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Bettin M, Dechering D, Frommeyer G, Larbig R, Löher A, Reinke F, Köbe J, Eckardt L. Right versus left parasternal electrode position in the entirely subcutaneous ICD. Clin Res Cardiol 2017; 107:389-394. [PMID: 29285623 DOI: 10.1007/s00392-017-1194-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 12/19/2017] [Indexed: 01/20/2023]
Abstract
OBJECTIVES The subcutaneous implantable cardioverter defibrillator (S-ICD®) has been established as an alternative to conventional transvenous ICD for the prevention of sudden cardiac death. Initial studies have shown safety and efficacy of the system with a left parasternal (LP) electrode. However, several case studies reported a right parasternal (RP) position. The purpose of this study was to analyze shock efficacy and safety of an RP electrode position. METHODS Between June 2010 and May 2016, 120 S-ICD® were implanted at our institution. On the basis of the heart location on preoperative chest radiography (CXR), the investigators decided on an RP (n = 52) or LP electrode position (n = 68). All perioperative induced VF episodes, and spontaneous appropriate and inappropriate episodes during follow-up were analyzed. RESULTS Patients with an RP electrode did not differ in terms of age, sex, or ejection fraction. A statistically significant difference in underlying cardiac disease was observed between the RP and LP electrode group, with more patients with channelopathies in the RP electrode group and more patients with non-ischemic cardiomyopathy in the LP electrode group. During a mean follow-up of 24.3 ± 19.5 months, 27 appropriate (19 in the LP group and 8 in the RP group) and 28 inappropriate (18 LP and 10 RP) ICD shocks occurred (p value = NS). CONCLUSIONS In the present study, an RP electrode position was chosen on the basis of chest radiographic characteristics and was efficient in terms of sensing and shock efficacy. Thus, a right-sided electrode implant might be an alternative if a left-sided electrode implant is inadequate. It might also be favorable for young patients with narrow heart silhouettes in the midsagittal position.
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Affiliation(s)
- Markus Bettin
- Division of Clinical and Experimental Electrophysiology, Department of Cardiology and Angiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany.
| | - Dirk Dechering
- Division of Clinical and Experimental Electrophysiology, Department of Cardiology and Angiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
| | - Gerrit Frommeyer
- Division of Clinical and Experimental Electrophysiology, Department of Cardiology and Angiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
| | - Robert Larbig
- Division of Clinical and Experimental Electrophysiology, Department of Cardiology and Angiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
| | - Andreas Löher
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University Hospital Münster, Münster, Germany
| | - Florian Reinke
- Division of Clinical and Experimental Electrophysiology, Department of Cardiology and Angiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
| | - Julia Köbe
- Division of Clinical and Experimental Electrophysiology, Department of Cardiology and Angiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
| | - Lars Eckardt
- Division of Clinical and Experimental Electrophysiology, Department of Cardiology and Angiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
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Moubarak G, Maison-Blanche P, Thomas O. Eligibility of cardiac resynchronization therapy patients for subcutaneous implantable cardioverter defibrillators. J Electrocardiol 2017; 51:531-533. [PMID: 29273233 DOI: 10.1016/j.jelectrocard.2017.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Indexed: 10/18/2022]
Abstract
The eligibility for subcutaneous implantable cardioverter-defibrillators (S-ICD) was assessed among patients already implanted with cardiac resynchronization therapy (CRT). We included 20 patients (15 men, age 73±10years, LVEF 35±10%). Seventeen (85%) patients were eligible for S-ICDs: 11 (55%) patients on only 1 vector and 6 (30%) patients on 2 or 3 vectors. Patients who were eligible on 2-3 vectors had narrower paced QRS than patients who were not eligible or were eligible on only one vector (133±18ms vs 167±17ms, p=0.007). If necessary, S-ICD implantation could be considered in most patients with CRT.
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Affiliation(s)
- Ghassan Moubarak
- Department of Electrophysiology and Pacing, Centre Médico-Chirurgical Ambroise Paré, Neuilly-sur-Seine, France.
| | - Pierre Maison-Blanche
- Department of Electrophysiology and Pacing, Centre Médico-Chirurgical Ambroise Paré, Neuilly-sur-Seine, France
| | - Olivier Thomas
- Department of Electrophysiology and Pacing, Centre Médico-Chirurgical Ambroise Paré, Neuilly-sur-Seine, France
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53
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Subcutaneous Versus Transvenous Implantable Defibrillator Therapy. JACC Clin Electrophysiol 2017; 3:1475-1483. [DOI: 10.1016/j.jacep.2017.07.017] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 06/19/2017] [Accepted: 07/20/2017] [Indexed: 11/22/2022]
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Abstract
The transvenous implantable cardioverter-defibrillator (ICD) has been shown in multiple studies to be effective in the prevention of sudden cardiac death in select populations. The Achilles heel of traditional ICD technology has been the transvenous lead. The subcutaneous ICD provides effective sudden death protection while avoiding lead-related complications of traditional transvenous systems. The subcutaneous ICD is a reasonable option for patients with an ICD indication who do not need bradycardia pacing or cardiac resynchronization therapy.
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Affiliation(s)
- Jonathan Weinstock
- Division of Cardiology, Cardiac Arrhythmia Center, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA.
