Background: Implantable cardioverter defibrillator (ICD) therapy is used to prevent sudden cardiac death (SCD) in patients that suffered from idiopathic ventricular fibrillation (IVF). Only certain IVF patients develop recurrence(s) of ventricular arrhythmia (VA). Yet, all IVF patients are exposed to the risk of complications. Transvenous ICD (TV-ICD) carries a significant complication risk. The subcutaneous ICD (S-ICD) may offer advantages in this young population.
Objectives: This study aimed to analyze ICD therapy in IVF patients, and to assess complications of ICD therapy, comparing S-ICD and TV-ICD.
Methods: Patients were included from the Dutch IVF registry. First, the occurrence of appropriate ICD therapy (shock/ATP) was analyzed. Afterwards, a subgroup was defined of patients with ICD implantation between 2010-2024 to assess inappropriate ICD therapy and other device related complications, and a comparison was made between S-ICD and TV-ICD.
Results: Of 415 included IVF patients, 132 (32%) experienced recurrent VA requiring ICD therapy. Subanalysis included 261 patients. There were no significant differences in inappropriate ICD therapy (S-ICD 13%; TV-ICD 13%, P=0.976) between S-ICD and TV-ICD. TV-ICD patients had more lead complications compared to S-ICD patients (S-ICD 2%; TV-ICD 13%, P<0.001). For the other device related complications there were no significant differences between S-ICD and TV-ICD. These results were consistent when corrected for different follow-up duration and age at index event.
Conclusions: VA recurrence occurs frequently, affecting nearly one-third of IVF patients. Comparing S-ICD and TV-ICD, there were no significant differences in inappropriate ICD therapy. Lead complications were more prevalent with TV-ICD compared to S-ICD.
Editor-in-Chief
Kalyanam Shivkumar, MD, PhD, FACC
CME Editor
Kenneth A. Ellenbogen, MD, FACC
Authors
Rozan Roodenburg, MD
Lisa Verheul, MD, PhD
Rutger J. Hassink, MD, PhD
Important Dates
Date of Release: August 24, 2026
Term of Approval/Date of CME/MOC Expiration: August 23, 2027