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Ricciardi D, Ziacchi M, Gasperetti A, Schiavone M, Picarelli F, Diemberger I, Bontempi L, Di Belardino N, Bisignani G, De Bonis S, Mitacchione G, Calabrese V, Lavalle C, Piro A, Pignalberi C, Santini L, Grigioni F, Tondo C, Biffi M, Forleo GB. Clinical impact of defibrillation testing in a real‐world S‐ICD population: Data from the ELISIR registry. J Cardiovasc Electrophysiol 2020; 32:468-476. [DOI: 10.1111/jce.14833] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/29/2020] [Accepted: 11/19/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Danilo Ricciardi
- Department of Cardiology Policlinico Universitario Campus Bio‐Medico Roma Italy
| | - Matteo Ziacchi
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine‐DIMES University of Bologna Bologna Italy
| | | | | | - Francesco Picarelli
- Department of Cardiology Policlinico Universitario Campus Bio‐Medico Roma Italy
- Department of Cardiology Ospedali Riuniti Anzio‐Nettuno Anzio Italy
| | - Igor Diemberger
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine‐DIMES University of Bologna Bologna Italy
| | - Luca Bontempi
- Department of Cardiology Spedali Civili Brescia Brescia Italy
| | | | - Giovanni Bisignani
- Department of Cardiology Ospedale “Ferrari”, Castrovillari Cosenza Italy
| | - Silvia De Bonis
- Department of Cardiology Ospedale “Ferrari”, Castrovillari Cosenza Italy
| | | | - Vito Calabrese
- Department of Cardiology Policlinico Universitario Campus Bio‐Medico Roma Italy
| | - Carlo Lavalle
- Department of Cardiovascular/Respiratory Diseases, Nephrology, Anesthesiology, and Geriatric Sciences Policlinico Umberto I Sapienza University of Rome Rome Italy
| | - Agostino Piro
- Department of Cardiovascular/Respiratory Diseases, Nephrology, Anesthesiology, and Geriatric Sciences Policlinico Umberto I Sapienza University of Rome Rome Italy
| | | | - Luca Santini
- Division of Cardiology Ospedale G.B. Grassi Ostia Italy
| | - Francesco Grigioni
- Department of Cardiology Policlinico Universitario Campus Bio‐Medico Roma Italy
| | - Claudio Tondo
- Heart Rhythm Center Centro Cardiologico Monzino, IRCCS Milan Italy
- Department of Clinical Sciences and Community Health University of Milan Milan Italy
| | - Mauro Biffi
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine‐DIMES University of Bologna Bologna Italy
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Singh P, Afzal MR, Weiss R. Perioperative considerations during implantation of the subcutaneous defibrillator: State‐of‐the‐art review. Pacing Clin Electrophysiol 2020; 43:1451-1458. [DOI: 10.1111/pace.14072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 09/08/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Prabhpreet Singh
- Division of Cardiovascular Medicine Wexner Medical Center, The Ohio State University Medical Center Columbus Ohio
| | - Muhammad Rizwan Afzal
- Division of Cardiovascular Medicine Wexner Medical Center, The Ohio State University Medical Center Columbus Ohio
| | - Raul Weiss
- Division of Cardiovascular Medicine Wexner Medical Center, The Ohio State University Medical Center Columbus Ohio
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Rordorf R, Casula M, Pezza L, Fortuni F, Sanzo A, Savastano S, Vicentini A. Subcutaneous versus transvenous implantable defibrillator: An updated meta-analysis. Heart Rhythm 2020; 18:382-391. [PMID: 33212250 DOI: 10.1016/j.hrthm.2020.11.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Implantable cardioverter-defibrillator (ICD) placement is a well-established therapy for prevention of sudden cardiac death. The subcutaneous implantable cardioverter-defibrillator (S-ICD) was specifically designed to overcome some of the complications related to the transvenous implantable cardioverter-defibrillator (TV-ICD), such as lead complications and systemic infections. Evidence on the comparison of S-ICD vs TV-ICD are limited. OBJECTIVE The purpose of this study was to conduct an updated meta-analysis comparing S-ICD vs TV-ICD. METHODS Electronic databases were searched for studies directly comparing clinical outcomes and complications between S-ICD and TV-ICD. The primary outcome was the composite of clinically relevant complications (lead, pocket, major procedural complications; device-related infections) and inappropriate shocks. Secondary outcomes included death and the individual components of the primary outcome. RESULTS Thirteen studies comprising 9073 patients were included in the analysis. Mean left ventricular ejection fraction was 40% ± 10%; 30% of patients were female; and 73% had an ICD implanted for primary prevention. There was no statistically significant difference in the risk of the primary outcome between S-ICD and TV-ICD (odds ratio [OR] 0.80; 95% confidence interval [CI] 0.53-1.19). Patients with S-ICD had lower risk of lead complications (OR 0.14; 95% CI 0.06-0.29; P <.00001) and major procedural complications (OR 0.18; 95% CI 0.06-0.57; P = .003) but higher risk of pocket complications (OR 2.18; 95% CI 1.30-3.66; P = .003) compared to those with TV-ICD. No significant differences were found for the other outcomes. CONCLUSION In patients with an indication for ICD without the need for pacing, TV-ICD and S-ICD are overall comparable in terms of the composite of clinically relevant device-related complications and inappropriate shock.
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Affiliation(s)
- Roberto Rordorf
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy.
| | - Matteo Casula
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy; Department of Molecular Medicine, Unit of Cardiology, University of Pavia, Pavia, Italy
| | - Laura Pezza
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy; Department of Molecular Medicine, Unit of Cardiology, University of Pavia, Pavia, Italy
| | - Federico Fortuni
- Department of Molecular Medicine, Unit of Cardiology, University of Pavia, Pavia, Italy
| | - Antonio Sanzo
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy
| | - Simone Savastano
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy
| | - Alessandro Vicentini
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy
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Pun PH, Parzynski CS, Friedman DJ, Sanders G, Curtis JP, Al-Khatib SM. Trends in Use and In-Hospital Outcomes of Subcutaneous Implantable Cardioverter Defibrillators in Patients Undergoing Long-Term Dialysis. Clin J Am Soc Nephrol 2020; 15:1622-1630. [PMID: 32967922 PMCID: PMC7646229 DOI: 10.2215/cjn.07920520] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/13/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Patients on dialysis are at high risk of complications related to implantable cardioverter defibrillator (ICD) implantation; use of subcutaneous ICDs may be preferred over transvenous devices due to lower risk of bloodstream infection and interference with vascular access sites. We evaluated trends in use and in-hospital outcomes of subcutaneous compared with transvenous ICDs among patients on dialysis in the United States. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Retrospective analysis of ICD implants from 2012 to 2018 among patients on dialysis reported to the National Cardiovascular Data Registry ICD Registry, a nationally representative US ICD Registry. We examined overall trends in subcutaneous ICD adoption as a proportion of all eligible ICD implants among patients on dialysis and then compared in-hospital outcomes between eligible subcutaneous ICD and transvenous ICD recipients using inverse probability of treatment weighting. RESULTS Of the 23,136 total ICD implants in patients on dialysis during the study period, 3195 (14%) were subcutaneous ICDs. Among eligible first-time ICD recipients on dialysis, the proportion of subcutaneous ICDs used increased yearly from 10% in 2012 to 69% in 2018. In propensity score-weighted analysis of 3327 patients, compared with transvenous ICDs, patients on dialysis receiving subcutaneous ICDs had a higher rate of in-hospital cardiac arrest (2% versus 0.4%, P=0.002), but there was no significant difference in total in-hospital complications (2% versus 1%, P=0.08), all-cause death, or length of hospital stay. CONCLUSIONS The utilization of subcutaneous ICDs among US patients on dialysis has been steadily increasing. The overall risk of short-term complications is low and comparable with transvenous ICDs, but higher risks of in-hospital cardiac arrest merits closer monitoring and further investigation. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2020_09_23_CJN07920520.mp3.
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Affiliation(s)
- Patrick H Pun
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina .,Division of Nephrology, Duke University Medical Center, Durham, North Carolina
| | - Craig S Parzynski
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Daniel J Friedman
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Gillian Sanders
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Jeptha P Curtis
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Sana M Al-Khatib
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.,Division of Cardiology, Duke University Medical Center, Durham, North Carolina
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Steffel J. The subcutaneous ICD for prevention of sudden cardiac death: Current evidence and future directions. Pacing Clin Electrophysiol 2020; 43:1421-1427. [PMID: 32896919 DOI: 10.1111/pace.14066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/20/2020] [Accepted: 09/06/2020] [Indexed: 11/30/2022]
Abstract
Despite major advances in medical therapy, sudden cardiac death remains an important cause of cardiovascular mortality. In order to improve the risk-benefit balance of transvenous implantable cardioverter-defibrillator (ICD) systems, a totally subcutaneous ICD (S-ICD) system was developed and approved for use in Europe in 2009. The currently available S-ICD system has undergone several important hardware- and software-related modifications and improvements over the last 10 years aimed at further improving its efficacy and safety. The results of the PRAETORIAN trial, that is, the first randomized comparison of S-ICD versus transvenous ICDs, of the prospective UNTOUCHED study, and the overall consistent observational data underline that current generation S-ICD systems may be a valid alternative in patients with an ICD indication in whom bradycardia pacing or cardiac resynchronization therapy is not required due to a lower risk of system-related problems. This review summarizes the key differences between the two systems, improvements in hardware components and algorithms over time, as well as most recent clinical evidence regarding the efficacy and safety of the S-ICD.