| | - Christopher Madias
- Division of Cardiology, Cardiac Arrhythmia Center, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
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55
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Rudic B, Tülümen E, Berlin V, Röger S, Stach K, Liebe V, El-Battrawy I, Dösch C, Papavassiliu T, Akin I, Borggrefe M, Kuschyk J. Low Prevalence of Inappropriate Shocks in Patients With Inherited Arrhythmia Syndromes With the Subcutaneous Implantable Defibrillator Single Center Experience and Long-Term Follow-Up. J Am Heart Assoc 2017; 6:e006265. [PMID: 29042423 PMCID: PMC5721842 DOI: 10.1161/jaha.117.006265] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 08/16/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Up to 40% of patients with transvenous implantable cardioverter-defibrillator (ICD) experience lead-associated complications and may suffer from high complication rates when lead extraction is indicated. Subcutaneous ICD may represent a feasible alternative; however, the efficacy of the subcutaneous ICD in the detection and treatment of ventricular arrhythmias in patients with hereditary arrhythmia syndromes has not been fully evaluated. METHODS AND RESULTS Patients with primary hereditary arrhythmia syndromes who fulfilled indication for defibrillator placement were eligible for enrollment. Between 2010 and 2016, 62 consecutive patients with primary hereditary arrhythmia syndromes, without indication for antibradycardia therapy, were enrolled in the study. Mean follow-up was 31.0±14.2 months. The study cohort comprised of 24 patients with Brugada syndrome, 17 with idiopathic ventricular fibrillation, 6 with long-QT syndrome, 1 with short-QT syndrome, 3 with catecholaminergic polymorphic ventricular tachycardia, 8 with hypertrophic cardiomyopathy, and 3 with arrhythmogenic right ventricular cardiomyopathy. Thirty-nine patients were implanted for secondary prevention. Twenty-two patients had a previous transvenous ICD implanted, but required revision because of infection or lead defects. A total of 20 spontaneous ventricular tachyarrhythmias requiring shock intervention occurred in 10 patients during follow-up. All episodes were terminated within the first ICD shock delivery with 80 J. Two patients had inappropriate therapies caused by oversensing following an uneventful implantation. No pocket-site infections and no premature revisions have occurred during follow-up. CONCLUSIONS Our study supports the use of the subcutaneous ICD for both secondary and primary prevention of sudden cardiac death as a reliable alternative to the conventional transvenous ICD.
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Affiliation(s)
- Boris Rudic
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Erol Tülümen
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Veronika Berlin
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Susanne Röger
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Ksenija Stach
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Volker Liebe
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Ibrahim El-Battrawy
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Christina Dösch
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Theano Papavassiliu
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Martin Borggrefe
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Jürgen Kuschyk
- Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
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Nishii N, Tachibana M, Morimoto Y, Kawada S, Miyoshi A, Sugiyama H, Nakagawa K, Watanabe A, Nakamura K, Morita H, Ito H. Initial experience with the subcutaneous implantable cardioverter-defibrillator in a single Japanese center. J Arrhythm 2017; 33:338-341. [PMID: 28765769 PMCID: PMC5529595 DOI: 10.1016/j.joa.2017.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 01/23/2017] [Accepted: 02/19/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The subcutaneous implantable cardioverter-defibrillator (S-ICD) is recognized as a viable alternative to the transvenous ICD. The safety and efficacy of this device has been demonstrated in Western countries, but studies with S-ICD implantation in Japanese patients have not been reported. METHODS AND RESULTS Twelve patients received an S-ICD implant in our institute between February and September 2016. All S-ICDs were successfully implanted without complications. One appropriate and one inappropriate therapy was identified. CONCLUSIONS S-ICD implantation appears to provide a viable alternative to transvenous ICD implantation for some Japanese patients. However, we should perform careful follow-up of patients to eliminate inappropriate therapy.
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Affiliation(s)
- Nobuhiro Nishii
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Motomi Tachibana
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Yoshimasa Morimoto
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Satoshi Kawada
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Akihito Miyoshi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroyasu Sugiyama
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Koji Nakagawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Atsuyuki Watanabe
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroshi Morita
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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57
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Thomas VC, Peterson M, McDaniel M, Restrepo H, Rothman A, Jain A. Analysis of Screening Electrocardiogram for the Subcutaneous Defibrillator in Adults with Congenital Heart Disease. Pediatr Cardiol 2017; 38:1162-1168. [PMID: 28534239 DOI: 10.1007/s00246-017-1635-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 05/13/2017] [Indexed: 01/04/2023]
Abstract
Candidates for the subcutaneous implantable cardioverter-defibrillator (S-ICD) are screened using an electrocardiogram (S-ECG) tool to measure appropriate detection. We sought to define the S-ICD candidacy of congenital heart disease patients using the S-ECG tool. We also analyzed the reliability of the (S-ECG) tool between measurers in this population. Patients above the age of 12 and with a diagnosis associated with either a higher incidence of cardiac arrest or vascular access challenges were asked to undergo screening. S-ECGs were then analyzed by a pediatric electrophysiologist, an S-ICD device engineer, and an S-ICD clinical representative for candidacy. Results were compared for interobserver variability and S-ECGs were analyzed by t test to determine variables that differ among passing and failing leads. Thirty-one patients underwent screening. Two of the 31 (6.5%) patients failed S-ICD screening. Analysis of the screening leads demonstrated the highest passing rates using lead III at a 5 mm/mV amplitude setting with 71 and 62% pass rate in the supine and standing positions, respectively. Interobserver analysis correlated well among the three measurers. There was a higher amplitude difference between QRS and T waves among passing versus failing S-ECG. Congenital heart disease patients have acceptable passage rates utilizing the S-ECG algorithm. Interobserver measurements were well correlated and these data suggest that the proximal coil to device (lead III) vector would be best utilized in this patient population. A larger difference between QRS and T wave amplitudes was associated with a higher S-ECG passing rate.
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Affiliation(s)
- Vincent C Thomas
- University of Nebraska Medical Center, Children's Hospital and Medical Center, 8200 Dodge Street, Omaha, NE, 68164, USA.
| | | | | | | | - Abraham Rothman
- Children's Heart Center Nevada, Las Vegas, NV, USA
- University of Nevada School of Medicine, Reno, NV, USA
| | - Amit Jain
- University of Nevada School of Medicine, Reno, NV, USA
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NISHIYAMA TAKAHIKO, KIMURA TAKEHIRO, NISHIYAMA NOBUHIRO, AIZAWA YOSHIYASU, FUKUDA KEIICHI, TAKATSUKI SEIJI. Discrimination between QRS and T Waves Using a Right Parasternal Lead for S-ICD in a Patient with a Single Ventricle. Pacing Clin Electrophysiol 2017; 40:904-907. [DOI: 10.1111/pace.13046] [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: 10/10/2016] [Revised: 12/19/2016] [Accepted: 01/30/2017] [Indexed: 12/01/2022]
Affiliation(s)
- TAKAHIKO NISHIYAMA
- Department of Cardiology; Keio University School of Medicine; Tokyo Japan
| | - TAKEHIRO KIMURA
- Department of Cardiology; Keio University School of Medicine; Tokyo Japan
| | - NOBUHIRO NISHIYAMA
- Department of Cardiology; Keio University School of Medicine; Tokyo Japan
| | - YOSHIYASU AIZAWA
- Department of Cardiology; Keio University School of Medicine; Tokyo Japan
| | - KEIICHI FUKUDA
- Department of Cardiology; Keio University School of Medicine; Tokyo Japan
| | - SEIJI TAKATSUKI
- Department of Cardiology; Keio University School of Medicine; Tokyo Japan
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Ferrero P, Ali H, Barman P, Foresti S, Lupo P, D’Elia E, Cappato R, Stuart AG. Entirely subcutaneous defibrillator and complex congenital heart disease: Data on long-term clinical follow-up. World J Cardiol 2017; 9:547-552. [PMID: 28706590 PMCID: PMC5491472 DOI: 10.4330/wjc.v9.i6.547] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 01/31/2017] [Accepted: 05/24/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To describe the long-term follow-up of patients with complex congenital heart disease who underwent subcutaneous implantable cardiac defibrillator (S-ICD), focusing on local complications, appropriate and inappropriate shocks.
