Subcutaneous ICDs in the Real World: Lessons from the French Nationwide HONEST Study

Introduction: The Evolution of Sudden Cardiac Death Prevention

The prevention of sudden cardiac death (SCD) remains a cornerstone of modern cardiology. For decades, the transvenous implantable cardioverter-defibrillator (TV-ICD) has been the gold standard. However, the Achilles’ heel of transvenous systems—lead-related complications such as fractures, insulation failure, and systemic infections—prompted the development of the subcutaneous implantable cardioverter-defibrillator (S-ICD). By avoiding the vasculature and the heart itself, the S-ICD offers a promising alternative, particularly for younger patients or those at high risk of infection. Despite its increasing adoption, long-term data from large-scale, industry-independent populations have been relatively scarce. The HONEST (Subcutaneous Implantable Cardioverter-defibrillator: A Nationwide French Study) study, recently published in the European Heart Journal, addresses this evidence gap by providing a comprehensive look at five-year outcomes in an unselected nationwide cohort.

Study Design and Patient Demographics