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Affiliation(s)
- Jan Steffel
- Division of Electrophysiology and Cardiac Devices, Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland
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56
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Outcomes of subcutaneous implantable cardioverter-defibrillator in dialysis patients: Results from the S-ICD post-approval study. Heart Rhythm 2020; 17:1566-1574. [DOI: 10.1016/j.hrthm.2020.04.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 04/20/2020] [Accepted: 04/22/2020] [Indexed: 12/29/2022]
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Defibrillation testing during implantation of the subcutaneous implantable cardioverter-defibrillator: a necessary standard or becoming redundant? Neth Heart J 2020; 28:122-127. [PMID: 32780342 PMCID: PMC7419406 DOI: 10.1007/s12471-020-01448-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Since the publication of the SIMPLE and NORDIC trials, defibrillation testing (DFT) is rarely performed during routine implantation of transvenous implantable cardioverter-defibrillators (ICD). However, the results of these trials cannot be extrapolated to the later introduced subcutaneous ICD (S-ICD) and a class I recommendation to perform DFT during the implantation of these devices remains in the current guidelines. Due to the high conversion success rate of DFT on one hand, and the risk of complications on the other, a significant number of physicians omit DFT in S‑ICD recipients. Several retrospective analyses have assessed the safety of the omission of DFT and report contradicting results and recommendations. It is known that implant position, as well as device factors and patient characteristics, influence defibrillation success. A better comprehension of these factors and their relationship could lead to more reliable and safer alternatives to DFT. An ongoing randomised clinical trial, which is expected to end in 2023, is the first study to implement a method that assesses implant position to identify patients who are likely to fail their DFT.
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Prevention of Sudden Cardiac Death: Focus on the Subcutaneous Implantable Cardioverter-Defibrillator. High Blood Press Cardiovasc Prev 2020; 27:291-297. [DOI: 10.1007/s40292-020-00394-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/02/2020] [Indexed: 11/26/2022] Open
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Gauthey A, Calle S, Accinelli S, Depuydt P, Garnir Q, Scavée C, Marchandise S, Wauters A, Bordachar P, de Pooter J, le Polain de Waroux JB. His bundle pacing for newly acquired pacing needs in patients implanted with a subcutaneous implantable cardioverter defibrillator: A feasibility study based on the automated screening score and clinical cases. J Cardiovasc Electrophysiol 2020; 31:1793-1800. [PMID: 32412155 DOI: 10.1111/jce.14566] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/04/2020] [Accepted: 05/12/2020] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Management of subcutaneous implantable cardioverter defibrillator (S-ICD) patients with newly acquired pacing needs remains problematic. His bundle pacing (HBP) allows for cardiac pacing without significant changes in the QRS morphology. We hypothesized that HBP does not alter S-ICD sensing and functions. METHODS Twenty consecutive patients were implanted with a HB pacemaker. Among them, 17 demonstrated successful His recruitment and were prospectively screened with the automated screening tool (AST). Results of screenings performed immediately after implant and during follow-up, during intrinsic rhythm and while pacing from all available pacing configurations, were compared using the AST score. Positive-screening tests were defined by greater than or equal to 1 positive vector. RESULTS Among the 17 patients successfully implanted (male: 41%; mean age: 73), 13 presented an indication of ventricular pacing and four of cardiac resynchronization. Absolute AST scores during both HBP (all configurations) and intrinsic rhythm were similar (p: NS). Due to left bundle branch block correction, HBP resulted in higher number of positive vectors (AST ≥ 100). AST scores were higher during HBP when compared with right ventricular pacing (RVP) (primary vector: 272 [16; 648] vs 4.6 [0.8; 16.2]; P = .003; secondary vector: 569 [183; 1186] vs 1.5 [0.7; 8.3]; P < .0001; alternate vector: 44 [2;125] vs 4.8 [0.9; 9.3]; P = .02) and resulted in a much higher number of positive vectors. Up to 90% of the patients had a positive-screening test during HBP. This passing rate was higher when compared RVP (17%; P < .0001). CONCLUSION HBP restores normal intrinsic conduction and minimally modifies the surface electrocardiograph and subcutaneous electrograms. When ventricular pacing is needed, HBP might represent an ideal pacing option for patients implanted with a S-ICD.
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Affiliation(s)
- Anaïs Gauthey
- Division of Cardiology, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Simon Calle
- Heart Center, Gent University Hospital, Ghent, Belgium
| | - Stefano Accinelli
- Division of Development, Boston Scientific Employee, Diegem, Belgium
| | - Philippe Depuydt
- Division of Development, Boston Scientific Employee, Diegem, Belgium
| | - Quentin Garnir
- Division of Cardiology, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Christophe Scavée
- Division of Cardiology, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Sébastien Marchandise
- Division of Cardiology, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Aurélien Wauters
- Division of Cardiology, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Pierre Bordachar
- IHU Lyric, Electrophysiology and Heart Modeling Institute, Université de Bordeaux, Pessac, France
| | - Jan de Pooter
- Heart Center, Gent University Hospital, Ghent, Belgium
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Ventricular tachycardia in cardiolaminopathy: Characteristics and considerations for device programming. Heart Rhythm 2020; 17:1704-1710. [PMID: 32454220 DOI: 10.1016/j.hrthm.2020.05.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Mutations in LMNA cause an arrhythmogenic cardiomyopathy (cardiolaminopathy) with high risk of ventricular tachycardia (VT). The natural history of VT among patients with cardiolaminopathy is incompletely understood. OBJECTIVE The purpose of this study was to determine the longitudinal burden and progression of VT, including change in tachycardia cycle length (TCL), response to antitachycardia pacing (ATP), and prognostic significance of high-burden VT (>5 episodes of VT at any device interrogation) in cardiolaminopathy patients. METHODS Patients with cardiolaminopathy and an implantable cardioverter-defibrillator (ICD) were identified from a single-center database. Serial device interrogations and medical records were used to collect data on VT burden, TCL, and response to ATP. RESULTS Cardiolaminopathy patients with primary (n = 27) or secondary prevention (n = 16) ICDs were followed for 2 years (interquartile range [IQR] 1-5). VT burden was substantially higher in patients receiving secondary prevention ICDs (28 ± 40.9 vs 3.6 ± 7.3 episodes per 100 patient-years; P <.001). ATP was highly effective (94%) at terminating VT except for short TCL (<250 ms), for which ATP failed in 60%. Among patients with recurrent VT, TCL increased by 112 ± 93.6 ms during follow-up. Inappropriate shocks were rare (0.4% of all therapies). Median time to transplantation, ventricular assist device, or death was 18 months (IQR 0.7-27.1) in patients with high-burden VT. CONCLUSION In patients with cardiolaminopathy, VT is recurrent and highly responsive to ATP, which supports the use of transvenous ICDs iteratively programmed to manage VT of various TCLs. Onset of high-burden VT indicates poor prognosis and should warrant referral to a heart failure specialist.
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Uran C, Giojelli A, Borgogna DA, Morello G, Marullo F, Iodice P, Greco A, Accogli M, Guido A, Palmisano P. Ultrasound-guided serratus anterior plane block combined with parasternal block in subcutaneous implantable cardioverter defibrillator implantation: Results of a pilot study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:705-712. [PMID: 32420626 DOI: 10.1111/pace.13944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/29/2020] [Accepted: 05/10/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND The standard approach to subcutaneous defibrillator (S-ICD) implantation often requires general anesthesia or anesthesiologist-delivered deep sedation. Ultrasound-guided serratus anterior plane block (SAPB) combined with parasternal block (PSB) has been proposed in order to provide anesthesia/analgesia and to reduce the need for sedation during S-ICD implantation. In this pilot study, we compared the double-block approach (SAPB + PSB) with the single-block approach (SAPB only) and with the standard approach involving local anesthesia and sedation. METHODS We prospectively enrolled 22 patients undergoing S-ICD implantation: in 10, the single-block approach was adopted; in 12, the double-block approach. As a control group, we retrospectively enrolled 14 consecutive patients who had undergone S-ICD implantation under standard local anesthesia and sedation in the previous 6 months. Intra- and postprocedural data, including patient-reported pain intensity, were collected and compared in the three study groups. RESULTS The double-block approach was associated with a shorter procedure duration than the single-block and standard approaches (63.3 ± 7.9 vs 70.1 ± 6.8 vs 76.9 ± 7.8 min; P < .05) and with a lower dose of local an aesthetic for infiltration (18.9 ± 1.7 vs 27.5 ± 4.6 vs 44.6 ± 4.0 cc; P < .001). Both the double- and single-block approaches were associated with lower pain intensity at the device pocket and the lateral tunneling site (P < .05). The double-block approach proved superior to the other two approaches in controlling intraoperative pain at the parasternal tunneling site (P < .05). CONCLUSIONS In our study, SAPB combined with PSB was superior to SAPB alone and to the standard approach in controlling intraoperative pain during S-ICD implantation. In addition, this approach resulted in shorter procedure durations.
