Fawzi Kerkouri, Morin Christelle, Serge Bovéda, Frédéric Anselme, Soraya Anys, Nicolas Badenco, Francis Bessière, Hugues Blangy, Pierre Bordachar, Laure Champ-Rigot, Michel Chauvin, Nicolas Clémenty, Gaël Clerici, Antoine Da Costa, Pascal Defaye, Maxime De Guillebon, Jean‐Claude Deharo, Romain Eschalier, Fabrice Extramiana, Laurent Fauchier, Pierre Frey, Estelle Gandjbakhch, Charles Guénancia, Benoît Guy-Moyat, Alexis Hermida, Jérôme Hourdain, Peggy Jacon, Laurence Jesel, Jérôme Lacotte, Christophe Leclercq, Nicolas Lellouche, Jacques Mansourati, Philippe Maury, Aymeric Menet, Pierre Mondoly, Mathieu Montoy, Kumar Narayanan, Jean‐Luc Pasquié, David Perrot, Bertrand Pierre, Frédéric Sacher, Nicolas Sadoul, Victor Waldmann, Rodrigue Garcia, Vincent Probst, Éloi Marijon, the HONEST Study Investigators, Alexandre Doucy, Hassan Barake, Aziz Kneizeh, Didier Scarlatti, Fabien Squara, Sok-Sithikun Bun, Philippe Durand, Lara Dabiri, Philippe Ricard, Laurent Liprandi, Garret Gauthier, Folco Frattini, Yann Dagher hayeck, Alaa Al Amoura, Bruno Maillier, Denis Gaty, Lilian Marty, Mohammed Benkaci Ali, Jean Claude Deharo, Jérôme Hourdain, Baptiste Maille, Mickael Peyrol, Jérémie Barraud, Florian Baptiste, Jerôme Taieb, Jerôme Bouet, Gilles Macaluso, Alexis Mechulan, Sébastien Prevot, Ahmed Bouharaoua, Edouard Gitenay, Clément Bars, Julien Seitz, Laure Champ Rigot, Pierre Ollitrault, Paul-Ursmar Milliez, Arnaud Pellissier, Alain Lebon, Sophie Gomes, Pamela Damiano, Antoine Milhem, Cécile Duplantier, Cyril Goujeau, Isabelle Heurtebise, Lila Khris, Charles Guénancia, Géraldine Bertaux, Gabriel Laurent, Audrey Sagnard, Marie Fichot, Sylvain Bodi, Anne Quentin, Jean Litalien
BACKGROUND AND AIMS: Although use of the subcutaneous implantable cardioverter defibrillator (S-ICD) is increasing, evidence from industry-independent and unselected populations remains limited. METHODS: HONEST is a ongoing nationwide academic observational study enrolling 98.2% of patients implanted with an S-ICD across France (2012-2019). Five-year clinical endpoints were centrally adjudicated. RESULTS: Overall, 4924 patients were enrolled (mean age 49.9 ± 15 years, 76.7% male, 63.0% for primary prevention). Implants used general anaesthesia (78.9%), and defibrillation testing (82.6%). Perioperative complications (within 30 days) occurred in 4.4%. At 5 years, cumulative incidence rates were 13.8% for inappropriate shocks, 10.8% for early battery depletion, 2.4% for infections, 1.5% for lead dysfunction, and 1.4% for chronic discomfort. Reoperation was required in 16.9%, need for cardiac pacing in 3.1%, and definite S-ICD extraction in 8.4%. Inappropriate shocks were independently associated with male sex (hazard ratio [HR] 1.29, 95% confidence interval [CI] 1.14-1.46, P < .001), obesity (HR 1.35, 95% CI 1.02-1.79, P = .032), arrhythmogenic right ventricular cardiomyopathy (HR 1.70, 95% CI 1.03-2.81, P = .036), and the presence of a pacemaker (HR 2.20, 95% CI 1.16-4.17, P = .016). SMART Pass filtering significantly reduced inappropriate shocks (HR 0.67, 95% CI 0.50-0.89, P = .007). Among patients with inappropriate shocks, ∼1% developed induced ventricular fibrillation (one fatality), and 10% underwent device extraction. Ineffective shocks or undetected arrhythmias occurred in only 0.2%. Among 547 deaths (11.1%), 53.9% were cardiovascular, including 26 sudden deaths, and 8 were S-ICD/procedure-related, with none related to S-ICD extraction. CONCLUSIONS: This nationwide study refines the long-term event profile of S-ICD therapy and may inform clinical practice and device selection.