METHODS Patients with complex congenital heart disease underwent S-ICD implant in two centers with the conventional technique. Data at follow-up were retrieved from clinical notes and institutional database.
RESULTS Eight patients were implanted in two centres between 2010 and 2016. Median age at implant was 37.5 years (range 13-57). All patients who were deemed suitable for S-ICD implant passed the pre-procedural screening. Three patients were previously implanted with a anti-bradycardia device, one of whom with CRT. In one patient the device was explanted due to local infection. During the total median follow-up of 874 d, one patient had an appropriate and one inappropriate shock triggered by fast atrial tachycardia. None of the patients had inappropriate shocks secondary to T wave oversensing or electrical interference with anti- bradycardia devices.
CONCLUSION S-ICD appears to be effective and safe in patients with complex congenital heart disease.
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60
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Osswald B. Subkutane implantierbare Kardioverter-Defibrillatoren. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2017. [DOI: 10.1007/s00398-016-0128-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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61
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RAVIELE ANTONIO, ROSSILLO ANTONIO. Combined Use of Subcutaneous ICD and Pacemakers: The Beginning of a New Era? J Cardiovasc Electrophysiol 2017; 28:549-551. [DOI: 10.1111/jce.13196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- ANTONIO RAVIELE
- ALFA-Alliance to Fight Atrial fibrillation; Venice-Mestre Italy
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Srinivasan NT, Patel KH, Qamar K, Taylor A, Bacà M, Providência R, Tome-Esteban M, Elliott PM, Lambiase PD. Disease Severity and Exercise Testing Reduce Subcutaneous Implantable Cardioverter-Defibrillator Left Sternal ECG Screening Success in Hypertrophic Cardiomyopathy. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.117.004801. [DOI: 10.1161/circep.117.004801] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 03/07/2017] [Indexed: 01/15/2023]
Abstract
Background—
The features of the hypertrophic cardiomyopathy (HCM) ECG make it a challenge for subcutaneous implantable cardioverter-defibrillator (S-ICD) screening. We aimed to investigate the causes of screening failure at rest and on exercise to inform optimal S-ICD ECG vector development.
Methods and Results—
One hundred and thirty-one HCM patients (age, 50±16 years; 92 males and 39 females) with ≥1 HCM risk factor for sudden death underwent S-ICD ECG screening at rest and on exercise. Fifty patients (38%) were ineligible for S-ICD because of screening failure in every lead vector: 33 (66%) failed in the supine position, 12 (24%) failed in the standing position, and 5 (10%) failed on exercise. In patients who could exercise and passed screening at rest, 31 (44%) had 1 vector safety, 16 (23%) had 2 vector safety, and 24 (33%) had 3 vector safety. Increased R:T wave ratio in the S-ICD screening ECG (odds ratio, 4.0; confidence interval, 3.0–5.3;
P
<0.001) was associated with screening failure, while R/T ratio <3 in aVF (odds ratio, 0.3; confidence interval, 0.12–0.69;
P
=0.006) and increasing age (odds ratio, 0.97; confidence interval, 0.95–0.99;
P
=0.03) was associated with reduced screening failure. European Society of Cardiology risk score was higher in those failing screening (risk score 5.5% [interquartile range, 3.2–8.7] in failed versus 4.5% [interquartile range, 2.9–7.4] in passed;
P
=0.04).
Conclusions—
HCM patients have a significant incidence of screening failure, which is determined primarily by the increased R:T ratio on the screening ECG and lead aVF. High-risk patients have an increased screening failure rate. Optimization of sensing algorithms is required to ensure that the highest risk HCM patients can benefit from S-ICD implantation.
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Affiliation(s)
- Neil T. Srinivasan
- From the Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew’s Hospital, London, United Kingdom (N.T.S., M.B., R.P., P.M.E., P.D.L.); Institute of Cardiovascular Science, University College London, United Kingdom (N.T.S., K.H.P., K.Q., A.T., P.M.E., P.D.L.); and Department of Cardiology, St George’s Hospital London, United Kingdom (M.T.-E.)
| | - Kiran H. Patel
- From the Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew’s Hospital, London, United Kingdom (N.T.S., M.B., R.P., P.M.E., P.D.L.); Institute of Cardiovascular Science, University College London, United Kingdom (N.T.S., K.H.P., K.Q., A.T., P.M.E., P.D.L.); and Department of Cardiology, St George’s Hospital London, United Kingdom (M.T.-E.)
| | - Kashif Qamar
- From the Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew’s Hospital, London, United Kingdom (N.T.S., M.B., R.P., P.M.E., P.D.L.); Institute of Cardiovascular Science, University College London, United Kingdom (N.T.S., K.H.P., K.Q., A.T., P.M.E., P.D.L.); and Department of Cardiology, St George’s Hospital London, United Kingdom (M.T.-E.)
| | - Amy Taylor
- From the Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew’s Hospital, London, United Kingdom (N.T.S., M.B., R.P., P.M.E., P.D.L.); Institute of Cardiovascular Science, University College London, United Kingdom (N.T.S., K.H.P., K.Q., A.T., P.M.E., P.D.L.); and Department of Cardiology, St George’s Hospital London, United Kingdom (M.T.-E.)