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Affiliation(s)
- Carlo Uran
- Cardiology and Intensive Care Unit, "San Giuseppe e Melorio" Hospital, Santa Maria Capua Vetere, Italy
| | - Angela Giojelli
- Diagnostic Imaging Unit, "San Giuseppe e Melorio" Hospital, Santa Maria Capua Vetere, Italy
| | - Donato Antonio Borgogna
- Anesthesia and Intensive Care Unit, "San Giuseppe e Melorio" Hospital, Santa Maria Capua Vetere, Italy
| | - Gerardo Morello
- Cardiology and Intensive Care Unit, "San Giuseppe e Melorio" Hospital, Santa Maria Capua Vetere, Italy
| | - Flavio Marullo
- Cardiology and Intensive Care Unit, "San Giuseppe e Melorio" Hospital, Santa Maria Capua Vetere, Italy
| | - Pietro Iodice
- Cardiology and Intensive Care Unit, "San Giuseppe e Melorio" Hospital, Santa Maria Capua Vetere, Italy
| | - Angelo Greco
- Anesthesia and Intensive Care Unit, "Card. Giovanni Panico" Hospital, Tricase, Italy
| | - Michele Accogli
- Cardiology Unit, "Card. Giovanni Panico" Hospital, Tricase, Italy
| | - Alessandro Guido
- Cardiology Unit, "Card. Giovanni Panico" Hospital, Tricase, Italy
| | - Pietro Palmisano
- Cardiology Unit, "Card. Giovanni Panico" Hospital, Tricase, Italy
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McFaul CM, Lombaard S, Arora V, Van Cleve WC, Rooke GA, Prutkin JM. Unexpected Shocks From a Subcutaneous Implantable Cardioverter-Defibrillator Despite Attempted Reprogramming and Magnet Use: A Case Report. A A Pract 2020; 14:e01178. [DOI: 10.1213/xaa.0000000000001178] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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63
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Rudic B, Tülümen E, Fastenrath F, Akin I, Borggrefe M, Kuschyk J. Defibrillation failure in patients undergoing replacement of subcutaneous defibrillator pulse generator. Heart Rhythm 2020; 17:455-459. [DOI: 10.1016/j.hrthm.2019.10.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Indexed: 11/30/2022]
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64
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Okabe T, Miller A, Koppert T, Cavalcanti R, Alcivar-Franco D, Osei J, Kahaly O, Afzal MR, Tyler J, Kalbfleisch SJ, Weiss R, Houmsse M, Augostini RS, Daoud EG, Andritsos MJ, Bhandary S, Dimitrova G, Fiorini K, Elsayed-Awad H, Flores A, Gorelik L, Iyer MH, Saklayen S, Stein E, Turner K, Perez W, Hummel JD, Essandoh MK. Feasibility and safety of same day subcutaneous defibrillator implantation and send home (DASH) strategy. J Interv Card Electrophysiol 2019; 57:311-318. [PMID: 31813098 DOI: 10.1007/s10840-019-00673-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/19/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To assess the feasibility and safety of same-day discharge after S-ICD implantation by implementing a specific analgesia protocol and phone follow-up. METHODS Consecutive patients presenting for outpatient S-ICD implantation were enrolled between 1/1/2018 and 4/30/2019. An analgesia protocol included pre-operative acetaminophen and oxycodone, intraoperative local bupivacaine, and limited use of oxycodone-acetaminophen at discharge. The primary outcome was successful same-day discharge. Numerical Pain Rating Scale (NPRS) on postoperative day (POD) 1, 3, 14, and 30 and any unplanned health care visits during the 1-month follow-up period were assessed. RESULTS Out of 53 potentially eligible S-ICD patients, 49 patients (92.5%) were enrolled and successfully discharged on the same day. Mean age of these 49 patients was 47 ± 14 years. There were no acute procedural complications. Severe pain (NPRS ≥ 8) on POD 0, 1, and 3 was present in 14.3%, 14.3%, and 8.2% of patients, respectively. The total in-hospital stay was 534 ± 80 min. Four unplanned visits (8%) due to cardiac or device-related issues occurred during 1-month follow-up, including 2 patients with heart failure exacerbation, one patient with an incisional infection, and one patient with inappropriate shocks. CONCLUSIONS With the appropriate institutional protocol including specific analgesics and phone follow-up, same-day discharge after outpatient S-ICD implantation is feasible and appears safe for most patients.. Device-related pain can be severe in the first 3 days post-implantation and can be successfully treated with limited supply of narcotic medications.
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Affiliation(s)
- Toshimasa Okabe
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Adrianne Miller
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Tanner Koppert
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Rafael Cavalcanti
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Diego Alcivar-Franco
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jemina Osei
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Omar Kahaly
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Muhammad R Afzal
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jaret Tyler
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Steven J Kalbfleisch
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Raul Weiss
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Mahmoud Houmsse
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ralph S Augostini
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Emile G Daoud
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Michael J Andritsos
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Sujatha Bhandary
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Galina Dimitrova
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kasey Fiorini
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Hamdy Elsayed-Awad
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Antolin Flores
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Leonid Gorelik
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Manoj H Iyer
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Samiya Saklayen
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Erica Stein
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Katja Turner
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - William Perez
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - John D Hummel
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Michael K Essandoh
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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65
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Kawamura I, Nakajima M, Kitamura T, Kaszynski RH, Hojo R, Ohbe H, Sasabuchi Y, Matsui H, Fushimi K, Fukamizu S, Yasunaga H. Patient characteristics and in-hospital complications of subcutaneous implantable cardioverter-defibrillator for Brugada syndrome in Japan. J Arrhythm 2019; 35:842-847. [PMID: 31844476 PMCID: PMC6898525 DOI: 10.1002/joa3.12234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 08/19/2019] [Accepted: 08/23/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Clinical features and complications of subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation for Brugada syndrome have not been well studied. METHODS We used the Japanese Diagnosis Procedure Combination database to retrospectively investigate patients who had undergone ICD implantation between April 2016 and March 2017. We compared the characteristics and in-hospital complications of patients with Brugada syndrome implanted with S-ICD or transvenous (TV)-ICD. RESULTS We extracted 3090 patients who received ICD implantation. Among them, we identified 278 Brugada patients. The mean age was 43 ± 14.4 years and 262 (94%) were male. Of these 278 patients, 136 (49%) received S-ICD and 142 (51%) received TV-ICD. TV-ICD recipients had a history of atrial fibrillation more frequently compared with S-ICD recipients. The median (interquartile range) of length of hospital stay was not significantly different between patients with S-ICD and TV-ICD (13 days [10-20.5] vs 12 days [10-18], respectively). The prevalence of in-hospital complications after ICD implantation was similar between the two groups. There were no patients with cardiac tamponade, hemothorax, pneumothorax, cardiovascular event, stroke, and death following the procedure during hospitalization in either group. CONCLUSIONS Short-term safety of S-ICD implantation may be identical to that of TV-ICD. Large prospective studies are warranted to compare the effects and long-term safety of S-ICD compared with TV-ICD.
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Affiliation(s)
- Iwanari Kawamura
- Department of CardiologyTokyo Metropolitan Hiroo HospitalTokyoJapan
| | - Mikio Nakajima
- Emergency and Critical Care CenterTokyo Metropolitan Hiroo HospitalTokyoJapan
- Department of Clinical Epidemiology and Health EconomicsSchool of Public HealthThe University of TokyoTokyoJapan
| | - Takeshi Kitamura
- Department of CardiologyTokyo Metropolitan Hiroo HospitalTokyoJapan
| | | | - Rintaro Hojo
- Department of CardiologyTokyo Metropolitan Hiroo HospitalTokyoJapan
| | - Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health EconomicsSchool of Public HealthThe University of TokyoTokyoJapan
| | | | - Hiroki Matsui
- Department of Clinical Epidemiology and Health EconomicsSchool of Public HealthThe University of TokyoTokyoJapan
| | - Kiyohide Fushimi
- Department of Health Policy and InformaticsTokyo Medical and Dental University Graduate School of MedicineTokyoJapan
| | - Seiji Fukamizu
- Department of CardiologyTokyo Metropolitan Hiroo HospitalTokyoJapan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health EconomicsSchool of Public HealthThe University of TokyoTokyoJapan
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66
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Afzal MR, Okabe T, Koppert T, Tyler J, Houmsse M, Augostini RS, Hummel JD, Kalbfleisch SJ, Iyer MH, Flores AS, Bhandary S, Dimitrova G, Elsayed‐Awad H, Fiorini K, Gorelik L, Perez W, Saklayen S, Stein E, Turner K, Franklin NP, Ryu JN, Bhatt A, Weiss R, Daoud EG, Essandoh M. Implantation of subcutaneous defibrillator is feasible and safe with monitored anesthesia care. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1552-1557. [DOI: 10.1111/pace.13838] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/09/2019] [Accepted: 10/28/2019] [Indexed: 01/26/2023]
Affiliation(s)
- Muhammad R. Afzal
- Division of Cardiovascular MedicineThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Toshimasa Okabe
- Division of Cardiovascular MedicineThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Tanner Koppert
- Division of Cardiovascular Medicine ElectrophysiologyDavis Heart and Lung Research Institute Columbus Ohio
| | - Jaret Tyler
- Division of Cardiovascular MedicineThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Mahmoud Houmsse
- Division of Cardiovascular MedicineThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Ralph S. Augostini
- Division of Cardiovascular MedicineThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - John D. Hummel
- Division of Cardiovascular MedicineThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Steven J. Kalbfleisch
- Division of Cardiovascular MedicineThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Manoj H. Iyer
- Division of AnesthesiologyThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Antolin S. Flores
- Division of AnesthesiologyThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Sujatha Bhandary
- Division of AnesthesiologyThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Galina Dimitrova
- Division of AnesthesiologyThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Hamdy Elsayed‐Awad
- Division of AnesthesiologyThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Kasey Fiorini
- Division of AnesthesiologyThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Leonid Gorelik
- Division of AnesthesiologyThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - William Perez
- Division of AnesthesiologyThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Samiya Saklayen
- Division of AnesthesiologyThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Erica Stein
- Division of AnesthesiologyThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Katja Turner
- Division of AnesthesiologyThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Nicholas P. Franklin
- Division of AnesthesiologyThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Jasmine N. Ryu
- Division of AnesthesiologyThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Amar Bhatt
- Division of AnesthesiologyThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Raul Weiss
- Division of Cardiovascular MedicineThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Emile G. Daoud
- Division of Cardiovascular MedicineThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
| | - Michael Essandoh
- Division of AnesthesiologyThe Ohio State University Wexner Medical Center, Ohio State University Medical Center Columbus Ohio
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67
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Goldenberg I, Huang DT, Nielsen JC. The role of implantable cardioverter-defibrillators and sudden cardiac death prevention: indications, device selection, and outcome. Eur Heart J 2019; 41:2003-2011. [DOI: 10.1093/eurheartj/ehz788] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/09/2019] [Accepted: 10/26/2019] [Indexed: 12/31/2022] Open
Abstract
Abstract
Multiple randomized multicentre clinical trials have established the role of the implantable cardioverter-defibrillator (ICD) as the mainstay in the treatment of ventricular tachyarrhythmias and sudden cardiac death (SCD) prevention. These trials have focused mainly on heart failure patients with advanced left ventricular dysfunction and were mostly conducted two decades ago, whereas a more recent trial has provided conflicting results. Therefore, much remains to be determined on how best to balance the identification of patients at high risk of SCD together with who would benefit most from ICD implantation in a contemporary setting. Implantable cardioverter-defibrillators have also evolved from the simple, defibrillation-only devices implanted surgically to more advanced technologies of multi-chamber devices, with physiologic bradycardic pacing, including cardiac resynchronization therapy, atrial and ventricular therapeutic pacing algorithms, and subcutaneous ICDs. These multiple options necessitate individualized approach to device selection and programming. This review will focus on the current knowledge on selection of patients for ICD treatment, device selection and programming, and future directions of implantable device therapy for SCD prevention.
