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                <title level="j">Journal of the American College of Cardiology</title>
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                  <date type="datePub">2025-07</date>
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                <term xml:lang="en">Defibrillation failure</term>
                <term xml:lang="en">Ineffective shock</term>
                <term xml:lang="en">Shock impedance</term>
                <term xml:lang="en">Subcutaneous implantable cardioverter defibrillator</term>
                <term xml:lang="en">Sudden cardiac death</term>
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              <classCode scheme="halDomain" n="sdv.mhep.csc">Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system</classCode>
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              <p>Background: Defibrillation testing (DT) remains recommended during subcutaneous implantable cardioverter defibrillator (S-ICD) implantation due to limited supporting evidence.Objectives: The objective of this study was to evaluate the long-term impact of DT during S-ICD implantation.Methods: The HONEST (coHOrte fraNcaise des dEfibrillateurs Sous cuTanés) study is a nationwide, ongoing observational study, including all S-ICD recipients in France (2012-2019). Five-year endpoints were centrally adjudicated, and propensity score-weighted analyses compared outcomes by DT status.Results: Among 4,924 patients, DT was performed in 4,066 (82.6%), decreasing from 85.4% (2012-2014) to 66.9% in 2019 (P &amp;lt; 0.001). Nontested patients were older (51.2 vs 49.6 years; P = 0.007), had lower left ventricular ejection fraction (37.6% vs 43.3%; P &amp;lt; 0.001), and were more frequently implanted for primary prevention (68.0% vs 62.4%; P = 0.002) and structural heart disease (84.9% vs 76.8%; P &amp;lt; 0.001). DT-related complications occurred in 0.1%, including 2 deaths. Failure rate was 1.0%, with 87.8% undergoing corrective reinterventions. Independent predictors of DT failure were elevated shock impedance (≥89 Ω; OR: 4.60; 95% CI: 2.32-9.66; P &amp;lt; 0.001) and obesity (body mass index ≥30 kg/m2; OR: 2.17; 95% CI: 1.01-4.55; P = 0.007). After adjustment, DT omission was not associated with increased risks of overall mortality (HR: 1.17; 95% CI: 0.86-1.61; P = 0.313), cardiovascular mortality (HR: 1.04; 95% CI: 0.70-1.56; P = 0.846), sudden cardiac death (HR: 0.27; 95% CI: 0.04-1.72; P = 0.167), and appropriate (HR: 1.01; 95% CI: 0.78-1.30; P = 0.945) or inappropriate shocks (HR: 0.98; 95% CI: 0.78-1.23; P = 0.865). Combined rates of ineffective shocks or undetected ventricular arrhythmias were similar (0.05 vs 0.06 per 100 person-years).Conclusions: Our findings suggest that DT can be safely omitted in the majority of S-ICD recipients, whereas selective DT may be considered in higher-risk subgroups. (S-ICD French Cohort Study (HONEST); NCT05302115).</p>
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          <orgName type="acronym">ORPHY (EA 4324)</orgName>
          <desc>
            <address>
              <addrLine>UFR Sciences et Techniques, 6 Avenue Le Gorgeu, CS 93837, 29238 BREST CEDEX 3</addrLine>
              <country key="FR"/>
            </address>
            <ref type="url">https://www.univ-brest.fr/laboratoire-orphy/fr</ref>
          </desc>
          <listRelation>
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            <relation active="#struct-519898" type="direct"/>
            <relation active="#struct-300314" type="direct"/>
          </listRelation>
        </org>
        <org type="department" xml:id="struct-33307" status="VALID">
          <orgName>Service de cardiologie [CHU HEGP]</orgName>
          <desc>
            <address>
              <addrLine>20 rue Leblanc, Cedex 15, 75908 Paris</addrLine>
              <country key="FR"/>
            </address>
          </desc>
          <listRelation>
            <relation active="#struct-300068" type="direct"/>
            <relation active="#struct-300119" type="direct"/>
            <relation active="#struct-353414" type="indirect"/>
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        </org>
        <org type="laboratory" xml:id="struct-1004693" status="VALID">
          <idno type="IdRef">166439185</idno>
          <idno type="ISNI">0000 0004 0495 1460</idno>
          <idno type="RNSR">201019165T</idno>
          <idno type="ROR">https://ror.org/03gvnh520</idno>
          <orgName>Paris-Centre de Recherche Cardiovasculaire</orgName>
          <orgName type="acronym">PARCC (UMR_S 970/ U970)</orgName>
          <date type="start">2020-01-01</date>
          <desc>
            <address>
              <addrLine>56 rue Leblanc75015 PARISFRANCE</addrLine>
              <country key="FR"/>
            </address>
            <ref type="url">http://parcc.inserm.fr/</ref>
          </desc>
          <listRelation>
            <relation name="U970" active="#struct-300119" type="direct"/>
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            <relation name="U970" active="#struct-303623" type="direct"/>
            <relation name="UMR_S 970" active="#struct-557826" type="direct"/>
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        </org>
        <org type="regroupinstitution" xml:id="struct-300144" status="VALID">
          <idno type="IdRef">026606836</idno>
          <idno type="ISNI">0000000406394151</idno>
          <idno type="ROR">https://ror.org/02tcf7a68</idno>