| | - Marco Bacà
- From the Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew’s Hospital, London, United Kingdom (N.T.S., M.B., R.P., P.M.E., P.D.L.); Institute of Cardiovascular Science, University College London, United Kingdom (N.T.S., K.H.P., K.Q., A.T., P.M.E., P.D.L.); and Department of Cardiology, St George’s Hospital London, United Kingdom (M.T.-E.)
| | - Rui Providência
- From the Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew’s Hospital, London, United Kingdom (N.T.S., M.B., R.P., P.M.E., P.D.L.); Institute of Cardiovascular Science, University College London, United Kingdom (N.T.S., K.H.P., K.Q., A.T., P.M.E., P.D.L.); and Department of Cardiology, St George’s Hospital London, United Kingdom (M.T.-E.)
| | - Maria Tome-Esteban
- From the Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew’s Hospital, London, United Kingdom (N.T.S., M.B., R.P., P.M.E., P.D.L.); Institute of Cardiovascular Science, University College London, United Kingdom (N.T.S., K.H.P., K.Q., A.T., P.M.E., P.D.L.); and Department of Cardiology, St George’s Hospital London, United Kingdom (M.T.-E.)
| | - Perry M. Elliott
- From the Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew’s Hospital, London, United Kingdom (N.T.S., M.B., R.P., P.M.E., P.D.L.); Institute of Cardiovascular Science, University College London, United Kingdom (N.T.S., K.H.P., K.Q., A.T., P.M.E., P.D.L.); and Department of Cardiology, St George’s Hospital London, United Kingdom (M.T.-E.)
| | - Pier D. Lambiase
- From the Department of Cardiac Electrophysiology, The Barts Heart Center, St Bartholomew’s Hospital, London, United Kingdom (N.T.S., M.B., R.P., P.M.E., P.D.L.); Institute of Cardiovascular Science, University College London, United Kingdom (N.T.S., K.H.P., K.Q., A.T., P.M.E., P.D.L.); and Department of Cardiology, St George’s Hospital London, United Kingdom (M.T.-E.)
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63
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Ip JE, Wu MS, Kennel PJ, Thomas G, Liu CF, Cheung JW, Markowitz SM, Lerman BB. Eligibility of Pacemaker Patients for Subcutaneous Implantable Cardioverter Defibrillators. J Cardiovasc Electrophysiol 2017; 28:544-548. [PMID: 28185354 DOI: 10.1111/jce.13182] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 01/12/2017] [Accepted: 01/30/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The subcutaneous implantable cardioverter defibrillator (ICD) has emerged as a viable therapeutic option for patients who are deemed high risk for sudden cardiac death. Previous studies have shown that 7-15% of patients are not candidates for the S-ICD based on their intrinsic QRS/T-wave morphology. Presently, it is not known if the S-ICD can be considered as supplementary therapy in patients who are ventricularly paced. We sought to determine the proportion of ventricularly paced patients who would qualify for an S-ICD. METHODS AND RESULTS We evaluated 100 patients with transvenous pacemakers/ICDs, including 25 biventricular devices to determine S-ICD candidacy during right ventricular (RV) pacing and biventricular pacing based on the recommended QRS:T-wave ratio screening template. Fifty-eight percent of patients qualified for an S-ICD based on their QRS morphology during ventricular pacing. More patients during biventricular pacing met criteria compared to during RV pacing alone (80% vs. 46%, P <0.01). Patients that were paced from the RV septum were more likely to qualify compared to those paced from the RV apex (67% vs. 37%, respectively, P <0.01). CONCLUSION While S-ICD implantation may be considered as supplemental therapy in select patients with preexisting transvenous devices, relatively fewer candidates who are paced from the RV apex qualify. QRS morphologies generated from biventricular pacing as well as from septal RV pacing are more likely to screen in based on the recommended S-ICD template.
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Affiliation(s)
- James E Ip
- Department of Medicine, Division of Cardiology, Cornell University Medical Center, New York, USA
| | - Michael S Wu
- Department of Medicine, Division of Cardiology, Cornell University Medical Center, New York, USA
| | - Peter J Kennel
- Department of Medicine, Division of Cardiology, Cornell University Medical Center, New York, USA
| | - George Thomas
- Department of Medicine, Division of Cardiology, Cornell University Medical Center, New York, USA
| | - Christopher F Liu
- Department of Medicine, Division of Cardiology, Cornell University Medical Center, New York, USA
| | - Jim W Cheung
- Department of Medicine, Division of Cardiology, Cornell University Medical Center, New York, USA
| | - Steven M Markowitz
- Department of Medicine, Division of Cardiology, Cornell University Medical Center, New York, USA
| | - Bruce B Lerman
- Department of Medicine, Division of Cardiology, Cornell University Medical Center, New York, USA
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The subcutaneous ICD as an alternative to the conventional ICD system: Initial experience in Greece and a review of the literature. Hellenic J Cardiol 2017; 58:4-16. [PMID: 28163146 DOI: 10.1016/j.hjc.2017.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 08/31/2016] [Indexed: 01/11/2023] Open
Abstract
The introduction of an implantable cardioverter defibrillator (ICD) in clinical practice has revolutionized our therapeutic approach for both primary and secondary prevention of sudden cardiac death (SCD), as it has proven to be superior to medical therapy in treating potentially life-threatening ventricular arrhythmias and has resulted in reduced mortality rates. However, implantation of a conventional ICD carries a non-negligible risk of periprocedural and long-term complications associated with the transvenous ICD leads. The entirely subcutaneous implantable cardioverter defibrillator (S-ICD) has recently emerged as a therapeutic alternative to the conventional ICD for patients with various cardiopathies and who are at high risk of SCD. The main advantage is the avoidance of vascular access and thus avoidance of complications associated with transvenous leads. Patients without pacing indications, such as bradycardia, a need for antitachycardia pacing or cardiac resynchronization, as well as those at higher risk of complications from transvenous lead implantation are perfect candidates for this novel technology. The subcutaneous ICD has proven to be equally safe and effective compared to transvenous ICD systems in early clinical trials. Further technical improvements of the system will likely lead to the expansion of indications and widespread use of this technology. In the present review, we discuss the indications for this system, summarize early clinical experiences and highlight the advantages and disadvantages of this novel technology. In addition, we present the first two cases of subcutaneous cardioverter defibrillator system implantation in Greece.