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Affiliation(s)
- Ilan Goldenberg
- Division of Cardiology, Department of Medicine, The Clinical Cardiovascular Research Center, University of Rochester Medical Center, 265 Crittenden Blvd CU 420653, Rochester, NY 14642, USA
| | - David T Huang
- Division of Cardiology, Department of Medicine, The Clinical Cardiovascular Research Center, University of Rochester Medical Center, 265 Crittenden Blvd CU 420653, Rochester, NY 14642, USA
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
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68
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The subcutaneous implantable cardioverter-defibrillator in review. Am Heart J 2019; 217:131-139. [PMID: 31654943 DOI: 10.1016/j.ahj.2019.08.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 08/13/2019] [Indexed: 01/14/2023]
Abstract
The subcutaneous implantable cardioverter defibrillator (S-ICD) is a completely extrathoracic device that has recently been FDA approved for the prevention of sudden cardiac death in select populations. Although the transvenous implantable cardioverter defibrillator (TV-ICD) has a proven mortality benefit in multiple patient populations, there are significant risks both with implantation and years after its placement. The S-ICD may help prevent some of these complications. Currently, the S-ICD is typically implanted in patients with prior device infection or at an increased risk for an infection, younger patients with difficult venous access related to either hemodialysis or difficult cardiac anatomy, patients who live active lifestyles, and those who may outlive the TV-ICD leads. There is an absolute contraindication for S-ICD implantations for patients who need pacing either for ventricular tachycardia or bradycardia because this device cannot perform these functions. To date, there are no randomized controlled trial (RCT) data evaluating the safety and efficacy of this relatively new device. Observational studies of both the S-ICD alone and in comparison with the TV-ICD have showed promising results, including a decrease in lead-related and periprocedural complications as well as a high level of effectiveness at terminating ventricular arrhythmias. These analyses over time may have contributed to the evolution and comfortability with the S-ICD system, as physicians are more often referring for and/or implanting this device for patients with appropriate indications. Furthermore, inappropriate shock rates with the S-ICD have decreased over time especially with dual zone programming. This review summarizes the results of a multitude of observational studies with respect to patient selection for the S-ICD, complication rates, appropriate and inappropriate shock rates, and programming. This review also tackles current ongoing randomized trials. Although the results of ongoing trials will be helpful, there is still a continued need to evaluate the efficacy of the S-ICD in broader patient populations including patients with several comorbidities and older patients so that more patients can be considered for this potentially lifesaving device.
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69
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Kim SM, Cheung JW. Public reporting on cardiac electrophysiology procedures and outcomes: where are we now and where are we headed? J Interv Card Electrophysiol 2019; 56:137-141. [DOI: 10.1007/s10840-018-0400-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/20/2018] [Indexed: 11/27/2022]
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70
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Diemberger I, Migliore F, Ricciardi G, Ottaviano L, Tavoletta V, Francia P, Viani S, Capucci A, de Filippo P, Nigro G, Caravati F, Palmisano P, Ziacchi M, Lovecchio M, Valsecchi S, Bongiorni MG, Biffi M. Time to therapy delivery and effectiveness of the subcutaneous implantable cardioverter-defibrillator. Heart Rhythm 2019; 16:1531-1537. [DOI: 10.1016/j.hrthm.2019.05.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Indexed: 11/25/2022]
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71
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Quast AB, Baalman SW, Van der Stuijt W, Wilde AA, Knops RE. Minimal defibrillation thresholds and the correlation with implant position in subcutaneous implantable‐defibrillator patients. J Cardiovasc Electrophysiol 2019; 30:2441-2447. [DOI: 10.1111/jce.14171] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/20/2019] [Accepted: 09/06/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Anne‐Floor B.E. Quast
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | - Sarah W.E. Baalman
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | - Willeke Van der Stuijt
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | - Arthur A.M. Wilde
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | - Reinoud E. Knops
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
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72
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León Salas B, Trujillo-Martín MM, García García J, Ramallo Fariña Y, García Quintana A, Quirós López R, Serrano-Aguilar P. Subcutaneous implantable cardioverter-defibrillator in primary and secondary prevention of sudden cardiac death: A meta-analysis. Pacing Clin Electrophysiol 2019; 42:1253-1268. [PMID: 31396970 DOI: 10.1111/pace.13774] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/18/2019] [Accepted: 08/04/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Subcutaneous implantable cardioverter-defibrillator (S-ICD) is gaining in popularity for primary and secondary prevention of sudden cardiac death. The objective was to evaluate the safety and clinical effectiveness of the S-ICD for prevention of sudden cardiac death compared to transvenous cardioverter-defibrillator (TV-ICD). METHODS A systematic review with meta-analyses was performed. The electronic databases MEDLINE, EMBASE, SCI, and Cochrane Central Register of Controlled Trials were consulted in March 2018 with no restrictions on publication date. Predefined criteria were used to determine inclusion of studies and to assess their methodologic quality. RESULTS Ten longitudinal-observational studies with comparison group presenting moderate methodologic flaws were included (N = 7820). The combination of results indicates that health-related quality of life is not significantly different between S-ICD and TV-ICD groups (Physical health: MD = 2.90; 95% CI = -3.88, 9.68/Mental health: MD = 0.13; 95% CI = -2.11, 2.37). Mortality occurred in 4.4% of S-ICD patients and 5.9% of TV-ICD patients died (OR = 0.79; 95% CI = 0.50, 1.24). The incidence of infections (OR = 1.79; 95% CI = 0.93, 3.43) and inappropriate shocks (OR = 1.28, 95% CI = 0.91, 1.78) is not significantly different between both groups. The S-ICD reduces complications related to electrodes/leads (OR = 0.13, 95% CI = 0.05, 0.29) and has lower electrodes/leads movement compared with TV-ICD (OR = 0.26; 95% CI 0.10, 0.67). In contrast, pneumothorax is more likely in TV-ICD than S-ICD (OR = 0.17; 95% CI = 0.03, 0.97). CONCLUSIONS S-ICD reduces electrodes/leads movement, electrodes/leads related complications, and pneumothorax. Our study did not demonstrate a statistically significant difference in mortality, health-related quality of life, and infection rate between S-ICD and TV-ICD.
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Affiliation(s)
- Beatriz León Salas
- Canary Islands Foundation of Health Research (FUNCANIS), Santa Cruz de Tenerife, Spain.,Spanish Network of Health Technology Assessment (RedETS), Spain
| | - María M Trujillo-Martín
- Canary Islands Foundation of Health Research (FUNCANIS), Santa Cruz de Tenerife, Spain.,Spanish Network of Health Technology Assessment (RedETS), Spain.,Health Services and Chronic Diseases Research Network (REDISSEC), Spain.,Center for Biomedical Research of the Canary Islands (CIBICAN), Santa Cruz de Tenerife, Spain
| | - Javier García García
- Quality and Patient Safety Unit, Nuestra Señora de Candelaria University Hospital, Santa Cruz de Tenerife, Spain
| | - Yolanda Ramallo Fariña
- Canary Islands Foundation of Health Research (FUNCANIS), Santa Cruz de Tenerife, Spain.,Spanish Network of Health Technology Assessment (RedETS), Spain.,Health Services and Chronic Diseases Research Network (REDISSEC), Spain.,Center for Biomedical Research of the Canary Islands (CIBICAN), Santa Cruz de Tenerife, Spain
| | - Antonio García Quintana
- Cardiology Unit, Dr. Negrin University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Raúl Quirós López
- Health Services and Chronic Diseases Research Network (REDISSEC), Spain.,Internal Medicine Service, Costa del Sol Hospital, Marbella, Spain
| | - Pedro Serrano-Aguilar
- Spanish Network of Health Technology Assessment (RedETS), Spain.,Health Services and Chronic Diseases Research Network (REDISSEC), Spain.,Center for Biomedical Research of the Canary Islands (CIBICAN), Santa Cruz de Tenerife, Spain.,Evaluation Service of the Canary Islands Health Service (SESCS), Canary Islands Health Service, Santa Cruz de Tenerife, Spain
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73
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Kaya E, Rassaf T, Wakili R. Subcutaneous ICD: Current standards and future perspective. IJC HEART & VASCULATURE 2019; 24:100409. [PMID: 31453314 PMCID: PMC6700427 DOI: 10.1016/j.ijcha.2019.100409] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 07/27/2019] [Accepted: 08/06/2019] [Indexed: 11/24/2022]
Abstract
The subcutaneous implantable cardioverter-defibrillator (S-ICD) system is an established therapy for prevention of sudden cardiac death (SCD) and an alternative to a transvenous implantable cardioverter-defibrillator (ICD) system in selected patients. Since introduction of S-ICD in 2010, the device has undergone further development. Based on the unique feature of an entirely extracardiac implantation, S-ICD is able to reduce the known common perioperative and long-term complications of conventional transvenous implanted ICD systems. Especially for patients with a complex anatomy and no option of an endovascular lead implantation, the S-ICD offers a potential alternative. Initial uncertainty existed, questioning whether this ICD approach would be reliable in detecting and terminating ventricular arrhythmias. Multiple clinical studies, however, provided evidence for an effective treatment. Based on obvious advantages compared to conventional ICD systems, the question arises whether the S-ICD should actually be the first choice in the majority of all primary prevention patients in the future. Recent data from large registries show that S-ICD indications are also expanding in secondary prevention patients. As a consequence, the S-ICD was listed in the 2015 ESC guidelines as an alternative therapeutic option with a class-IIa recommendation in patients with an ICD indication not requiring pacing for bradycardia, cardiac resynchronization therapy or anti-tachycardia pacing (ATP). In addition, the American Heart Association guidelines refer to class-I recommendation for patients with a complex anatomy and venous access problems or at a high risk for infections who need ICD therapy. Limitations with respect to the not available pacing option of S-ICD might be also overcome by a potential combination with a leadless pacemaker in the near future. This article provides an overview of recent developments of S-ICD and reviews the most recent literature and ongoing studies.
