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Abstract: TH-OR146

Trends in Use and In-Hospital Outcomes of Subcutaneous Implantable Cardioverter Defibrillators in Dialysis Patients: A Report from the National Cardiovascular Data Registry

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Pun, Patrick H., Duke University, Durham, North Carolina, United States
  • Parzynski, Craig S., Yale New Haven Health, New Haven, Connecticut, United States
  • Friedman, Daniel J., Duke University, Durham, North Carolina, United States
  • Sanders, Gillian, Duke University, Durham, North Carolina, United States
  • Curtis, Jeptha P., Yale University School of Medicine, New Haven, Connecticut, United States
  • Al-Khatib, Sana, Duke University, Durham, North Carolina, United States

Dialysis patients are at high risk of infectious and vascular complications related to implantable cardioverter defibrillator (ICD) implantation; many have advocated for the preferential use of subcutaneous (S-ICD) over transvenous devices (TV-ICD) due to the potential benefits of reduced risk of blood stream infection and interference with vascular access sites. We evaluated trends in use and in-hospital outcomes of S-ICD compared to TV-ICDs among dialysis patients in the United States


This was a retrospective analysis of 23,136 ICD implants among dialysis patients reported between 2012 and 2018 to the National Cardiovascular Data Registry ICD Registry, a nationally representative US ICD registry. We first examined the utilization and patient and procedure characteristics of dialysis patients receiving S-ICD. Next, among dialysis patients eligible to receive an S-ICD, we examined trends in S-ICD adoption as a proportion of all ICD implants and compared in-hospital outcomes (death, complications) among S-ICD and TV-ICD recipients using inverse probability weighted estimators.


Of all ICDs implanted among dialysis patients during the study period, 3,195 (13.81%) were S-ICD. Among eligible first-time ICD dialysis recipients, the proportion of S-ICDs utilized increased yearly from 10.3% in 2012 to 68.5% in 2018. Compared to TV-ICD recipients, S-ICD recipients were more likely to be black (42.6% vs. 34.3%) and undergo implantation in teaching hospitals (62.8% vs 53.2%). In the inverse probability weighted estimators analysis of 3,327 patients, compared to TV-ICD, dialysis patients receiving S-ICDs had a higher rate of in-hospital cardiac arrest (1.53% vs 0.36%, p=0.002); in-hospital complications ((2.4% vs 1.48% p=0.08) and length of hospitalization ((1.57 vs. 1.24 days, p=0.08) were not significantly different between the 2 groups.


There has been a steady increase in the utilization of S-ICD among dialysis patients in the United States. The increased risk of in-hospital cardiac arrest in S-ICD recipients could have been due to residual confounding and selection bias, but randomized clinical trials are needed to definitively compare the outcomes of TV-ICD with S-ICDs in dialysis patients.


  • Private Foundation Support