BACKGROUND: During long-term follow-up of patients with implantable cardioverter defibrillators (ICD) numerous problems may occur. Apart from lead failure with oversensing, cardiac device related infectious endocarditis poses a serious adverse event. To date, there is no data whether re-implantation of a transvenous ICD (tv-ICD) or the implantation of a subcutaneous ICD (S-ICD) might be the better choice after lead failure or infection related revision/explantation of the ICD system.

METHODS AND RESULTS: The present study represents a single-center experience of matched patients with a need for tv-ICD explantation and subsequent re-implantation of a new tv- or a S-ICD. 103 patients (53 patients in each group) were included, follow-up was about 3 years in both groups. Patients from the tv-ICD group were slightly older (58±17 vs. 52±17 years). Infections as well as oversensing were equally responsible for ICD revisions in both groups (infection: tv 49%, S-ICD 45%, oversensing: tv 51%, S-ICD 45%). During a mean follow-up of 47±37 months unscheduled re-hospitalizations (tv-ICD 60%, S-ICD: 38%), re-infection (tv-ICD 9.4% vs. S-ICD 1.9%) and re-revision (tv-ICD: 18.9% vs S-ICD 5.7%) significantly differed between both groups.

Conclusion: ICD patients who experienced a prior severe complication of a tv-ICD with need for surgical revision were at a remarkable high risk for another major adverse event requiring revison if a new tv-ICD is re-implanted. Complication rates of S-ICD in these patients were significantly lower so that S-ICD implantation might be preferred in this situation. This clinically relevant hypothesis generating observation should be tested in randomized controlled trials.