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Affiliation(s)
- Elif Kaya
- Corresponding author at: Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany.
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74
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Quast AFB, Baalman SW, Betts TR, Boersma LV, Bonnemeier H, Boveda S, Brouwer TF, Burke MC, Delnoy PPH, El-Chami M, Kuschyk J, Lambiase P, Marquie C, Miller MA, Smeding L, Wilde AA, Knops RE. Rationale and design of the PRAETORIAN-DFT trial: A prospective randomized CompArative trial of SubcutanEous ImplanTable CardiOverter-DefibrillatoR ImplANtation with and without DeFibrillation testing. Am Heart J 2019; 214:167-174. [PMID: 31220775 DOI: 10.1016/j.ahj.2019.05.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 05/02/2019] [Indexed: 12/15/2022]
Abstract
In transvenous implantable cardioverter-defibrillator (TV-ICD) implants, routine defibrillation testing (DFT) does not improve shock efficacy or reduce arrhythmic death but patients are exposed to the risk of complications related to DFT. The conversion rate of DFT in subcutaneous ICD (S-ICD) is high and first shock efficacy is similar to TV-ICD efficacy rates. STUDY DESIGN: The PRAETORIAN-DFT trial is an investigator-initiated, randomized, controlled, multicenter, prospective two-arm trial designed to demonstrate non-inferiority of omitting DFT in patients undergoing S-ICD implantation in which the S-ICD system components are optimally positioned. Positioning of the S-ICD will be assessed with the PRAETORIAN score. The PRAETORIAN score is developed to systematically evaluate implant position of the S-ICD system components which determine the defibrillation threshold on post-operative chest X-ray. A total of 965 patients, scheduled to undergo a de novo S-ICD implantation without contra-indications for either DFT strategy, will be randomized to either standard of care S-ICD implantation with DFT, or S-ICD implantation without DFT but with evaluation of the implant position using the PRAETORIAN score. The study is powered to claim non-inferiority of S-ICD implantation without DFT in de novo S-ICD patients in respect to the primary endpoint of first shock efficacy in spontaneous arrhythmia episodes. Patients with a high PRAETORIAN score (≥90) in the interventional arm of this study will undergo DFT according to the same DFT protocol as in the control arm. CONCLUSION: The PRAETORIAN-DFT trial is a randomized trial that aims to gain scientific evidence to safely omit a routine DFT after S-ICD implantation in patients with correct device positioning.
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75
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Adduci C, Ali H, Francia P, Mantovani R, Palano F, Lupo P, Foresti S, De Ambroggi G, Cappato R. The subcutaneous implantable cardioverter-defibrillator: Current trends in clinical practice between guidelines and technology progress. Eur J Intern Med 2019; 65:6-11. [PMID: 31005441 DOI: 10.1016/j.ejim.2019.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/23/2019] [Accepted: 04/09/2019] [Indexed: 01/21/2023]
Abstract
The subcutaneous implantable cardioverter defibrillator (S-ICD) is a valuable alternative to the conventional trans-venous ICD (TV-ICD) for the prevention of sudden cardiac death (SCD). Prospective registries showed that the S-ICD is safe and effective in treating ventricular tachyarrhythmias in high-risk patients without pacing indications. While in earlier studies patients implanted with S-ICDs were young and mostly affected by channelopathies, contemporary S-ICD cohorts include patients with severely impaired left ventricular function and significant comorbidities. This review focuses on S-ICD evidence-based use and highlights current gaps between guidelines recommendations and real-world clinical practice.
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Affiliation(s)
- Carmen Adduci
- Department of Clinical and Molecular Medicine, Sapienza University, St Andrea Hospital, Rome, Italy.
| | - Hussam Ali
- Arrhythmia & EP Research Center, IRCCS Humanitas Research & University Hospital, Rozzano, Milan, Italy
| | - Pietro Francia
- Department of Clinical and Molecular Medicine, Sapienza University, St Andrea Hospital, Rome, Italy
| | - Riccardo Mantovani
- Arrhythmia & EP Research Center, IRCCS Humanitas Research & University Hospital, Rozzano, Milan, Italy
| | - Francesca Palano
- Department of Clinical and Molecular Medicine, Sapienza University, St Andrea Hospital, Rome, Italy
| | - Pierpaolo Lupo
- Arrhythmia & EP Research Center, IRCCS Humanitas Research & University Hospital, Rozzano, Milan, Italy
| | - Sara Foresti
- Arrhythmia & EP Research Center, IRCCS Humanitas Research & University Hospital, Rozzano, Milan, Italy
| | - Guido De Ambroggi
- Arrhythmia & EP Research Center, IRCCS Humanitas Research & University Hospital, Rozzano, Milan, Italy
| | - Riccardo Cappato
- Arrhythmia & EP Research Center, IRCCS Humanitas Research & University Hospital, Rozzano, Milan, Italy
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76
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Abstract
The article presents the history of the issue, the concept of iatrogenia, possible negative consequences of the interaction of the doctor and the patient in modern conditions. The main forms of iatrogenic (psychogenic, hospital, iatrogenic diagnostic procedures, medicinal, etc.) are given. An important place is occupied by implantation of iatrogenic (patients with artificial heart valves, cardio-implanted electronic devices, coronary stents, articular endoprostheses). The most vulnerable to the development of iatrogenic are elderly and senile patients. The interdisciplinarity of the iatrogenic problem and its educational significance for therapists, general practitioners, clinical pharmacologists, pathologists. Keywords: iatrogeniа, iatrogenic events, undesirable drug reactions, мedical error.
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Affiliation(s)
- L I Dvoretsky
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
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77
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Droghetti A, Fusco P, Marini M, Harizai F, Scimia P. Ultrasound‐guided serratus anterior plane block and parasternal block in cooperative sedation for S‐ICD implantation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1076-1078. [DOI: 10.1111/pace.13727] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 05/16/2019] [Accepted: 05/16/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | - Pierfrancesco Fusco
- Department of Anesthesia and Intensive Care UnitSan Salvatore Academic Hospital of L'Aquila L'Aquila Italy
| | | | - Fabiola Harizai
- Department of Anesthesia and Intensive Care UnitASST Cremona Cremona Italy
| | - Paolo Scimia
- Department of Anesthesia and Intensive Care UnitASST Cremona Cremona Italy
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Biffi M, Ziacchi M, Angeletti A, Castelli A, Massaro G, Martignani C, Lovecchio M, Valsecchi S, Diemberger I. Successful defibrillation verification in subcutaneous implantable cardioverter-defibrillator recipients by low-energy shocks. Clin Cardiol 2019; 42:612-617. [PMID: 30989668 PMCID: PMC6553357 DOI: 10.1002/clc.23184] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/05/2019] [Accepted: 04/13/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The subcutaneous implantable cardioverter-defibrillator (S-ICD) is an effective alternative to the transvenous one. Defibrillation efficacy depends on maximum device output and on the optimal device location at device implantation. HYPOTHESIS We sought to investigate the defibrillation safety margin in real life clinical practice. METHODS We sought to understand what is the efficacy of induced ventricular fibrillation (VF) termination at S-ICD implantation using lower energies than the recommended 65 J. RESULTS Sixty-four consecutive S-ICD recipients underwent VF termination attempts at implantation with energies ranging from 20 to 50 J. Overall, VF termination occurred in 84% of patients with ≤40 J, in 88% with 45 J, and in 100% with 60 J. Intermuscular S-ICD placement was associated with 94% VF termination at ≤40 J. An ejection fraction <35% was associated to higher energy requirement for defibrillation; however, an intermuscular S-ICD placement conferred 90% defibrillation efficacy at 31 ± 5 J in this patients subset. CONCLUSIONS This is a hypothesis-generating observation that prompts a methodologically correct investigation to prove that a 60 J output S-ICD can provide an adequate safety margin to terminate VF in clinical practice. This would enable superior device longevity and/or device downsizing for pediatric/small size patients.
