, F., … Marijon, E. (2025). Long-term outcomes of subcutaneous implantable cardioverter defibrillators: the French nationwide HONEST study. In European Heart Journal. https://dx.doi.org/10.1093/eurheartj/ehaf918

MLA

Kerkouri, Fawzi, et al. “Long-Term Outcomes of Subcutaneous Implantable Cardioverter Defibrillators: the French Nationwide HONEST Study.” European Heart Journal, Dec. 2025, https://dx.doi.org/10.1093/eurheartj/ehaf918.

Chicago

Kerkouri, Fawzi, Christelle Marquié, Serge Boveda, et al. 2025. “Long-Term Outcomes of Subcutaneous Implantable Cardioverter Defibrillators: the French Nationwide HONEST Study.” In European Heart Journal. https://dx.doi.org/10.1093/eurheartj/ehaf918.

Harvard

Kerkouri, F. et al. (2025) “Long-term outcomes of subcutaneous implantable cardioverter defibrillators: the French nationwide HONEST study,” European Heart Journal. Available at: https://dx.doi.org/10.1093/eurheartj/ehaf918.

ISO 690

KERKOURI, Fawzi, MARQUIÉ, Christelle, BOVEDA, Serge, ANSELME, Frédéric, ANYS, Soraya, BADENCO, Nicolas, BESSIERE, Francis, BLANGY, Hugues, BORDACHAR, Pierre, CHAMP-RIGOT, Laure, CHAUVIN, Michel, CLEMENTY, Nicolas, CLERICI, Gaël, DA COSTA, Antoine, DEFAYE, Pascal, DE GUILLEBON, Maxime, DEHARO, Jean-Claude, ESCHALIER, Romain, EXTRAMIANA, Fabrice, FAUCHIER, Laurent, FREY, Pierre, GANDJBAKHCH, Estelle, GUENANCIA, Charles, GUY-MOYAT, Benoit, HERMIDA, Alexis, HOURDAIN, Jérôme, JACON, Peggy, JESEL, Laurence, LACOTTE, Jérôme, LECLERCQ, Christophe, LELLOUCHE, Nicolas, MANSOURATI, Jacques, MAURY, Philippe, MENET, Aymeric, MONDOLY, Pierre, MONTOY, Mathieu, NARAYANAN, Kumar, PASQUIÉ, Jean Luc, PERROT, David, PIERRE, Bertrand, SACHER, Frédéric, SADOUL, Nicolas, WALDMANN, Victor, GARCIA, Rodrigue, PROBST, Vincent and MARIJON, Eloi, 2025. Long-term outcomes of subcutaneous implantable cardioverter defibrillators: the French nationwide HONEST study [en ligne]. December 2025. Disponible à l'adresse : https://dx.doi.org/10.1093/eurheartj/ehaf918

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