title: Outcomes of subcutaneous implantable cardioverter-defibrillator implantation in patients on hemodialysis.
abstract: BACKGROUND
  Subcutaneous implantable cardioverter-defibrillator (S-ICD) provides potential benefits in patients on hemodialysis (HD) by reducing the risk of blood stream infection and preserving vascular access sites. We evaluated the safety and efficacy of S-ICD in patients with end-stage renal disease (ESRD) on HD.
  
  
  METHODS
  All consecutive patients implanted with S-ICD between October 2012 and April 2015 at our high-volume center were included in this retrospective, single-center study. Baseline demographics, procedural details, and short- as well as long-term outcomes were compared between patients on HD and not on HD.
  
  
  RESULTS
  A total of 86 S-ICDs were implanted at our institution during the study period. Eighteen (21%) patients were on HD at the time of implant. HD patients were more likely to be implanted for secondary prevention. There was no statistically significant difference in procedural complications between the two groups. HD patients had a longer duration hospital stay after implant (3.6 ± 5.14 vs. 1.69 ± 2.29 days, p = 0.021). During a mean follow-up of 205 ± 208 days in the HD cohort and 242 ± 238 days in the non-HD cohort (p = 0.268), there was no device or blood stream infection in the HD group, compared with five device infections in the non-HD group. The incidence of inappropriate shocks was similar in both groups. All appropriate shocks were successful in terminating ventricular tachyarrhythmias in both groups. Patients on hemodialysis had worse inpatient as well as long-term mortality after S-ICD implant, compared with non-HD patients.
  
  
  CONCLUSIONS
  Our study demonstrates the safety and efficacy of S-ICD in patients on HD. Despite representing a sicker patient population, HD patients implanted with S-ICD had similar procedural outcomes and inappropriate shocks. There was no device or blood stream-related infection in HD patients. All appropriate shocks for ventricular arrhythmias in HD patients were successful.
authors.affiliation: Department of Internal Medicine, Drexel University College of Medicine, New College Building 245 N. 15th Street, 6th Floor, Philadelphia, PA, 19102, USA. eduard.koman@drexelmed.edu.
authors.forename: Eduard
authors.initials: E
authors.lastname: Koman
authors.affiliation: Division of Cardiac Electrophysiology, Drexel University College of Medicine, Philadelphia, PA, USA.
authors.forename: Ashwani
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Division of Cardiac Electrophysiology, Drexel University College of Medicine, Philadelphia, PA, USA.
authors.forename: Faiz
authors.initials: F
authors.lastname: Subzposh
authors.affiliation: Division of Cardiac Electrophysiology, Drexel University College of Medicine, Philadelphia, PA, USA.
authors.forename: Heath
authors.initials: H
authors.lastname: Saltzman
authors.affiliation: Division of Cardiac Electrophysiology, Drexel University College of Medicine, Philadelphia, PA, USA.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Kutalek
mesh_terms: D015897:Comorbidity; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000517:prevention & control*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D015995:Prevalence; D019919:Prosthesis Implantation / Q000401:mortality / Q000706:statistics & numerical data; D006435:Renal Dialysis / Q000401:mortality* / Q000706:statistics & numerical data; D051437:Renal Insufficiency; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
keywords: End-stage renal disease; Hemodialysis; Implantable cardioverter-defibrillator; Subcutaneous implantable cardioverter-defibrillator