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Affiliation(s)
- Mauro Biffi
- PoloCardio‐Toraco‐VascolareAzienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Matteo Ziacchi
- PoloCardio‐Toraco‐VascolareAzienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Andrea Angeletti
- PoloCardio‐Toraco‐VascolareAzienda Ospedaliero‐Universitaria di BolognaBolognaItaly
- Università di BolognaBolognaItaly
| | - Andrea Castelli
- PoloCardio‐Toraco‐VascolareAzienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Giulia Massaro
- PoloCardio‐Toraco‐VascolareAzienda Ospedaliero‐Universitaria di BolognaBolognaItaly
- Università di BolognaBolognaItaly
| | - Cristian Martignani
- PoloCardio‐Toraco‐VascolareAzienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | | | | | - Igor Diemberger
- PoloCardio‐Toraco‐VascolareAzienda Ospedaliero‐Universitaria di BolognaBolognaItaly
- Università di BolognaBolognaItaly
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79
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Chen CF, Jin CL, Liu MJ, Xu YZ. Efficacy, safety, and in-hospital outcomes of subcutaneous versus transvenous implantable defibrillator therapy: A meta-analysis and systematic review. Medicine (Baltimore) 2019; 98:e15490. [PMID: 31083185 PMCID: PMC6531055 DOI: 10.1097/md.0000000000015490] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Lead-related complication is an important drawback of trans-venous implantable cardioverter-defibrillators (TV-ICD). The subcutaneous ICD (S-ICD) was developed to overcome ICD lead associated complications; however, whether the S-ICD confers enhanced clinical benefits compared with TV-ICD remains unclear. The present systematic review and meta-analysis aimed to assess TV-ICD and S-ICD for safety, efficacy, and in-hospital outcomes in the prevention of sudden cardiac death (SCD) in patients not requiring pacing. METHODS The Medline, PubMed, EmBase, and Cochrane Library databases were searched for studies comparing TV-ICD and S-ICD. RESULTS A total of 9 eligible studies, including 5 propensity-matched case-control, 3 retrospective, and 1 cross-sectional studies were identified, assessing 7361 patients in all. Pool analyses demonstrated that SICD were associated with lower lead-related complication rates [odds ratio (OR) = 0.13; 95% confidence interval [CI] 0.05-0.33; I = 0%], and S-ICD was more beneficial in terms of reducing ICD shocks [OR = 0.48; 95% CI 0.32-0.72, I = 4%]. In addition, the patients administered S-ICD tend to have shorter length of hospital stay after implantation (SMD = -0.06; 95% CI -0.11 to 0.00, I = 0%) and reduce total complication rates (OR = 0.72; 95% CI 0.50-1.03; I = 18%), non-decreased quality of life (QoL). Moreover, both devices appeared to perform equally well with respect to infection rate and death. CONCLUSIONS Available overall data suggested that S-ICD is associated with reducing lead-related complications, ICD shocks. In addition, S-ICD has tendency to shorten hospitalization and reduce total complications, although the difference is no significant. Equivalent death rate, infection, and QoL were found between 2 groups. Therefore, S-ICD could be considered an alternative approach to TV-ICD in appropriate patients for SCD prevention.
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Affiliation(s)
- Chao-Feng Chen
- Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine
| | - Chao-Lun Jin
- Nanjing Medical University, Hangzhou, Zhejiang, China
| | - Mei-Jun Liu
- Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine
| | - Yi-Zhou Xu
- Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine
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80
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Amin AK, Gold MR, Burke MC, Knight BP, Rajjoub MR, Duffy E, Husby M, Stahl WK, Weiss R. Factors Associated With High-Voltage Impedance and Subcutaneous Implantable Defibrillator Ventricular Fibrillation Conversion Success. Circ Arrhythm Electrophysiol 2019; 12:e006665. [DOI: 10.1161/circep.118.006665] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Anish K. Amin
- Riverside Methodist Hospital, Upper Arlington, OH (A.K.A.)
| | | | | | - Bradley P. Knight
- Northwestern University Feinberg School of Medicine, Chicago, IL (B.P.K.)
| | - Moutie R. Rajjoub
- Division of Cardiovascular Medicine, Ohio State University Medical Center, Columbus (M.R.R., R.W.)
| | | | | | | | - Raul Weiss
- Division of Cardiovascular Medicine, Ohio State University Medical Center, Columbus (M.R.R., R.W.)
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81
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Bögeholz N, Willy K, Niehues P, Rath B, Dechering DG, Frommeyer G, Kochhäuser S, Löher A, Köbe J, Reinke F, Eckardt L. Spotlight on S-ICD™ therapy: 10 years of clinical experience and innovation. Europace 2019; 21:1001-1012. [DOI: 10.1093/europace/euz029] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 02/09/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Subcutaneous ICD (S-ICD™) therapy has been established in initial clinical trials and current international guideline recommendations for patients without demand for pacing, cardiac resynchronization, or antitachycardia pacing. The promising experience in ‘ideal’ S-ICD™ candidates increasingly encourages physicians to provide the benefits of S-ICD™ therapy to patients in clinical constellations beyond ‘classical’ indications of S-ICD™ therapy, which has led to a broadening of S-ICD™ indications in many centres. However, the decision for S-ICD™ implantation is still not covered by controlled randomized trials but rather relies on patient series or observational studies. Thus, this review intends to give a contemporary update on available empirical evidence data and technical advancements of S-ICD™ technology and sheds a spotlight on S-ICD™ therapy in recently discovered fields of indication beyond ideal preconditions. We discuss the eligibility for S-ICD™ therapy in Brugada syndrome as an example for an adverse and dynamic electrocardiographic pattern that challenges the S-ICD™ sensing and detection algorithms. Besides, the S-ICD™ performance and defibrillation efficacy in conditions of adverse structural remodelling as exemplified for hypertrophic cardiomyopathy is discussed. In addition, we review recent data on potential device interactions between S-ICD™ systems and other implantable cardio-active systems (e.g. pacemakers) including specific recommendations, how these could be prevented. Finally, we evaluate limitations of S-ICD™ therapy in adverse patient constitutions, like distinct obesity, and present contemporary strategies to assure proper S-ICD™ performance in these patients. Overall, the S-ICD™ performance is promising even for many patients, who may not be ‘classical’ candidates for this technology.
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Affiliation(s)
- Nils Bögeholz
- Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany
| | - Kevin Willy
- Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany
| | - Philipp Niehues
- Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany
| | - Benjamin Rath
- Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany
| | - Dirk G Dechering
- Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany
| | - Gerrit Frommeyer
- Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany
| | - Simon Kochhäuser
- Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany
| | - Andreas Löher
- Department of Cardiothoracic Surgery, University Hospital of Muenster, Muenster, Germany
| | - Julia Köbe
- Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany
| | - Florian Reinke
- Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany
| | - Lars Eckardt
- Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany
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82
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Quality and Safety in Health Care, Part XLIV. Clin Nucl Med 2019; 44:119-120. [DOI: 10.1097/rlu.0000000000002136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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83
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D'Onofrio A, Pieragnoli P, Biffi M, Nigro G, Migliore F, Francia P, De Filippo P, Capucci A, Botto GL, Giammaria M, Palmisano P, Pisanò E, Bisignani G, La Greca C, Sarubbi B, Sala S, Viscusi M, Landolina M, Lovecchio M, Valsecchi S, Bongiorni MG. Subcutaneous implantable cardioverter defibrillator implantation: An analysis of Italian clinical practice and its evolution. Int J Cardiol 2018; 272:162-167. [DOI: 10.1016/j.ijcard.2018.07.139] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 07/26/2018] [Accepted: 07/30/2018] [Indexed: 12/22/2022]
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84
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Migliore F, Pelliccia F, Autore C, Bertaglia E, Cecchi F, Curcio A, Bontempi L, Curnis A, De Filippo P, D’Onofrio A, Francia P, Maurizi N, Musumeci B, Proclemer A, Zorzi A, Corrado D. Subcutaneous implantable cardioverter defibrillator in cardiomyopathies and channelopathies. J Cardiovasc Med (Hagerstown) 2018; 19:633-642. [DOI: 10.2459/jcm.0000000000000712] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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85
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How the S-ICD (subcutaneous implantable cardiac defibrillator) senses cardiac signals to minimize cardiac over-sensing and maximize rhythm discrimination. J Electrocardiol 2018; 51:S38-S43. [DOI: 10.1016/j.jelectrocard.2018.08.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/27/2018] [Accepted: 08/15/2018] [Indexed: 11/18/2022]
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86
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Rogstad TL, Powell AC, Song Y, Cordier T, Price SE, Long JW, Deshmukh UU, Simmons JD. Determinants of outcomes following outpatient placement of implantable cardioverter defibrillators in a Medicare Advantage population. Clin Cardiol 2018; 41:1130-1135. [PMID: 30091205 DOI: 10.1002/clc.23041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 08/02/2018] [Accepted: 08/05/2018] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Recipients of ICD are likely to have several risk factors that could interfere with successful use of implantable cardioverter defibrillators (ICDs). HYPOTHESIS Age, sex, and factors indicated in claims are associated with one-year mortality and complications after ICD placement. METHODS Adult Medicare Advantage patients who underwent outpatient ICD implantation from January 2014 to September 2015 were included. Age, sex, Charlson Comorbidity Index (CCI), prior year hospitalization and emergency department (ED) visit, diabetes, heart failure, ischemic heart disease, and indicators of the need for pacing were evaluated as risk factors. Mortality and device-related complications (lead and nonlead) were assessed at one-year post-procedure using Kaplan-Meier and Cox Proportional Hazard analysis. RESULTS Among 8450 patients who underwent implantation, 1-year event-free survival was 80.1%, based on an overall composite measure of complications and mortality. Adjusted survival analysis showed that age ≥ 65, male sex, incremental increase in CCI, heart failure, prior year hospitalization, ED visit, and prior year pacing procedure were significant predictors of mortality. Age ≥ 65, male sex, and prior year hospitalization were significant predictors of a composite measure of device-related complications. CCI and prior hospitalization were significant predictors of a composite measure of any adverse outcome. CONCLUSIONS Results suggest most patients in an older population do not experience adverse outcomes in the year following ICD implantation. The risk of mortality may be greater in men, patients over the age of 65, and patients with greater general morbidity, heart failure, or a history of a pacing procedure.
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87
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Abstract
PURPOSE OF REVIEW Clear guidelines on when to select a subcutaneous ICD (S-ICD) over a transvenous ICD (TV-ICD) are lacking. This review will provide an overview of the most recent clinical data on S-ICD and TV-ICD therapy by pooling comparison studies in order to aid clinical decision making. RECENT FINDINGS Pooling of observational-matched studies demonstrated an incidence rate ratio (IRR) for device-related complication of 0.90 (95% CI 0.58-1.42) and IRR for lead-related complications of 0.15 (95% CI 0.06-0.39) in favor of S-ICD. The IRR for device infections was 2.00 (95% CI 0.95-4.22) in favor of TV-ICD. Both appropriate shocks (IRR 0.67 (95% CI 0.42-1.06)) and inappropriate shocks (IRR 1.17 (95% CI 0.77-1.79)) did not differ significantly between both groups. With randomized data underway, the observational data demonstrate that the S-ICD is associated with reduced lead complications, but this has not yet resulted in a significant reduction in total number of complications compared to TV-ICDs. New technologies are expected to make the S-ICD a more attractive alternative.
