Efficacy and safety of the subcutaneous implantable cardioverter-defibrillator in patients with and without obesity a meta-analysis /
The subcutaneous implantable cardioverter-defibrillator (S-ICD) has emerged as an alternative to transvenous systems for preventing sudden cardiac death. However, concerns have been raised regarding its efficacy and safety in obese individuals.This meta-analysis aims to evaluate the efficacy and saf...
Elmentve itt :
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| Dokumentumtípus: | Cikk |
| Megjelent: |
2024
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| Sorozat: | HEART RHYTHM
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| Tárgyszavak: | |
| doi: | 10.1016/j.hrthm.2024.07.021 |
| mtmt: | 35147173 |
| Online Access: | http://publicatio.bibl.u-szeged.hu/34396 |
| Tartalmi kivonat: | The subcutaneous implantable cardioverter-defibrillator (S-ICD) has emerged as an alternative to transvenous systems for preventing sudden cardiac death. However, concerns have been raised regarding its efficacy and safety in obese individuals.This meta-analysis aims to evaluate the efficacy and safety of the S-ICD in patients with obesity by assessing the relationship between body mass index (BMI) and clinical outcomes.A comprehensive search of multiple databases was conducted for English-language peer-reviewed studies reporting clinical outcomes in S-ICD recipients with (BMI ≥30 kg/m2) and without obesity (BMI <30 kg/m2). Data on pre-implantation screening failure, defibrillation testing, complications, appropriate and inappropriate shocks, and survival were analysed using standard random-effect meta-analytical techniques.Twenty-nine studies involving 20,486 patients were included. There was no statistically significant difference in the mean BMI values of patients with failed or successful preimplantation screening (mean difference -0.60 kg/m2, 95% CI -2.06 to 0.86). Obesity was associated with higher rates of failed defibrillation testing at ≤65J (OR 2.16, 95% CI 1.39-3.35), and mal-/suboptimal positioning occurred more frequently in obese compared to non-obese patients (OR 3.37, 95% CI 1.76-6.44). Increased BMI as a continuous variable (per increase in 1 kg/m2 BMI) was associated with elevated defibrillation thresholds (OR 1.05, 95% CI 1.03-1.08), a higher risk of complications (HR 1.04, 95% CI 1.02-1.05), a trend towards increased number of appropriate shocks (HR 1.02, 95% CI 1.00-1.04), and no significant increase in the risk for inappropriate shocks (HR 1.01, 95% CI 0.99-1.03).This meta-analysis underscores the importance of considering obesity in S-ICD implantation decisions. While S-ICD remains effective in obese patients, attention to potential technical challenges and higher complication rates is warranted. |
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| ISSN: | 1547-5271 |