          <orgName>CHU Clermont-Ferrand</orgName>
          <desc>
            <address>
              <country key="FR"/>
            </address>
            <ref type="url">https://www.chu-clermontferrand.fr/</ref>
          </desc>
        </org>
        <org type="institution" xml:id="struct-456899" status="VALID">
          <idno type="ROR">https://ror.org/006evg656</idno>
          <orgName>Hôpital de la Croix-Rousse [CHU - HCL]</orgName>
          <desc>
            <address>
              <addrLine>103 Grande Rue de la Croix-Rousse69004 Lyon</addrLine>
              <country key="FR"/>
            </address>
            <ref type="url">http://www.chu-lyon.fr/fr/hopital-de-la-croix-rousse</ref>
          </desc>
          <listRelation>
            <relation active="#struct-300074" type="direct"/>
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        </org>
        <org type="institution" xml:id="struct-425779" status="VALID">
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          <idno type="ISNI">0000000404718845</idno>
          <idno type="ROR">https://ror.org/02ppyfa04</idno>
          <idno type="Wikidata">Q2945741</idno>
          <orgName>Centre Hospitalier Régional Universitaire [CHU Lille]</orgName>
          <orgName type="acronym">CHRU Lille</orgName>
          <desc>
            <address>
              <addrLine>CHU/CHRU Lille - 2, avenue Oscar Lambret - 59037 Lille Cedex</addrLine>
              <country key="FR"/>
            </address>
            <ref type="url">http://www.chru-lille.fr/</ref>
          </desc>
        </org>
        <org type="institution" xml:id="struct-380304" status="VALID">
          <idno type="ROR">https://ror.org/04qyzam39</idno>
          <orgName>Hôpital Privé Jacques Cartier [Massy]</orgName>
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            <address>
              <addrLine>6 Avenue du Noyer Lambert, 91300 Massy</addrLine>
              <country key="FR"/>
            </address>
            <ref type="url">http://hopital-prive-jacques-cartier-massy.ramsaygds.fr/</ref>
          </desc>
        </org>
        <org type="institution" xml:id="struct-409419" status="VALID">
          <orgName>Groupe Hospitalier Intercommunal Le Raincy-Montfermeil</orgName>
          <date type="start">2009-01-01</date>
          <desc>
            <address>
              <addrLine>10 Rue du Général Leclerc, 93370 Montfermeil</addrLine>
              <country key="FR"/>
            </address>
          </desc>
        </org>
        <org type="laboratory" xml:id="struct-110054" status="VALID">
          <orgName>Service de Cardiologie [CHU Rouen]</orgName>
          <desc>
            <address>
              <addrLine>1 rue de Germont 76031 Rouen cedex</addrLine>
              <country key="FR"/>
            </address>
            <ref type="url">https://www.chu-rouen.fr/service/cardiologie/</ref>
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          <listRelation>
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            <relation active="#struct-300318" type="direct"/>
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        </org>
        <org type="laboratory" xml:id="struct-525327" status="VALID">
          <orgName>Service de cardiologie [CHRU de Besançon]</orgName>
          <desc>
            <address>
              <addrLine>3, boulevard A. Fleming - 25030 Besançon Cedex</addrLine>
              <country key="FR"/>
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            <ref type="url">https://www.chu-besancon.fr/offre-de-soins/les-services-et-activites/cardiologie.html</ref>
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          <listRelation>
            <relation active="#struct-300165" type="direct"/>
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        </org>
        <org type="laboratory" xml:id="struct-455421" status="VALID">
          <orgName>Service de cardiologie et maladies vasculaires [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes]</orgName>
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            <address>
              <addrLine>CHU Rennes, 2 Rue Henri le Guilloux, 35000 Rennes</addrLine>
              <country key="FR"/>
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            <ref type="url">https://www.chu-rennes.fr/</ref>
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        <org type="laboratory" xml:id="struct-123560" status="VALID">
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          <desc>
            <address>
              <addrLine>33604 Pessac</addrLine>
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            </address>
          </desc>
          <listRelation>
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        <org type="institution" xml:id="struct-362016" status="VALID">
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            <address>
              <addrLine>112 Rue de la Marne, 33500 Libourne</addrLine>
              <country key="FR"/>
            </address>
            <ref type="url">http://www.ch-libourne.fr/</ref>
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        </org>
        <org type="laboratory" xml:id="struct-181288" status="VALID">
          <orgName>Service de cardiologie et de pathologie vasculaire [CHU Caen]</orgName>
          <desc>
            <address>
              <addrLine>Centre Hospitalier UniversitaireAvenue de la Côte de NacreCS 3000114033 CAEN cedex 9</addrLine>
