title: Outcome of Subcutaneous Implantable Cardioverter Defibrillator Implantation in Patients with End-Stage Renal Disease on Dialysis.
abstract: BACKGROUND
  Although the subcutaneous ICD (S-ICD®) is an attractive alternative in patients with end-stage renal disease (ESRD), data on S-ICD outcomes in dialysis patients are lacking.
  
  
  METHODS
  Patients with cardiomyopathy undergoing S-ICD implantation in our center were stratified by need for chronic dialysis at the time of implant. The primary endpoint was incidence of death, heart failure hospitalization or appropriate S-ICD shocks, and secondary endpoints were incidence of inappropriate shocks or implant related complications requiring surgical re-intervention. Mean follow-up was longer in the nondialysis cohort (514 ± 495 vs. 227 ± 233 days, P = 0.006), so all endpoints were analyzed using time-dependent comparisons and reported as annual event rates.
  
  
  RESULTS
  Out of 79 S-ICD implants included in this analysis, 27 patients were on dialysis. Dialysis patients were older and more likely to be diabetic. Mean ejection fraction across the entire cohort was 26.9% without significant difference between dialysis and nondialysis groups. Although not significant, the incidence of the primary endpoint was higher in the dialysis cohort (23.8%/year vs. 10.9%/year, P = 0.317), driven primarily by a higher rate of appropriate shocks. The rate of inappropriate shocks was similar between groups (dialysis 6.0%/year vs. nondialysis 6.8%/year, P = 0.509). No patients in the dialysis cohort had complications requiring surgical re-intervention versus 6 patients in the nondialysis cohort (P = 0.086).
  
  
  CONCLUSIONS
  Our data suggest that S-ICD implantation in dialysis patients is not associated with an excess risk of implant related complications or inappropriate shocks.
authors.affiliation: Division of Cardiology-Section of Electrophysiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Mikhael F
authors.initials: MF
authors.lastname: El-Chami
authors.affiliation: Emory Healthcare, Atlanta, Georgia, USA.
authors.forename: Mathew
authors.initials: M
authors.lastname: Levy
authors.affiliation: Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Heval M
authors.initials: HM
authors.lastname: Kelli
authors.affiliation: Emory Healthcare, Atlanta, Georgia, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Casey
authors.affiliation: Division of Cardiology-Section of Electrophysiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Hoskins
authors.affiliation: Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Abhinav
authors.initials: A
authors.lastname: Goyal
authors.affiliation: Division of Cardiology-Section of Electrophysiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Langberg
authors.affiliation: Division of Cardiology-Section of Electrophysiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Anshul
authors.initials: A
authors.lastname: Patel
authors.affiliation: Division of Cardiology-Section of Electrophysiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: David
authors.initials: D
authors.lastname: Delurgio
authors.affiliation: Division of Cardiology-Section of Electrophysiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lloyd
authors.affiliation: Division of Cardiology-Section of Electrophysiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Angel R
authors.initials: AR
authors.lastname: Leon
authors.affiliation: Division of Cardiology-Section of Electrophysiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Faisal M
authors.initials: FM
authors.lastname: Merchant
mesh_terms: D000328:Adult; D000368:Aged; D009202:Cardiomyopathies / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D005845:Georgia; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: dialysis; end-stage renal disease; implantable cardioverter-defibrillator; subcutaneous ICD; sudden cardiac death