Subcutaneous Implantable Defibrillators in Young Patients: Arrhythmias, Complications, and Physical Activity
Authors: Francia Pietro , Ziacchi Matteo , Migliore Federico , De Filippo Paolo , Dello Russo Antonio , Viani Stefano , Rapacciuolo Antonio , Falasconi Giulio , Adduci Carmen , Bisignani Giovanni , Checchi Luca , Busacca Giuseppe , Santini Luca , Lavalle Carlo , Calvi Valeria Ilia , Curcio Antonio , Silvetti Massimo , Pangallo Antonio , Carbonaro Marco , Giorgi Davide , Pittorru Raimondo , Lovecchio Mariolina , Valsecchi Sergio , Biffi Mauro , D’Onofrio Antonio , Pelliccia Antonio , Botto G.L. , Canevese F.L. , Casale M.C. , Caravati F. , Schintu B. , Scalone A. , Tola G. , Setzu A. , Santarpia G. , Santoro A , Baiocchi C , Gentilini, SLunghetti R , Palmisano P. , Accogli M. , Pisanò E. , Milanese G. , Pepi P. , Nicolis D. , Mariani M. , Pagani M. , Vincenzo Bonfantino Massimo , Caccavo V. , Grimaldi M. , Katsouras G. , Forleo GB. , Chieffo E. , Tavarelli E. , Brambilla R. , Pani A. , Giammaria M. , Lucciola M.T. , Amellone C. , Uran C. , Baroni M. , Ferrari P. , Leidi C. , Drago F. , Pazzano V. , Russo S. , Remoli R. , Battipaglia I. , Cazzoli I. , Saputo F. , Devecchi C. , Barbonaglia L. , Viscusi M. , Brignoli M. , Mattera A. , Pedretti S. , Lupi A , Tommasi S. , Kol A. , Gatto M. C. , Persi A. , Gonella A. , Rossetti G. , Menardi E. , Rossini R. , Notarstefano P. , Nesti M. , Fraticelli A. , Carreras G. , Donzelli S. , Marini C. , Tordini A. , Lazzari L. , Sartori P. , Rossi P. , Di Donna P. , Mascia G. , Capogrosso P. , Magliano P. , Colimodio M. , Sala S. , Mazzone P. , Della Bella P. , Coppolino A. , Arena G. , Borrello V. , Ratti M. , Bartoli C. , Palano F. , Torriglia A. , Laffi M. , Manzo M. , Esposito C. , Giano A. , Franculli F. , De Bonis S. , Sarubbi B. , Colonna D. , Correra A. , Romeo E. , Liguori V. , Viggiano A. , Strisciullo T. , Diemberger I. , Martignani C. , Piro A. , Magnocavallo M. , Mariani M. V. , Ricciardi D. , Calabrese V. , Gioia F. , Picarelli F. , Licciardello G. , Lamberti F. , Lumia G. , Bellini C. , Bianchi C. , Savarese G. , Andreoli C. , Pimpinicchio L. , Pellegrini D. , Bovenzi  , Busoni F. , Daleffe E. , Facchin D. , Rebellato L , Stifano G. , Magliano G. , Sergi D. , Barone L. , Morgagni R. , Casella M. , Guerra F. , Cipolletta L. , Molini S. , De Lucia R. , Di Cori A. , Grifoni G. , Paperini L. , Segreti L. , Soldati E. , Zucchelli G. , Nigro G. , Russo V. , Rago A. , Ammendola E. , Papa A. , Pieragnoli P. , Ricciardi G. , Perrotta L. 
Published: February 2025

BACKGROUND:
The safety of subcutaneous implantable cardioverter defibrillator (S-ICD) recipients who lead active lifestyles and engage in recreational sports is unknown. We aimed to evaluate the association between lifestyle and recreational sports and the occurrence of arrhythmia- and device-related complications, appropriate and inappropriate shocks in S-ICD recipients.

METHODS:
We assessed a cohort of young-adult (15–65 years) S-ICD patients, evaluated their physical activity with IPAQ (International Physical Activity Questionnaire), and assessed the association between lifestyle and recreational sports on S-ICD safety and shocks.

RESULTS:

We enrolled 602 S-ICD recipients (77% males; age, 46±14 years). According to the IPAQ, patients were categorized as inactive subjects (26.4%), moderately active subjects (45.2%), or highly active subjects (28.4%). Among moderately/highly active subjects, 163 (27.1%) were recreational athletes. During follow-up (47.3 [interquartile range, 27.0–67.6] months), 23 patients (3.8%) reached the safety end point of arrhythmia- or device-related complications, with moderately and highly active subjects showing in multivariate analysis similar incidence compared with inactive subjects (
P
=0.59 and
P
=0.83, respectively). Forty-four patients had 87 appropriate shocks. In multivariate analysis, moderately and highly active subjects showed a nonsignificantly lower incidence of appropriate shocks compared with inactive subjects (
P
=0.12 and
P
=0.11, respectively). Consistently, there was a nonsignificant lower incidence of appropriate shocks in athletes versus nonathletes (
P
=0.06). Thirty-nine patients had 46 inappropriate shocks. Moderately and highly active subjects had similar incidence of inappropriate shocks compared with inactive subjects (
P
=0.92 and
P
=0.88, respectively).

CONCLUSIONS:
Young S-ICD patients often lead active lifestyles and participate in sports. Higher activity levels were not associated with increased implantable cardioverter defibrillator–related complications or increased risk of implantable cardioverter defibrillator shocks.