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          <listRelation>
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        <org type="institution" xml:id="struct-1088019" status="VALID">
          <orgName>Clinique de l'Orangerie [Strasbourg]</orgName>
          <orgName type="acronym">CDOS</orgName>
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            <address>
              <addrLine>29 All. de la Robertsau, 67000 Strasbourg</addrLine>
              <country key="FR"/>
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            <ref type="url">https://www.elsan.care/fr/clinique-orangerie</ref>
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        <org type="laboratory" xml:id="struct-227732" status="VALID">
          <orgName>Services de Pneumologie, Exploration Fonctionnelle Respiratoire et Cardiologie</orgName>
          <orgName type="acronym">Hôpital Louis Pradel</orgName>
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            <address>
              <addrLine>28 Avenue du Doyen Jean Lépine 69500 Bron</addrLine>
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          </desc>
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        <org type="laboratory" xml:id="struct-1220465" status="VALID">
          <orgName>Service de Cardiologie [CHU Saint-Etienne]</orgName>
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            <address>
              <addrLine>Centre Hospitalier Universitaire de Saint-Étienne 42055 SAINT-ÉTIENNE Cedex 2</addrLine>
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            <ref type="url">https://www.chu-st-etienne.fr/Offre_De_Soins/Cardiologie/Consultation</ref>
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        <org type="laboratory" xml:id="struct-530068" status="VALID">
          <orgName>Département de cardiologie [CHU de Grenoble]</orgName>
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              <addrLine>CHU de GrenobleAvenue Maquis du Grésivaudan 38700 La Tronche</addrLine>
              <country key="FR"/>
            </address>
            <ref type="url">http://www.chu-grenoble.fr/content/cardiologie-1</ref>
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        <org type="laboratory" xml:id="struct-532052" status="VALID">
          <orgName>Département de Cardiologie [Hôpital de la Timone - APHM]</orgName>
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            <address>
              <addrLine>Boulevard Jean Moulin, 13005 Marseille, France</addrLine>
              <country key="FR"/>
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        <org type="institution" xml:id="struct-179009" status="VALID">
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          <orgName>Centre Hospitalier Régional Universitaire de Tours</orgName>
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            <address>
              <addrLine>Centre Hospitalier Régional Universitaire de Tours2 Boulevard Tonnellé 37044 Tours cedex 9</addrLine>
              <country key="FR"/>
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            <ref type="url">https://www.chu-tours.fr/</ref>
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              <addrLine>52 Bd Vincent Auriol, 75013 Paris France</addrLine>
              <country key="FR"/>
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            <ref type="url">https://chirurgie-cardiaque-pitie.fr/institut-de-cardiologie/</ref>
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            <address>
              <addrLine>Hôpital Saint Joseph 26 Boulevard de Louvain, 13000 Marseille</addrLine>
              <country key="FR"/>
            </address>
            <ref type="url">http://www.hopital-saint-joseph.fr/1_votre_hopital/1d_vous_entrez_a_l_hopital/consultations_cardiologie.php</ref>
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            <address>
              <addrLine>1 Place Alexis-Ricordeau, 44000 Nantes</addrLine>
              <country key="FR"/>
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            <ref type="url">https://www.chu-nantes.fr</ref>
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          <orgName>Service de Cardiologie [CHU de Dijon]</orgName>
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            <address>
              <addrLine>CHU Dijon - 14 rue Paul Gaffarel - 21079 Dijon</addrLine>
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          <orgName>Centre hospitalier de Pau</orgName>
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            <address>
              <addrLine>4 Boulevard Hauterive, 64000 Pau</addrLine>
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            <ref type="url">https://www.ch-pau.fr/</ref>
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          <desc>
            <address>
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        <org type="laboratory" xml:id="struct-1520898" status="VALID">
          <orgName>Neurologie [CHU Amiens]</orgName>
          <desc>
            <address>
              <addrLine>CHU Amiens-Picardie – Site Sud - 1 rond-point du Professeur Christian Cabrol - 80054 Amiens</addrLine>
              <country key="FR"/>
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            <ref type="url">https://www.chu-amiens.fr/patients-et-visiteurs/services-et-contacts/medecine/cardiologie/</ref>
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        <org type="laboratory" xml:id="struct-543674" status="VALID">