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Kawabata M, Goya M, Sasaki T, Maeda S, Yagishita A, Shirai Y, Kaneko M, Shiohira S, Isobe M, Hirao K. Surface Electrocardiogram Screening for Subcutaneous Implantable Cardioverter-Defibrillators in Japanese Patients With and Without Brugada Syndrome. Circ J 2017; 81:981-987. [DOI: 10.1253/circj.cj-16-1295] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Masahiko Goya
- Heart Rhythm Center, Tokyo Medical and Dental University
| | - Takeshi Sasaki
- Heart Rhythm Center, Tokyo Medical and Dental University
| | - Shingo Maeda
- Heart Rhythm Center, Tokyo Medical and Dental University
| | | | | | | | | | - Mitsuaki Isobe
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Kenzo Hirao
- Heart Rhythm Center, Tokyo Medical and Dental University
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Tachibana M, Nishii N, Morimoto Y, Kawada S, Miyoshi A, Sugiyama H, Nakagawa K, Watanabe A, Nakamura K, Morita H, Ito H. Complete right bundle branch block and QRS-T discordance can be the initial clue to detect S-ICD ineligibility. J Cardiol 2016; 70:23-28. [PMID: 28034575 DOI: 10.1016/j.jjcc.2016.11.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 10/30/2016] [Accepted: 11/11/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND In order to minimize inappropriate shocks of subcutaneous implantable cardioverter-defibrillators (S-ICD), it is important to recognize who is suitable for S-ICD indication. This study aimed to clarify what types of cardiac disease are likely to fulfill the S-ICD screening criteria and ineligible factors for S-ICD in the standard 12-lead electrocardiogram (ECG). METHODS A total of 348 patients with heart disease were enrolled. They were assessed by supine and standing ECG recording to simulate the 3 S-ICD sensing vectors and standard 12-lead ECG, simultaneously. Clinical and ECG characteristics were analyzed to compare the patients who are eligible and ineligible with S-ICD screening ECG indication. RESULTS The mean age of study patients was 49±21 years and 244 (70%) were men. Nineteen percent of patients were unsuitable for S-ICD. There was no significant difference in ineligibility for S-ICD among cardiac diseases (p=0.48). Univariate analysis showed complete right bundle branch block (CRBBB), QRS-T discordance in lead II, and QRS-T discordance in 3 leads (I, II, and aVF) were more frequent in patients who were ineligible for S-ICD than in the eligible group. Multivariate regression analysis showed CRBBB and QRS-T discordance in 3 leads were independent predictors for ineligibility of S-ICD. CONCLUSION There are no differences in eligibility of S-ICD among types of cardiac diseases. CRBBB and QRS-T discordance were independent predictors for ineligibility.
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Affiliation(s)
- Motomi Tachibana
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
| | - Nobuhiro Nishii
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yoshimasa Morimoto
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Satoshi Kawada
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Akihito Miyoshi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroyasu Sugiyama
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Koji Nakagawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Atsuyuki Watanabe
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroshi Morita
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Algorithm-Based Screening May Improve Patient Selection for the Subcutaneous Implantable Defibrillator. JACC Clin Electrophysiol 2016; 2:605-614. [DOI: 10.1016/j.jacep.2016.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 02/12/2016] [Accepted: 02/18/2016] [Indexed: 11/17/2022]
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Willcox ME, Prutkin JM, Bardy GH. Recent developments in the subcutaneous ICD. Trends Cardiovasc Med 2016; 26:526-35. [DOI: 10.1016/j.tcm.2016.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 03/12/2016] [Accepted: 03/12/2016] [Indexed: 11/29/2022]
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Ziacchi M, Corzani A, Diemberger I, Martignani C, Marziali A, Mazzotti A, Massaro G, Rapezzi C, Biffi M, Boriani G. Electrocardiographic Eligibility for Subcutaneous Implantable Cardioverter Defibrillator: Evaluation during Bicycle Exercise. Heart Lung Circ 2016; 25:476-83. [DOI: 10.1016/j.hlc.2015.10.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 09/08/2015] [Accepted: 10/21/2015] [Indexed: 10/22/2022]
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Bhakta D, Foreman L. Editorial Commentary: Keeping it simple: The subcutaneous implantable cardioverter defibrillator. Trends Cardiovasc Med 2016; 26:536-7. [PMID: 27107844 DOI: 10.1016/j.tcm.2016.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 03/24/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Deepak Bhakta
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN; Indiana University Health Physicians, Indianapolis, IN.
| | - Lynne Foreman
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
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Okamura H, McLeod CJ, DeSimone CV, Webster TL, Bonnichsen CR, Grogan M, Phillips SD, Connolly HM, Ammash NM, Warnes CA, Friedman PA. Right Parasternal Lead Placement Increases Eligibility for Subcutaneous Implantable Cardioverter Defibrillator Therapy in Adults With Congenital Heart Disease. Circ J 2016; 80:1328-35. [PMID: 27109124 DOI: 10.1253/circj.cj-16-0153] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The subcutaneous implantable cardioverter defibrillator (S-ICD) provides an attractive option for patients with congenital heart disease (CHD) in whom a transvenous defibrillator is contraindicated. Given the unusual cardiac anatomy and repolarization strain, the surface electrocardiogram (ECG) is frequently abnormal, potentially increasing the screen failure rate. METHODS AND RESULTS We prospectively screened 100 adult CHD patients regardless of the presence of clinical indication for ICD utilizing a standard left sternal lead placement, as well as a right parasternal position. Baseline patient and 12-lead ECG characteristics were examined to assess for predictors of screen failure. Average patient age was 48±14 years, average QRS duration was 134±37 ms, and 13 patients were pacemaker dependent. Using the standard left parasternal electrode position, 21 patients failed screening. Of these 21 patients with screen failure, 9 passed screening with the use of right parasternal electrode positioning, reducing screening failure rate from 21% to 12%. QT interval and inverted T wave anywhere in V2-V6 leads were found to be independent predictors of left parasternal screening failure (P=0.01 and P=0.04, respectively). CONCLUSIONS Utilization of both left and right parasternal screening should be used in evaluation of CHD patients for S-ICD eligibility. ECG repolarization characteristics were also identified as novel predictors of screening failure in this group. (Circ J 2016; 80: 1328-1335).
