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Publications

Journal Article Ahead of print

PubMed: 42554569 DOI: 10.1016/j.jacep.2026.06.013

Subcutaneous Implantable Cardioverter-Defibrillator Therapy in Women.

JACC Clin Electrophysiol

Authors: Rodrigue Garcia, Fawzi Kerkouri, Christelle Marquié, Mina Ait Said, Frédéric Anselme, Warda Aoudjeghout, Nicolas Badenco, Marc Badoz, Sergio Barra, Olivier Barthez, Hugues Blangy, Pierre Bordachar, Laure Champ-Rigot, Stéphane Combes, Pascal Defaye, Jean Claude Deharo, Estelle Gandjbakhch, Edouard Gitenay, Hervé Gorka, Isabelle Heurtebise, Jérôme Hourdain, Laurence Jesel, Lila Khris, Alain Lebon, Christophe Leclercq, Sophie Le Page, Alexis Mechulan, Pierre Mondoly, Jean-Luc Pasquié, David Perrot, Bertrand Pierre, Olivier Piot, Anne Quentin, Eric Rendu, Olivier Villejoubert, Victor Waldmann, Orianne Weizman, Vincent Probst, Serge Boveda, Eloi Marijon

Affiliations

  • Department of Cardiology, University Hospital of Poitiers, Poitiers, France; Centre d'Investigation Clinique 1402, University Hospital of Poitiers, Poitiers, France.
  • Department of Cardiology, University Hospital of Brest, Brest, France; Division of Cardiology, European Georges Pompidou Hospital, Paris, France; Université Paris Cité, INSERM U970, Paris Cardiovascular Research Centre, Paris, France; University of Brest, Laboratoire ORPHY EA 4324, Brest, France.
  • Heart and Lung Institute, University Hospital of Lille, Lille, France.
  • Department of Cardiology, Hôpital Privé Jacques Cartier, Massy, France.
  • Department of Cardiology, University Hospital of Rouen, Rouen, France.
  • Division of Cardiology, European Georges Pompidou Hospital, Paris, France; Université Paris Cité, INSERM U970, Paris Cardiovascular Research Centre, Paris, France.
  • Department of Cardiology, La Pitié-Salpêtrière Hospital, Paris, France.
  • Department of Cardiology, University Hospital of Besançon, Besançon, France.
  • Department of Cardiology, Hospital da Luz, Luz Arrábida, V. N. Gaia, Portugal.
  • Department of Cardiology, Hospital of Avignon, Avignon, France.
  • Department of Cardiology, University Hospital of Nancy, Vandoeuvre-Lès-Nancy, France.
  • Department of Cardiology, University Hospital of Bordeaux, Bordeaux, France.
  • Department of Cardiology, University Hospital of Caen, Caen, France.
  • Department of Cardiology, Pasteur Clinic, Toulouse, France.
  • Department of Cardiology, University Hospital Grenoble Alpes, Grenoble, France.
  • Department of Cardiology, University Hospital of Marseille-La Timone, Marseille, France.
  • Department of Cardiology, Saint Joseph hospital, Marseille, France.
  • Department of Cardiology, Hospital of Chartres, Chartres, France.
  • Department of Cardiology, Hospital of Bourges, Bourges, France.
  • Department of Cardiology, University Hospital of Strasbourg, Strasbourg, France.
  • Department of Cardiology, Hospital of Bastia, Bastia, France.
  • Department of Cardiology, Saint Martin Private Hospital, Caen, France.
  • Department of Cardiology, University Hospital Pontchaillou, Rennes, France.
  • Department of Cardiology, University Hospital of Angers, Angers, France.
  • Department of Cardiology, Clairval Hospital, Marseille, France.
  • Department of Cardiology, University Hospital of Toulouse, Toulouse, France.
  • Department of Cardiology, University Hospital of Montpellier, Montpellier, France.
  • Division of Cardiology, European Georges Pompidou Hospital, Paris, France.
  • Department of Cardiology, University Hospital of Tours, Tours, France.
  • Department of Cardiology, Centre Cardiologique du Nord, Saint Denis, France.
  • Department of Cardiology, Hospital of Saint Brieuc, Saint Brieuc, France.
  • Department of Cardiology, Hospital of Vannes, Vannes, France.
  • Department of Cardiology, Rythmopôle Paris, Paris, France.
  • Clinique Claude Bernard, ELSAN, Metz, France.
  • Department of Cardiology, University Hospital of Nantes, Nantes, France.
  • Department of Cardiology, Pasteur Clinic, Toulouse, France; Brussels University, VUB, Brussels, Belgium.
  • Division of Cardiology, European Georges Pompidou Hospital, Paris, France; Université Paris Cité, INSERM U970, Paris Cardiovascular Research Centre, Paris, France.

Abstract

BACKGROUND

The subcutaneous implantable cardioverter-defibrillator (S-ICD) is an established therapy for sudden cardiac death prevention, but sex-specific outcomes remain incompletely characterized.

OBJECTIVES

This study evaluated sex-related differences in baseline characteristics, appropriate shocks, complications, reinterventions, and mortality among S-ICD recipients.

METHODS

The nationwide HONEST (S-ICD French Cohort Study) cohort enrolled all patients who received an S-ICD in France between 2012 and 2019. Clinical endpoints were centrally adjudicated. Sex-specific associations with outcomes were assessed by using propensity score-based inverse probability weighting.

RESULTS

Among 4,924 S-ICD recipients, 1,148 were women (23.3%). Compared with men, women were younger (47.3 ± 15.6 years vs 50.6 ± 14.7 years; P < 0.001), less frequently received an implant for primary prevention (57.6% vs 65.1%; P < 0.001), less often had coronary artery disease (38.9% vs 56.5%; P < 0.001), and more often had electrical heart disease (26.3% vs 20.4%; P < 0.001). After adjustment, women had a lower 5-year risk of appropriate shocks (HR: 0.85; 95% CI: 0.74-0.98; P = 0.023) and similar overall complication and reintervention rates but a distinct complication profile, with higher risks of chronic pain (HR: 2.63; 95% CI: 1.61-4.29; P < 0.001) and lead dislodgment (HR: 1.79; 95% CI: 1.09-2.95; P = 0.022) and a lower risk of inappropriate shocks (HR: 0.64; 95% CI: 0.50-0.82; P < 0.001). All-cause mortality was lower in women, whereas S-ICD-unresponsive sudden death and device-related mortality were similar.

CONCLUSIONS

Women receiving an S-ICD experienced fewer appropriate shocks, with similar overall complication and reintervention rates, but a distinct complication profile. These findings support sex-informed S-ICD selection and follow-up. (S-ICD French Cohort Study [HONEST]; NCT05302115).

MeSH

Mortality, Epidemiology, Cardiovascular Diseases, Cohort Studies, Heart Arrest, Sex, Death, Sudden, Cardiac, Therapeutics, Defibrillators, Implantable, Defibrillators