Arrhythmias & electrophysiologyCohort study
Long-term outcomes of subcutaneous implantable cardioverter defibrillators: the French nationwide HONEST study
- Prospective observational cohort study
- nationwide
- academic
- centrally adjudicated endpoints
Authors' conclusion
This nationwide study refines the long-term event profile of S-ICD therapy
Study context
- Population
- Patients implanted with an subcutaneous implantable cardioverter defibrillator (S-ICD) across France (2012–2019)98.2% of French S-ICD implants
- Participants
- 4,924 patients
- Outcome
- Clinical endpoints (centrally adjudicated)
- Follow-up
- 5 years
Main finding
As reported in the abstract
Cumulative incidence at 5 years
- Inappropriate shocks
- 13.8%
- Early battery depletion
- 10.8%
- Infections
- 2.4%
- Lead dysfunction
- 1.5%
- Chronic discomfort
- 1.4%
- Reoperation
- 16.9%
- Need for cardiac pacing
- 3.1%
- Definite S-ICD extraction
- 8.4%
Observational data: associations, not effects.
Further findings
Independent predictors of inappropriate shocks
| Comparison | HR (95% CI) | P value | |
|---|---|---|---|
| Male sex | 1.29 (1.14–1.46) | P < 0.001 | |
| Obesity | 1.35 (1.02–1.79) | P = 0.032 | |
| arrhythmogenic right ventricular cardiomyopathy | 1.70 (1.03–2.81) | P = 0.036 | |
| Presence of a pacemaker | 2.20 (1.16–4.17) | P = 0.016 | |
| 0.20.5125Hazard ratio (log scale) |
Inappropriate shocks with SMART Pass filtering
| Comparison | HR (95% CI) | P value | |
|---|---|---|---|
| SMART Pass filtering | 0.67 (0.50–0.89) | P = 0.007 | |
| 0.512Hazard ratio (log scale) |
Deaths
- Deaths
- 547 (11.1%)
- CV deaths
- 53.9%
- Sudden deaths
- 26
- S-ICD/procedure-related deaths
- 8
- Deaths related to S-ICD extraction
- 0
Safety
Perioperative complications (within 30 days)
- Perioperative complications
- 4.4%
Consequences of inappropriate shocks
- Induced VF (one fatality)
- ∼1%
- Device extraction
- 10%
- among patients with inappropriate shocks
Ineffective shocks or undetected arrhythmias
- Ineffective shocks or undetected arrhythmias
- 0.2%
Original publication
Long-term outcomes of subcutaneous implantable cardioverter defibrillators: the French nationwide HONEST study. Eur Heart J. Published 19 December 2025. doi:10.1093/eurheartj/ehaf918
Summarised from the published abstract; every number is checked against it