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Affiliation(s)
- S. W. E. Baalman
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Medical Center, University of Amsterdam, PO Box 22700, 1100 Amsterdam, DE The Netherlands
| | - A. B. E. Quast
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Medical Center, University of Amsterdam, PO Box 22700, 1100 Amsterdam, DE The Netherlands
| | - T. F. Brouwer
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Medical Center, University of Amsterdam, PO Box 22700, 1100 Amsterdam, DE The Netherlands
| | - R. E. Knops
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Medical Center, University of Amsterdam, PO Box 22700, 1100 Amsterdam, DE The Netherlands
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88
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Implantation of the subcutaneous implantable cardioverter–defibrillator with truncal plane blocks. Heart Rhythm 2018; 15:1108-1111. [DOI: 10.1016/j.hrthm.2018.02.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Indexed: 11/22/2022]
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89
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Harolds JA. Quality and Safety in Health Care, Part XLII: Introduction to the Implantable Cardioverter Defibrillator Registry. Clin Nucl Med 2018; 43:818-819. [PMID: 29939951 DOI: 10.1097/rlu.0000000000002121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Implantable cardioverter defibrillators for both primary and secondary prevention have been successful in decreasing sudden cardiac death. The Implantable Cardioverter Defibrillator Registry was established partly for reimbursement for primary prevention. However, the registry also has been helpful in better understanding the risks and appropriate selection of patients to receive these devices, serving as an impetus for quality improvement by giving outcome information to the contributing institutions regarding their performance relative to the national results, and increasing research. It is also expected to be helpful to compare results from different devices and provide information to the public.
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Affiliation(s)
- Jay A Harolds
- From Advanced Radiology Services and the Division of Radiology and Biomedical Imaging, College of Human Services, Michigan State University, Grand Rapids, MI
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90
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Bettin M, Rath B, Ellermann C, Leitz P, Reinke F, Köbe J, Eckardt L, Frommeyer G. Follow-up of the first patients with a totally subcutaneous ICD in Germany from implantation till battery depletion. Clin Res Cardiol 2018; 108:16-21. [DOI: 10.1007/s00392-018-1296-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 06/11/2018] [Indexed: 10/14/2022]
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91
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Peddareddy L, Merchant FM, Leon AR, Smith P, Patel A, El-Chami MF. Effect of defibrillation threshold testing on effectiveness of the subcutaneous implantable cardioverter defibrillator. Pacing Clin Electrophysiol 2018; 41:996-1000. [PMID: 29893508 DOI: 10.1111/pace.13416] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/08/2018] [Accepted: 06/05/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Defibrillation threshold (DFT) testing is recommended with the subcutaneous implantable cardioverter defibrillator (SICD). OBJECTIVE To describe first shock efficacy for appropriate SICD therapies stratified by the presence of implant DFT testing. METHODS We reviewed all patients receiving SICDs at our institution and stratified them based on whether implant DFT testing was performed. Appropriate shocks were reviewed to see if ventricular tachycardia/ventricular fibrillation (VT/VF) terminated with a single shock. First shock efficacy was stratified by implant DFT status. RESULTS 178 patients implanted with SICDs and followed in our center were included in this study. Of these, 135 (76%) underwent DFT testing (DFT (+) group). In the DFT (+), 80 appropriate shocks were needed to treat 69 episodes of VT/VF. The first shock was effective in 61 out of 69 episodes (88.4%), whereas multiple shocks were required to terminate VT/VF in the remaining eight episodes. Among 43 patients without implant DFT testing (DFT (-) group), 20 appropriate shocks to treat 17 episodes of VT/VF occurred in seven patients. VT/VF was successfully terminated with the first shock in 16 out of 17 episodes (first shock efficacy 94.1 %). There was no significant difference in first shock effectiveness between those with and without implant DFT testing (P = 0.97). CONCLUSION A strategy that omits DFT testing at implant did not appear to compromise the effectiveness of the SICD. These data suggest that routine DFT testing at SICD implant might not be necessary. Randomized trials are needed to confirm this finding.
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Affiliation(s)
| | - Faisal M Merchant
- Emory University School of Medicine, Department of Medicine, Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Angel R Leon
- Emory University School of Medicine, Department of Medicine, Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Paige Smith
- Emory University School of Medicine, Atlanta, GA, USA
| | | | - Mikhael F El-Chami
- Emory University School of Medicine, Department of Medicine, Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, GA, USA
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92
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Essandoh MK, Mark GE, Aasbo JD, Joyner CA, Sharma S, Decena BF, Bolin ED, Weiss R, Burke MC, McClernon TR, Daoud EG, Gold MR. Anesthesia for subcutaneous implantable cardioverter‐defibrillator implantation: Perspectives from the clinical experience of a U.S. panel of physicians. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:807-816. [DOI: 10.1111/pace.13364] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 02/25/2018] [Accepted: 03/18/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Michael K. Essandoh
- Department of AnesthesiologyThe Ohio State University Wexner Medical Center Columbus OH USA
| | - George E. Mark
- Department of CardiologyCooper University Hospital Camden NJ USA
| | - Johan D. Aasbo
- The Heart Institute of ProMedica Toledo Hospital Toledo OH USA
| | - Charles A Joyner
- Department of CardiologyLevinson Heart Hospital at Chippenham and Johnston Willis Medical Center Richmond VA USA
| | - Saumya Sharma
- Department of ElectrophysiologyMcGovern Medical School ‐ University of Texas Health Science Center Houston TX USA
| | - Beningo F Decena
- Department of CardiologyTucson Medical Center and Northwest Medical Center Tucson AZ USA
| | - Eric D Bolin
- Department of Anesthesia and Perioperative MedicineMedical University of South Carolina Charleston SC USA
| | - Raul Weiss
- Division of Cardiovascular Medicine, Department of Internal MedicineThe Ohio State University Wexner Medical Center Columbus OH USA
| | | | | | - Emile G. Daoud
- Division of Cardiovascular Medicine, Department of Internal MedicineThe Ohio State University Wexner Medical Center Columbus OH USA
| | - Michael R. Gold
- Division of CardiologyMedical University of South Carolina Charleston SC USA
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93
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Kaya E, Wakili R, Rassaf T. [Journey of the S‑ICD to first-line therapy]. Herzschrittmacherther Elektrophysiol 2018; 29:228-232. [PMID: 29761338 DOI: 10.1007/s00399-018-0559-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/03/2018] [Indexed: 06/08/2023]
Abstract
The subcutaneous implantable cardioverter-defibrillator (S-ICD®, Boston Scientific, Marlborough, MA, USA, previously Cameron Health, San Clemente, CA, USA) represents an important milestone in ICD therapy for prevention of sudden cardiac death (SCD). Since the introduction of the S‑ICD in 2010, the device has undergone further development. Based on the unique feature of an entirely extracardiac implantation, the S‑ICD is able to reduce the common perioperative and long-term complications of the usual endovascular implanted ICD systems. Especially for patients with a complex anatomy and no option of an endovascular lead implantation, the S‑ICD offers a potential alternative. Regarding the initial uncertainty if this innovative ICD approach is actually reliable in detecting and terminating ventricular arrhythmias has been resolved by multiple clinical studies and trials providing evidence for an effective treatment. Based on the obvious advantages compared to conventional ICD systems, the question arises if the S‑ICD should actually be the first choice in the majority of all primary prevention patients in the future. Furthermore, recent data from large registries show that S‑ICD indications are also expanding in secondary prevention patients. As a consequence the S‑ICD was listed in the 2015 ESC guidelines as an alternative therapeutic option with a class IIa recommendation in patients with an ICD indication not requiring pacing for bradycardia, cardiac resynchronization therapy or anti-tachycardia pacing (ATP). In addition, the American Heart Association guidelines refer to class I recommendation for patients with a complex anatomy and venous access problems or at a high risk for infections who need ICD therapy. Limitations with respect to the not available pacing option of S‑ICD might be also overcome by a potential combination with a leadless pacemaker in the near future. This article provides an overview of recent developments of the S‑ICD and reviews the most recent literature and ongoing studies.
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Affiliation(s)
- Elif Kaya
- Klinik für Kardiologie und Angiologie, Westdeutsches Herz- und Gefäßzentrum Essen, Universitätsmedizin Essen, Hufelandstraße 55, 45147, Essen, Deutschland.
