Long-Term Performance of Subcutaneous Implantable Defibrillators in Athletes: A Multicenter, Real-World Analysis of Sport Activities from the iSUSI Registry

Alessio Gasperetti; Marco Schiavone; Julia Vogler; Paolo Compagnucci; Mikael Laredo; Alexander Breitenstein; Simone Gulletta; Martin Martinek; Lukas Kaiser; Carlo Lavalle; Sean Gaine; Luca Santini; Antonio Dello Russo; Pietro Palmisano; Giovanni Rovaris; Antonio Curnis; Nicoletta Ventrella; Jürgen Kuschyk; Mauro Biffi; Roland Tilz; Luigi Di Biase; Claudio Tondo; Giovanni B Forleo; i-SUSI investigators

doi:10.1016/j.hrthm.2024.09.039

Long-Term Performance of Subcutaneous Implantable Defibrillators in Athletes: A Multicenter, Real-World Analysis of Sport Activities from the iSUSI Registry

Heart Rhythm. 2024 Sep 20:S1547-5271(24)03367-8. doi: 10.1016/j.hrthm.2024.09.039. Online ahead of print.

Authors

Alessio Gasperetti¹, Marco Schiavone², Julia Vogler³, Paolo Compagnucci⁴, Mikael Laredo⁵, Alexander Breitenstein⁶, Simone Gulletta⁷, Martin Martinek⁸, Lukas Kaiser⁹, Carlo Lavalle¹⁰, Sean Gaine¹¹, Luca Santini¹², Antonio Dello Russo⁴, Pietro Palmisano¹³, Giovanni Rovaris¹⁴, Antonio Curnis¹⁵, Nicoletta Ventrella¹⁶, Jürgen Kuschyk¹⁷, Mauro Biffi¹⁸, Roland Tilz³, Luigi Di Biase¹⁹, Claudio Tondo²⁰, Giovanni B Forleo²¹; i-SUSI investigators

Affiliations

¹ Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA. Electronic address: alessio.gasperetti93@gmail.com.
² Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
³ Department of Rhythmology, University Heart Center Lübeck, Lubeck, Germany.
⁴ Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Ancona, Italy.
⁵ Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière and Sorbonne Université, Paris, France.
⁶ Cardiology Clinic, University Hospital Zurich, Zurich, Switzerland.
⁷ Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy.
⁸ Ordensklinikum Linz Elisabethinen Internal Medicine 2 with Cardiology, Angiology, and Intensive Care Medicine, Linz, Austria.
⁹ Department of Cardiology and Critical Care Medicine, St George Klinik Asklepios, Hamburg, Germany.
¹⁰ Department of Cardiology, Policlinico Umberto I, Rome, Italy.
¹¹ Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA.
¹² Cardiology Unit, Ospedale G.B. Grassi, Ostia, Rome, Italy.
¹³ Cardiology department, Ospedale Tricase, Tricase, Italy.
¹⁴ Cardiology Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
¹⁵ Cardiology Unit, Spedali Civili Brescia, Brescia, Italy.
¹⁶ Post-graduate School of Cardiology, University of Milan, Milan, Italy.
¹⁷ Cardiology Unit, University Medical Centre Mannheim, Manheim, Germany.
¹⁸ Cardiology Unit, IRCCS, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Italy.
¹⁹ Cardiac Arrhythmia Center, Division of Cardiology at Montefiore-Einstein Center, Bronx, New York, USA.
²⁰ Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
²¹ Cardiology Unit, Luigi Sacco University Hospital, Milan, Italy.

PMID: 39307379
DOI: 10.1016/j.hrthm.2024.09.039

Abstract

Background: No data regarding subcutaneous-implantable cardioverter defibrillator (S-ICD) technology in patients actively engaging in sports activities are available.

Objective: This study aims to compare S-ICD performance between athletes and nonathletes.

Methods: The primary outcome of the study was the comparison of overall device-related complications between athletes and nonathletes. Appropriate shocks, inappropriate shocks, and individual device-related complications were secondary outcomes.

Results: A total of 1493 patients were extracted from the International Subcutaneous Implantable Cardioverter Defibrillator Registry (iSUSI) registry, of whom 152 (10.2%) were athletes, mostly engaging in dynamic sports (54.2%). Brugada syndrome, myocarditis, and arrhythmogenic right ventricular cardiomyopathy (ARVC) were more common in athletes (11.2% vs 3.3%, P < .001; 19.1% vs 9.0%, P < .001; 8.6% vs 2.8%, P < .001, respectively). During a median follow-up time of 25.5 (12.0-41.2) months, athletes were more likely to experience appropriate shocks (yearly rate: 7.2 [4.9-10.7] % vs 4.3 [3.6-5.1] %, P = .028), occurring more frequently during exercise (3.9% vs 0.6%, P < .001). This finding lost significance when adjusting for confounders (adjusted hazard ratio [aHR] 1.440 [0.909-2.281], P = .120). No differences were found in overall device-related complications (yearly rate: 3.3% vs 3.4%, P = .448) and inappropriate shocks (yearly rate: 5.3% vs 3.7%, P = 0.111). Myopotential oversensing (4.0% vs 1.3%, P = .011) was more common in athletes, as were lead infections (3.3% vs 0.9%, P =.008), with the latter clustering in the early postimplantation period.

Conclusion: The S-ICD is a valid therapeutic option for preventing sudden cardiac death in athletes. Sports practice was not associated with an increased risk of complications or inappropriate shocks, although athletes are exposed to a higher risk of S-ICD infections in the early postoperative period.

Keywords: Athletes; Inappropriate shocks; S-ICD; Sport activity; Sudden cardiac death.