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Weinstock J, Bader YH, Maron MS, Rowin EJ, Link MS. Subcutaneous Implantable Cardioverter Defibrillator in Patients With Hypertrophic Cardiomyopathy: An Initial Experience. J Am Heart Assoc 2016; 5:JAHA.115.002488. [PMID: 26873684 PMCID: PMC4802466 DOI: 10.1161/jaha.115.002488] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The subcutaneous implantable cardioverter defibrillator (S‐ICD) has been developed to avert risks associated with transvenous defibrillator leads. The technology is attractive for younger patients, such as those with hypertrophic cardiomyopathy (HCM). However, there are limited data on S‐ICD use in HCM. Methods and Results HCM patients identified at risk for sudden death were considered for S‐ICD implantation. Patients were screened for potential oversensing by surface electrocardiography (ECG). At implant, defibrillation threshold (DFT) testing was performed at 65, 50, and 35 joules (J). Twenty‐seven patients were considered for S‐ICD implantation, and after screening, 23 (85%) remained eligible. The presence of a bundle branch block was associated with screening failure, whereas elevated body mass index (BMI) showed a trend toward association. One patient passed screening at rest, but failed with an ECG obtained after exercise. At implant, the S‐ICD terminated ventricular fibrillation (VF) with a 65J shock in all 15 implanted patients and a 50J shock was successful in 12 of 15. A 35J shock terminated VF in 10 of 12 patients. DFT failure at 50 J was associated with a higher BMI. There were no appropriate shocks after a median follow‐up of 17.5 (3–35) months, and 1 patient received an inappropriate shock attributable to a temporary reduction in QRS amplitude while bending forward, resulting in oversensing, despite successful screening. Conclusions In a high‐risk HCM cohort without a pacing indication referred for consideration of an ICD, the majority were eligible for S‐ICD. The S‐ICD is effective at recognizing and terminating VF at implant with a wide safety margin.
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Affiliation(s)
- Jonathan Weinstock
- Cardiac Arrhythmia Center and The Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA
| | - Yousef H Bader
- Cardiac Arrhythmia Center and The Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA
| | - Martin S Maron
- Cardiac Arrhythmia Center and The Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA
| | - Ethan J Rowin
- Cardiac Arrhythmia Center and The Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA
| | - Mark S Link
- Cardiac Arrhythmia Center and The Hypertrophic Cardiomyopathy Center, Tufts Medical Center, Boston, MA
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El-Chami MF, Harbieh B, Levy M, Leon AR, Merchant FM. Clinical and electrocardiographic predictors of T wave oversensing in patients with subcutaneous ICD. J Arrhythm 2016; 32:181-5. [PMID: 27354862 PMCID: PMC4913160 DOI: 10.1016/j.joa.2016.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 12/18/2015] [Accepted: 01/07/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND T wave oversensing (TWOS) is a major drawback of the subcutaneous implantable cardioverter defibrillator (S-ICD). Data on predictors of TWOS in S-ICD recipients are limited. We sought to investigate predictors of TWOS in a cohort of patients receiving an S-ICD at our institution. METHODS S-ICD recipients at our center were identified retrospectively and stratified based on the presence or absence of TWOS. Clinical and electrocardiographic parameters were collected and compared between the 2 groups. RESULTS Ninety-two patients underwent an S-ICD implantation at our institution between April 2010 and January 2015. Six (6.5%) patients had TWOS. These patients were younger (38.1±13.7 vs. 52.3±16.1 years, p=0.04) and had higher left ventricle ejection fractions (48.5±14.9% vs. 28.4±12.2%, p<0.01) than patients without a history of TWOS. Baseline 12-lead electrocardiogram (ECG) parameters were not different between the 2 groups. Leads I, II, and avF (which mimic the sensing vectors of the S-ICD) were further inspected to identify ECG characteristics that could predict TWOS. The QRS amplitude in ECG lead I was significantly smaller in the TWOS group than in the non-TWOS group (3.7 vs. 7.4 mV, p=0.02). CONCLUSION In this study, younger age, higher ejection fraction, and lower QRS amplitude were associated with TWOS. These findings could help identify patients referred for S-ICD at high-risk of TWOS.
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Affiliation(s)
- Mikhael F El-Chami
- Department of Medicine, Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, Atlanta, GA 30308, USA
| | - Bernard Harbieh
- Department of Medicine, Division of Cardiology, American University of Beirut, AUBMC, Department of Internal Medicine, P.O. Box: 11-0236, Riad El-Solh, Beirut 1107 2020, Lebanon
| | - Mathew Levy
- Department of Medicine, Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, Atlanta, GA 30308, USA
| | - Angel R Leon
- Department of Medicine, Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, Atlanta, GA 30308, USA
| | - Faisal M Merchant
- Department of Medicine, Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, 550 Peachtree Street NE, Atlanta, GA 30308, USA
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Ali H, Lupo P, Cappato R. The Entirely Subcutaneous Defibrillator - A New Generation and Future Expectations. Arrhythm Electrophysiol Rev 2016; 4:116-21. [PMID: 26835112 DOI: 10.15420/aer.2015.04.02.116] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Although conventional implantable cardioverter-defibrillators (ICDs) have proved effective in the prevention of sudden cardiac death (SCD), they still appear to be limited by non-trivial acute and long-term complications. The recent advent of an entirely subcutaneous ICD (S-ICD) represents a further step in the evolution of defibrillation technology towards a less-invasive approach. This review highlights some historical and current issues concerning the S-ICD that may offer a viable therapeutic option in selected patients at high risk of SCD and in whom pacing is not required. After the CE Mark and US Food and Drug Administration (FDA) approvals, the S-ICD is being implanted worldwide with growing clinical data regarding its safety and efficacy (the EFFORTLESS Registry). The recently developed new generation of S-ICD (EMBLEM, Boston Scientific) demonstrates favourable features including a smaller device, longer longevity and remote-monitoring compatibility. Further innovations in the S-ICD system and potential integration with leadless pacing may play an important role in defibrillation therapy and prevention of SCD in the near future.