| | - Reza Wakili
- Klinik für Kardiologie und Angiologie, Westdeutsches Herz- und Gefäßzentrum Essen, Universitätsmedizin Essen, Hufelandstraße 55, 45147, Essen, Deutschland
| | - Tienush Rassaf
- Klinik für Kardiologie und Angiologie, Westdeutsches Herz- und Gefäßzentrum Essen, Universitätsmedizin Essen, Hufelandstraße 55, 45147, Essen, Deutschland
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Sheldon SH, Cunnane R, Lavu M, Parikh V, Atkins D, Reddy YM, Berenbom LD, Emert MP, Pimentel R, Dendi R, Lakkireddy DR. Perioperative hematoma with subcutaneous ICD implantation: Impact of anticoagulation and antiplatelet therapies. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:799-806. [DOI: 10.1111/pace.13349] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 03/05/2018] [Accepted: 03/25/2018] [Indexed: 02/07/2023]
Affiliation(s)
- Seth H. Sheldon
- Division of Cardiovascular DiseasesUniversity of Kansas Medical Center Kansas City KS USA
| | - Ryan Cunnane
- Division of Cardiovascular DiseasesUniversity of Michigan Ann Arbor MI USA
| | - Madhav Lavu
- Division of Cardiovascular DiseasesUniversity of Kansas Medical Center Kansas City KS USA
| | - Valay Parikh
- Division of Cardiovascular DiseasesUniversity of Kansas Medical Center Kansas City KS USA
| | - Donita Atkins
- Division of Cardiovascular DiseasesUniversity of Kansas Medical Center Kansas City KS USA
| | - Yeruva Madhu Reddy
- Division of Cardiovascular DiseasesUniversity of Kansas Medical Center Kansas City KS USA
| | - Loren D. Berenbom
- Division of Cardiovascular DiseasesUniversity of Kansas Medical Center Kansas City KS USA
| | - Martin P. Emert
- Division of Cardiovascular DiseasesUniversity of Kansas Medical Center Kansas City KS USA
| | - Rhea Pimentel
- Division of Cardiovascular DiseasesUniversity of Kansas Medical Center Kansas City KS USA
| | - Raghuveer Dendi
- Division of Cardiovascular DiseasesUniversity of Kansas Medical Center Kansas City KS USA
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95
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Brouwer TF, Knops RE, Kutyifa V, Barr C, Mondésert B, Boersma LVA, Lambiase PD, Wold N, Jones PW, Healey JS. Propensity score matched comparison of subcutaneous and transvenous implantable cardioverter-defibrillator therapy in the SIMPLE and EFFORTLESS studies. Europace 2018; 20:f240-f248. [DOI: 10.1093/europace/euy083] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/26/2018] [Indexed: 01/21/2023] Open
Affiliation(s)
- Tom F Brouwer
- Department of Clinical and Experimental Cardiology, Heart Center, Academic Medical Center, University of Amsterdam, 1100 DE Amsterdam, The Netherlands
| | - Reinoud E Knops
- Department of Clinical and Experimental Cardiology, Heart Center, Academic Medical Center, University of Amsterdam, 1100 DE Amsterdam, The Netherlands
| | | | - Craig Barr
- Department of Cardiology, Russells Hall Hospital, Dudley, UK
| | | | - Lucas V A Boersma
- Department of Cardiology, St Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | - Pier D Lambiase
- Institute of Cardiovascular Science, The Heart Hospital, University College London, London, UK
| | | | - Paul W Jones
- Boston Scientific Corporation, Minneapolis, MN, USA
| | - Jeffrey S Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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96
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Koneru JN, Jones PW, Hammill EF, Wold N, Ellenbogen KA. Risk Factors and Temporal Trends of Complications Associated With Transvenous Implantable Cardiac Defibrillator Leads. J Am Heart Assoc 2018; 7:JAHA.117.007691. [PMID: 29748177 PMCID: PMC6015312 DOI: 10.1161/jaha.117.007691] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background The transvenous implantable cardioverter‐defibrillator (ICD) lead is the most common source of complications in a traditional ICD system. This investigation aims to determine the incidence, predictors, and costs associated with these complications using a large insurance database. Methods and Results Data from the OptumLabs™ Data Warehouse, which include diagnosis, physician and procedure codes, and claims from patient hospitalizations, were analyzed. Patients with a de novo ICD or cardiac resynchronization therapy defibrillator implanted from January 1, 2003, through June 30, 2015, were included; those who did not have continuous coverage beginning 1 year before implantation were excluded, resulting in 40 837 patients followed up over an average of 2.3±2.1 years. Patients were followed up until they had the procedure or their last active date in the database. Of 20 580 device procedures, 2165 (5.3%) and 771 (1.9%) had mechanical and infectious complications, respectively. The 5‐year rate of freedom from mechanical complication was 92.0% and 89.3% for ICDs and cardiac resynchronization therapy defibrillators, respectively. Infectious complications were more likely in patients with a history of atrial fibrillation, diabetes mellitus, and renal disease, and the risk increased with subsequent device procedures. Younger age, female sex, lack of comorbidities, and implantations between 2003 and 2008 were associated with more mechanical complications. Conclusions Incidence of mechanical and infectious complications of transvenous ICD leads over long‐term follow‐up is much higher in the real world than in clinical studies. In our study cohort, 1 of 4 transvenous ICD leads had mechanical complications when followed up to 10 years. The high rate of reintervention leads to additional complications.
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Affiliation(s)
- Jayanthi N Koneru
- VCU School of Medicine, Medical College of Virginia Hospitals, Richmond, VA
| | - Paul W Jones
- Boston Scientific, Marlborough, MA.,OptumLabs, Cambridge, MA
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97
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Khazen C, Magnusson P, Flandorfer J, Schukro C. The subcutaneous implantable cardioverter-defibrillator: A tertiary center experience. Cardiol J 2018; 26:543-549. [PMID: 29718532 DOI: 10.5603/cj.a2018.0050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 03/05/2018] [Accepted: 04/02/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The aim of the study was to evaluate subcutaneous implantable cardioverter-defibrillator (S-ICD) patients with regard to underlying etiology, peri-procedural outcome, appropriate/inappropriate shocks, and complications during follow-up. METHODS All patients who underwent S-ICD implantation from February 2013 to March 2017 at an academic hospital in Vienna were included. Medical records were examined and follow-up interrogations of devices were conducted. RESULTS A total of 79 S-ICD patients (58.2% males) with a mean age of 44.5 ± 17.2 years were followed for a mean duration of 12.8 ± 13.7 months. A majority of patients (58.2%) had S-ICD for primary prevention of sudden cardiac death. The most common of the 16 underlying etiologies were ischemic cardiomyopathy, non-ischemic cardiomyopathy, and idiopathic ventricular fibrillation. The lead was implanted to the left sternal border in 96.2% of cases, between muscular layers in 72.2%. Mean implant time was 45 min, 3 patients were induced, and all patients except one were programmed to two zones. Six (7.6%) patients experienced at least one appropriate therapy for ventricular arrhythmias and the time to first event ranged from 1 to 52 months. Seven patients experienced inappropriate shocks due to T-wave oversensing, atrial tachycardia with rapid atrioventricular conduction, external electromagnetic interference, and/or baseline oversensing due to lead movement. Four patients underwent revision for lead repositioning (n = 1), loose device suture (n = 1), and infection (n = 2). CONCLUSIONS While S-ICDs are a feasible and effective treatment, issues remain with inappropriate shock and infection.
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Affiliation(s)
- Cesar Khazen
- Department of Surgery, Medical University of Vienna, Division of Cardiac Surgery, Vienna, Austria, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Peter Magnusson
- Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden.
| | | | - Christoph Schukro
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria, Austria
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98
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Patton KK. Anesthesia and SICD implantation-When less (invasive) may be more. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:817-819. [PMID: 29718581 DOI: 10.1111/pace.13360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 04/21/2018] [Accepted: 04/24/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Kristen K Patton
- Division of Cardiology, University of Washington, Seattle, WA, USA
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99
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Grabowski M, Gawałko M, Michalak M, Cacko A, Kowara M, Kołodzińska A, Januszkiewicz Ł, Balsam P, Vitali Serdoz L, Winter J, Opolski G. Initial experience with the subcutaneous implantable cardioverter-defibrillator with the real costs of hospitalization analysis in a single Polish center. Cardiol J 2018; 26:360-367. [PMID: 29611175 DOI: 10.5603/cj.a2018.0024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 02/11/2018] [Accepted: 02/12/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The recent introduction of an entirely subcutaneous implantable cardioverter-defibril-lator (S-ICD) represents an important progress in the defibrillation technology towards a less invasive approach. This is a single-center observational study of S-ICD implantations in Poland. METHODS The S-ICD was implanted in 11 patients with standard indications for an ICD. Patients in whom the device was implanted were evaluated for adverse events and device function at hospital discharge. All hospitalization costs were calculated and summed up for all patients. Costs were divided into following categories: medical materials, pharmaceuticals, operating theatre staff, cardiology depart-ment staff, laboratory tests, non-laboratory tests and additional non-medical costs. RESULTS The mean age of patients was 51.6 ± 16.4 years, 9 were men and 2 were women. Four pa-tients had atrial fibrillation as the basal rhythm, 1 patient had atrial flutter and 6 patients had sinus rhythm. All patients had at least one condition that precluded the use of a traditional ICD system or the S-ICD was preferred due to other conditions, i.e. a history complicated transvenous ICD therapy (18%), anticipated higher risk of infection (27%), lack or difficult vascular access (18%), young age and anticipated high cumulated risk of lifetime device therapy (36%). The mean duration of the im-plantation procedure was 2 h. One patient developed a postoperative pocket hematoma. Mean total time of hospitalization was 28 (6-92) days. Average cost of hospitalization per patient was 21,014.29 EUR (minimal = 19,332.71 EUR and maximal = 24,824.14 EUR). CONCLUSIONS S-ICD implantation appears to provide a viable alternative to transvenous ICD, espe-cially for patients without pacing requirements.
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Affiliation(s)
- Marcin Grabowski
- 1st Department of Cardiology, Medical University of Warsaw, Poland.
| | - Monika Gawałko
- 1st Department of Cardiology, Medical University of Warsaw, Poland
| | - Marcin Michalak
- 1st Department of Cardiology, Medical University of Warsaw, Poland
| | - Andrzej Cacko
- 1st Department of Cardiology, Medical University of Warsaw, Poland
| | - Michał Kowara
- 1st Department of Cardiology, Medical University of Warsaw, Poland.,Chair and Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Poland
| | | | | | - Paweł Balsam
- 1st Department of Cardiology, Medical University of Warsaw, Poland
| | | | - Joachim Winter
- Division of Cardiac Surgery, University of Düsseldorf, Germany
| | - Grzegorz Opolski
- 1st Department of Cardiology, Medical University of Warsaw, Poland
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100
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McNamara C, Daoud EG, Gorelik L, Sipes A, Tyler JD, Essandoh M. Refractory Heart Failure After Failed Subcutaneous Implantable Cardioverter-Defibrillator Defibrillation Testing: The Potential Value of Early Mechanical Circulatory Support. J Cardiothorac Vasc Anesth 2018; 32:942-944. [DOI: 10.1053/j.jvca.2017.05.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Indexed: 11/11/2022]
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