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          <orgName type="acronym">PERITOX</orgName>
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          <desc>
            <address>
              <addrLine>Université de Picardie Jules Verne - CURS - CHU Sud avenue Laënnec - 80054 AMIENS CEDEX 1</addrLine>
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          <orgName type="acronym">GHBS</orgName>
          <date type="start">2018-01-01</date>
          <desc>
            <address>
              <addrLine>5 Avenue de ChoiseulBP 12233 - Lorient cedex</addrLine>
              <country key="FR"/>
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          </desc>
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            <ref type="url">https://www.chru-strasbourg.fr/</ref>
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            <address>
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              <addrLine>371 Avenue du Doyen G. Giraud, CHU Arnaud de Villeneuve, Bâtiment INSERM Crastes de Paulet - 34295 Montpellier Cedex 5</addrLine>
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              <addrLine>Université de Bretagne Occidentale - 3 Rue des Archives 29238, Brest</addrLine>
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          <orgName type="acronym">IBSAM</orgName>
          <date type="start">2017-10-12</date>
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              <addrLine>Université de Brest- UBO29238 Brest</addrLine>
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              <addrLine>85 boulevard Saint-Germain75006 Paris</addrLine>
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            <ref type="url">https://www.chu-rouen.fr/</ref>
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          <orgName>Normandie Université</orgName>
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            <address>
              <addrLine>Esplanade de la Paix - CS 14032 - 14032 Caen Cedex 5</addrLine>
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              <addrLine>Avenue de la Côte de Nacre 14000 Caen</addrLine>
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            <ref type="url">https://www.chu-caen.fr/</ref>
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            <ref type="url">http://www.chu-lyon.fr/fr/hopital-louis-pradel</ref>
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          <orgName type="acronym">UJM EPE</orgName>
          <date type="start">2025-01-01</date>
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            <address>
              <addrLine>10 rue Tréfilerie42100 Saint-Etienne</addrLine>
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            <ref type="url">https://www.univ-st-etienne.fr/fr/index.html</ref>
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          <idno type="Wikidata">Q623154</idno>
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          <desc>
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            <ref type="url">http://www.aphp.fr/contenu/hopital-universitaire-pitie-salpetriere-0</ref>
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          <orgName>Sorbonne Université</orgName>
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          <desc>
            <address>
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            <address>
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            <ref type="url">http://www.chu-dijon.fr/fr</ref>
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              <addrLine>Centre Hospitalier Universitaire Dupuytren - 2 avenue Martin Luther King 87042 LIMOGES</addrLine>
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            <ref type="url">http://www.chu-limoges.fr/</ref>
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            <ref type="url">http://www.ineris.fr/</ref>
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            <ref type="url">https://www.u-picardie.fr/</ref>
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            <address>
              <addrLine>1 place de l'hôpital BP 426 67091 Strasbourg cedex</addrLine>
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            <ref type="url">https://www.chru-strasbourg.fr/</ref>
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          <orgName type="acronym">CHU Toulouse</orgName>
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            <address>
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              <country key="FR"/>
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              <addrLine>163 rue Auguste Broussonnet - 34090 Montpellier</addrLine>
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            <ref type="url">http://www.chu-nancy.fr</ref>
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        <org type="institution" xml:id="struct-300170" status="VALID">
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          <orgName>Centre hospitalier universitaire de Poitiers = Poitiers University Hospital</orgName>
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          <desc>
            <address>
              <addrLine>2 rue de la Milétrie – 86000 Poitiers – France</addrLine>
              <country key="FR"/>
            </address>
            <ref type="url">http://www.chu-poitiers.fr/</ref>
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