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Affiliation(s)
- Hussam Ali
- Arrhythmia & Electrophysiology Research Center, IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy; Arrhythmia & Electrophysiology Unit II, Humanitas Gavazzeni Clinics, Bergamo, Italy
| | - Pierpaolo Lupo
- Arrhythmia & Electrophysiology Research Center, IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy; Arrhythmia & Electrophysiology Unit II, Humanitas Gavazzeni Clinics, Bergamo, Italy
| | - Riccardo Cappato
- Arrhythmia & Electrophysiology Research Center, IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy; Arrhythmia & Electrophysiology Unit II, Humanitas Gavazzeni Clinics, Bergamo, Italy
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Panna ME, Miles WM. The Subcutaneous Implantable Cardioverter-Defibrillator: A Practical Review and Real-World Use and Application. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2016. [DOI: 10.15212/cvia.2015.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Lewis GF, Gold MR. Safety and Efficacy of the Subcutaneous Implantable Defibrillator. J Am Coll Cardiol 2016; 67:445-454. [DOI: 10.1016/j.jacc.2015.11.026] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 11/05/2015] [Indexed: 10/22/2022]
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Maurizi N, Olivotto I, Olde Nordkamp LR, Baldini K, Fumagalli C, Brouwer TF, Knops RE, Cecchi F. Prevalence of subcutaneous implantable cardioverter-defibrillator candidacy based on template ECG screening in patients with hypertrophic cardiomyopathy. Heart Rhythm 2016; 13:457-63. [DOI: 10.1016/j.hrthm.2015.09.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Indexed: 01/08/2023]
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Trivedi A, Knight BP. ICD Therapy for Primary Prevention in Hypertrophic Cardiomyopathy. Arrhythm Electrophysiol Rev 2016; 5:188-196. [PMID: 28116084 DOI: 10.15420/aer.2016:30:2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a common and heterogeneous disorder that increases an individual's risk of sudden cardiac death (SCD). This review article discusses the relevant factors that are involved in the challenge of preventing SCD in patients with HCM. The epidemiology of SCD in patients is reviewed as well as the structural and genetic basis behind ventricular arrhythmias in HCM. The primary prevention of SCD with implantable cardioverter-defibrillator (ICD) therapy is the cornerstone of modern treatment for individuals at high risk of SCD. The focus here is on the current and emerging predictors of SCD as well as risk stratification recommendations from both North American and European guidelines. Issues related to ICD implantation, such as programming, complications and inappropriate therapies, are discussed. The emerging role of the fully subcutaneous ICD and the data regarding its implantation are reviewed.
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Affiliation(s)
- Amar Trivedi
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Bradley P Knight
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL, USA
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The subcutaneous implantable cardioverter defibrillator: state-of-the-art review. Eur Heart J 2015; 38:247-257. [DOI: 10.1093/eurheartj/ehv507] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 08/14/2015] [Accepted: 09/07/2015] [Indexed: 01/20/2023] Open
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Verma N, Rhyner J, Knight BP. The subcutaneous implantable cardioverter and defibrillator: advantages, limitations and future directions. Expert Rev Cardiovasc Ther 2015; 13:989-99. [DOI: 10.1586/14779072.2015.1071189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Right Parasternal Electrode Configuration Converts a Failed Electrocardiographic Screening to a Pass for Subcutaneous Implantable Cardioverter-Defibrillator Implantation. Heart Lung Circ 2015; 24:e203-5. [PMID: 26320627 DOI: 10.1016/j.hlc.2015.07.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 07/21/2015] [Accepted: 07/27/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Pre-operative electrocardiographic (ECG) screening before subcutaneous implantable cardioverter-defibrillator (SICD) implantation is essential to prevent T-wave oversensing and inappropriate shocks. The failure rate of ECG screening was reported to be up to 8% when only two body positions were tested. METHOD Three subcutaneous ECG vectors represented by lead I, II and III were obtained in standing, supine, sitting and squatting positions. A patient qualified if the ECG in any same lead passed in all four positions. We report a 31-year-old man with idiopathic ventricular fibrillation who failed ECG screening for SICD implantation with the conventional left parasternal electrode (LPS) configuration in all three subcutaneous ECG vectors. Right parasternal electrode (RPS) configuration with left arm and right arm ECG electrodes positioned 1cm lateral to right sternal border was attempted for screening. RESULT The amplitude of the QRS complex was significantly larger in the RPS compared to the LPS configuration in lead III and the patient passed the ECG screening in four body positions. He underwent successful SICD implantation with RPS approach with appropriate sensing both during the procedure and exercise treadmill test four weeks later. Ventricular fibrillation was successfully converted with 65J standard polarity shock during the procedure and no ICD shock was experienced by the patient on six-month follow-up. CONCLUSION RPS configuration may be considered in patients who fail the ECG screening with the conventional LPS approach for SICD implantation.
