Implantable Cardioverter Defibrillator Therapy and Implantable Cardioverter Defibrillator Complications in Idiopathic Ventricular Fibrillation Patients (JCEP August 2026)-Article: Implantable Cardioverter Defibrillator Therapy and Implantable Cardioverter Defibrillator Complications in Idiopathic Ventricular Fibrillation Patients

Article: Implantable Cardioverter Defibrillator Therapy and Implantable Cardioverter Defibrillator Complications in Idiopathic Ventricular Fibrillation Patients

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This Dutch registry study evaluated implantable cardioverter-defibrillator (ICD) therapy in patients with idiopathic ventricular fibrillation (IVF), a condition in which sudden cardiac arrest occurs without an identifiable cause. Among 415 patients with IVF followed for a median of 8.6 years, 32% experienced recurrent ventricular arrhythmia (VA) requiring appropriate ICD therapy, showing that arrhythmia recurrence is common and supporting the need for ICD treatment in this population. Most first recurrences occurred within 3 years, but some happened much later, even after 20 years.<br /><br />A subgroup of 261 patients who received ICDs from 2010 onward was analyzed for complications and compared between subcutaneous ICDs (S-ICD) and transvenous ICDs (TV-ICD). Inappropriate ICD therapy occurred in 13% of patients overall, with no significant difference between S-ICD and TV-ICD (13% vs 13%). The main causes of inappropriate therapy were supraventricular tachycardia, ICD malfunction, T-wave oversensing, and electrical noise. T-wave oversensing was more common in S-ICD patients.<br /><br />Device-related complications other than inappropriate therapy occurred in 11% of patients. Lead complications were the most important difference between device types and were significantly more frequent with TV-ICD than with S-ICD (13% vs 2%). Other complications such as infection, thrombosis, pocket problems, and Twiddler’s syndrome were uncommon and did not differ significantly between groups.<br /><br />Overall, the study suggests that ICD therapy is often necessary in IVF because recurrence of life-threatening arrhythmia is frequent. However, because lead complications are lower with S-ICD and inappropriate therapy is similar between systems, S-ICD may be the preferred option for IVF patients who do not need pacing.

Meta Tag

Concept Idiopathic Ventricular Fibrillation

Concept Implantable Cardioverter-Defibrillator

Concept Inappropriate ICD Therapy

Concept Lead Complication

Concept Ventricular Arrhythmia

Keywords

idiopathic ventricular fibrillation

implantable cardioverter-defibrillator

ICD therapy

ventricular arrhythmia recurrence

sudden cardiac arrest

subcutaneous ICD

transvenous ICD

inappropriate ICD therapy

lead complications

device-related complications

Idiopathic Ventricular Fibrillation

Implantable Cardioverter-Defibrillator

Inappropriate ICD Therapy

Lead Complication

Ventricular Arrhythmia