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Frommeyer G, Dechering DG, Zumhagen S, Löher A, Köbe J, Eckardt L, Reinke F. Long-term follow-up of subcutaneous ICD systems in patients with hypertrophic cardiomyopathy: a single-center experience. Clin Res Cardiol 2015; 105:89-93. [DOI: 10.1007/s00392-015-0901-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 07/30/2015] [Indexed: 01/14/2023]
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FRANCIA PIETRO, ADDUCI CARMEN, PALANO FRANCESCA, SEMPRINI LORENZO, SERDOZ ANDREA, MONTESANTI DALMA, SANTINI DARIA, MUSUMECI BEATRICE, SALVATI ADRIANO, VOLPE MASSIMO, AUTORE CAMILLO. Eligibility for the Subcutaneous Implantable Cardioverter-Defibrillator in Patients With Hypertrophic Cardiomyopathy. J Cardiovasc Electrophysiol 2015; 26:893-899. [DOI: 10.1111/jce.12714] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 04/21/2015] [Accepted: 04/24/2015] [Indexed: 12/22/2022]
Affiliation(s)
- PIETRO FRANCIA
- Division of Cardiology; Department of Clinical and Molecular Medicine; St. Andrea Hospital; Sapienza University; Rome Italy
| | - CARMEN ADDUCI
- Division of Cardiology; Department of Clinical and Molecular Medicine; St. Andrea Hospital; Sapienza University; Rome Italy
| | - FRANCESCA PALANO
- Division of Cardiology; Department of Clinical and Molecular Medicine; St. Andrea Hospital; Sapienza University; Rome Italy
| | - LORENZO SEMPRINI
- Division of Cardiology; Department of Clinical and Molecular Medicine; St. Andrea Hospital; Sapienza University; Rome Italy
| | - ANDREA SERDOZ
- Division of Cardiology; Department of Clinical and Molecular Medicine; St. Andrea Hospital; Sapienza University; Rome Italy
| | - DALMA MONTESANTI
- Division of Cardiology; Department of Clinical and Molecular Medicine; St. Andrea Hospital; Sapienza University; Rome Italy
| | - DARIA SANTINI
- Division of Cardiology; Department of Clinical and Molecular Medicine; St. Andrea Hospital; Sapienza University; Rome Italy
| | - BEATRICE MUSUMECI
- Division of Cardiology; Department of Clinical and Molecular Medicine; St. Andrea Hospital; Sapienza University; Rome Italy
| | - ADRIANO SALVATI
- Division of Cardiology; Department of Clinical and Molecular Medicine; St. Andrea Hospital; Sapienza University; Rome Italy
| | - MASSIMO VOLPE
- Division of Cardiology; Department of Clinical and Molecular Medicine; St. Andrea Hospital; Sapienza University; Rome Italy
- IRCCS Neuromed; Pozzilli Isernia Italy
| | - CAMILLO AUTORE
- Division of Cardiology; Department of Clinical and Molecular Medicine; St. Andrea Hospital; Sapienza University; Rome Italy
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85
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Swerdlow CD, Asirvatham SJ, Ellenbogen KA, Friedman PA. Troubleshooting implantable cardioverter-defibrillator sensing problems II. Circ Arrhythm Electrophysiol 2015; 8:212-20. [PMID: 25691555 DOI: 10.1161/circep.114.002514] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Charles D Swerdlow
- From the Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.D.S.); Division of Cardiology, Mayo Clinic, Rochester, MN (S.J.A., P.A.F.); and Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA (K.A.E.).
| | - Samuel J Asirvatham
- From the Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.D.S.); Division of Cardiology, Mayo Clinic, Rochester, MN (S.J.A., P.A.F.); and Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA (K.A.E.)
| | - Kenneth A Ellenbogen
- From the Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.D.S.); Division of Cardiology, Mayo Clinic, Rochester, MN (S.J.A., P.A.F.); and Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA (K.A.E.)
| | - Paul A Friedman
- From the Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (C.D.S.); Division of Cardiology, Mayo Clinic, Rochester, MN (S.J.A., P.A.F.); and Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA (K.A.E.)
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86
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Lewis GF, Gold MR. Clinical experience with subcutaneous implantable cardioverter-defibrillators. Nat Rev Cardiol 2015; 12:398-405. [DOI: 10.1038/nrcardio.2015.56] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Porterfield C, DiMarco JP, Mason PK. Effectiveness of implantation of a subcutaneous implantable cardioverter-defibrillator in a patient with complete heart block and a pacemaker. Am J Cardiol 2015; 115:276-8. [PMID: 25465940 DOI: 10.1016/j.amjcard.2014.10.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 10/21/2014] [Accepted: 10/21/2014] [Indexed: 10/24/2022]
Abstract
The subcutaneous implantable cardioverter-defibrillator (S-ICD) represents an important alternative to traditional ICD therapy. The major limitation of this technology is the inability to provide pacing. Here, we present a case of a patient with complete heart block and a pacemaker who underwent placement of an S-ICD. Special considerations had to be taken with regards to evaluation and implantation of the S-ICD because of the pacemaker. In conclusion, implantation of an S-ICD can be done in patients with pacemaker effectively with appropriate electrocardiographic screening, device testing, and programming.
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Arce-León Á, Arana-Rueda E, García-Riesco L, Guerrero-Márquez F, Pedrote A. Postimplant Shocks in a Totally Subcutaneous Defibrillator: What Is the Mechanism? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 38:1225-7. [PMID: 25533853 DOI: 10.1111/pace.12554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 11/09/2014] [Accepted: 11/09/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Álvaro Arce-León
- From the Arrhythmia Unit, Department of Cardiology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Eduardo Arana-Rueda
- From the Arrhythmia Unit, Department of Cardiology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Lorena García-Riesco
- From the Arrhythmia Unit, Department of Cardiology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Francisco Guerrero-Márquez
- From the Arrhythmia Unit, Department of Cardiology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Alonso Pedrote
- From the Arrhythmia Unit, Department of Cardiology, Hospital Universitario Virgen del Rocío, Seville, Spain
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89
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Patel KHK, Lambiase PD. The subcutaneous ICD-current evidence and challenges. Cardiovasc Diagn Ther 2014; 4:449-59. [PMID: 25610802 PMCID: PMC4278039 DOI: 10.3978/j.issn.2223-3652.2014.12.02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 12/07/2014] [Indexed: 02/01/2023]
Abstract
The subcutaneous implantable cardioverter-defibrillator (S-ICD) represents an exciting development in ICD technology. It has relative advantages over traditional transvenous systems, particularly for young patients in whom the lifetime risk of device-related complications may be deemed to be unacceptably high. While data relating to device longevity and long term safety profile is yet to be accrued, several recent studies have demonstrated good clinical efficacy comparable to transvenous ICDs. Indeed, new techniques have also been developed to simplify the S-ICD implantation procedure and attempts have been made to address challenges pertaining to T-wave oversensing to reduce the delivery of inappropriate shocks. The impact of inappropriate shocks and lack of anti-tachycardia pacing (ATP) function are not only contentious matters, but also have important implications for patients in whom the S-ICD would be suitable. It is envisaged that subsequent models of this device will be less cumbersome, with the possibility that an entirely leadless pacemaker-defibrillator will one day be possible. Although the S-ICD may not completely replace transvenous devices in its current form, evidence suggests that it is a viable alternative particularly in preventing sudden cardiac death in non-pacing dependent patients.
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Affiliation(s)
| | - Pier D Lambiase
- Department of Cardiology, The Heart Hospital, University College London, London W1G 8PH, UK
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