1
|
Zhang L, Li X, Liang Y, Wang J, Li M, Pan L, Chen X, Qin S, Bai J, Wang W, Su Y, Ge J. Real-world evidence for the use of subcutaneous implantable cardioverter-defibrillators in China: A single-center experience. Herz 2023; 48:462-469. [PMID: 37540305 DOI: 10.1007/s00059-023-05192-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 05/26/2023] [Accepted: 05/27/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Subcutaneous implantable cardioverter-defibrillators (S-ICDs) have been shown to be non-inferior to transvenous ICDs in the prevention of sudden cardiac death (SCD), but there is still a lack of evidence from clinical trials in China. We investigated whether S‑ICD implantation in the Chinese population is safe and feasible and should be promoted in the future. METHODS Consecutive patients undergoing S‑ICD implantation at our center were enrolled in this retrospective study. Data were collected within the median follow-up period of 554 days. Data concerning patient selection, implantation procedures, complications, and episodes of shock were analyzed. RESULTS In total, 70.2% of all 47 patients (median age = 39 years) were included for secondary prevention of SCD with different etiologies. Vector screening showed that 98% of patients were with > 1 appropriate vector in all postures. An intraoperative defibrillation test was not performed on six patients because of the high risk of disease deterioration, while all episodes of ventricular fibrillation induced post implantation were terminated by one shock. As expected, no severe complications (e.g., infection and device-related complications) were observed, except for one case of delayed healing of the incision. Overall, 15 patients (31.9%) experienced appropriate shocks (AS) with all episodes terminated by one shock. Two patients (4.3%) experienced inappropriate shocks (IAS) due to noise oversensing, resulting in a high Kaplan-Meier IAS-free rate of 95.7%. CONCLUSION Based on appropriate patient selection and standardized implantation procedures, this real-world study confirmed the safety and efficacy of S‑ICD in Chinese patients, indicating that it may help to promote the prevention of SCD in China.
Collapse
Affiliation(s)
- Lei Zhang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Xietu Road, 1069, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Xiao Li
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Xietu Road, 1069, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yixiu Liang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Xietu Road, 1069, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Jingfeng Wang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Xietu Road, 1069, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Minghui Li
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Xietu Road, 1069, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Lei Pan
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Xietu Road, 1069, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Xueying Chen
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Xietu Road, 1069, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Shengmei Qin
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Xietu Road, 1069, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Jin Bai
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Xietu Road, 1069, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Wei Wang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Xietu Road, 1069, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yangang Su
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Xietu Road, 1069, Shanghai, China.
- National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China.
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Xietu Road, 1069, Shanghai, China.
- National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China.
| |
Collapse
|
2
|
Hsue W, Gagnon AL. Treating Stubborn Cardiac Arrhythmias-Looking Toward the Future. Vet Clin North Am Small Anim Pract 2023; 53:1415-1428. [PMID: 37541824 DOI: 10.1016/j.cvsm.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
As animals can develop significant side effects or remain refractory while on antiarrhythmic medical therapy for tachyarrhythmias, interventional therapies are progressively being explored. This review will highlight the principles and utilities of implantable cardioverter-defibrillators, electrophysiological mapping and catheter ablation, three-dimensional electroanatomical mapping, and stereotactic arrhythmia radiotherapy. In particular, three-dimensional electroanatomical mapping is emerging as an adjunct electrophysiology tool to facilitate activation, substrate, and pace mapping for intuitive analysis of complex tachyarrhythmias. Unlike antiarrhythmic medications, these modalities offer potential for decreasing risk of sudden death and even permanent termination of tachyarrhythmias.
Collapse
Affiliation(s)
- Weihow Hsue
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, 930 Campus Road, Ithaca, NY 14853, USA.
| | - Allison L Gagnon
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California - Davis, One Shields Avenue, Davis, CA 95616, USA.
| |
Collapse
|
3
|
Fong KY, Ng CJR, Wang Y, Yeo C, Tan VH. Subcutaneous Versus Transvenous Implantable Defibrillator Therapy: A Systematic Review and Meta-Analysis of Randomized Trials and Propensity Score-Matched Studies. J Am Heart Assoc 2022; 11:e024756. [PMID: 35656975 PMCID: PMC9238723 DOI: 10.1161/jaha.121.024756] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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 Subcutaneous implantable cardioverter‐defibrillators (S‐ICDs) have been of great interest as an alternative to transvenous implantable cardioverter‐defibrillators (TV‐ICDs). No meta‐analyses synthesizing data from high‐quality studies have yet been published. Methods and Results An electronic literature search was conducted to retrieve randomized controlled trials or propensity score–matched studies comparing S‐ICD against TV‐ICD in patients with an implantable cardioverter‐defibrillator indication. The primary outcomes were device‐related complications and lead‐related complications. Secondary outcomes were inappropriate shocks, appropriate shock, all‐cause mortality, and infection. All outcomes were pooled under random‐effects meta‐analyses and reported as risk ratios (RRs) and 95% CIs. Kaplan–Meier curves of device‐related complications were digitized to retrieve individual patient data and pooled under a 1‐stage meta‐analysis using Cox models to determine hazard ratios (HRs) of patients undergoing S‐ICD versus TV‐ICD. A total of 5 studies (2387 patients) were retrieved. S‐ICD had a similar rate of device‐related complications compared with TV‐ICD (RR, 0.59 [95% CI, 0.33–1.04]; P=0.070), but a significantly lower lead‐related complication rate (RR, 0.14 [95% CI, 0.07–0.29]; P<0.0001). The individual patient data–based 1‐stage stratified Cox model for device‐related complications across 4 studies yielded no significant difference (shared‐frailty HR, 0.82 [95% CI, 0.61–1.09]; P=0.167), but visual inspection of pooled Kaplan–Meier curves suggested a divergence favoring S‐ICD. Secondary outcomes did not differ significantly between both modalities. Conclusions S‐ICD is clinically superior to TV‐ICD in terms of lead‐related complications while demonstrating comparable efficacy and safety. For device‐related complications, S‐ICD may be beneficial over TV‐ICD in the long term. These indicate that S‐ICD is likely a suitable substitute for TV‐ICD in patients requiring implantable cardioverter‐defibrillator implantation without a pacing indication.
Collapse
Affiliation(s)
- Khi Yung Fong
- Yong Loo Lin School of MedicineNational University of Singapore Singapore
| | | | - Yue Wang
- Department of Cardiology Changi General Hospital Singapore
| | - Colin Yeo
- Department of Cardiology Changi General Hospital Singapore
| | - Vern Hsen Tan
- Department of Cardiology Changi General Hospital Singapore
| |
Collapse
|
5
|
Savarimuthu S, Roy S, Obeidat M, Harky A. Subcutaneous implantable cardioverter defibrillator: Can it overtake its transvenous counterpart. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1413-1420. [PMID: 33878197 DOI: 10.1111/pace.14246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/22/2021] [Accepted: 04/11/2021] [Indexed: 11/29/2022]
Abstract
Over the past decade, the emergence of the subcutaneous implantable cardioverter defibrillator (S-ICD) has provided cardiologists with an option to provide both primary or secondary prevention treatment of sudden cardiac death (SCD) without the associated risks that come with the use of intracardiac leads. S-ICD may prove to be a useful option in those who are young, have thromboembolic risk, immunodeficiency states, unfavorable anatomy due to adult congenital heart disease (ACHD). This article reviews the existing literature to determine whether S-ICD can prove to be a safe alternative in comparison to Transvenous implantable cardioverter defibrillator (TV-ICD) and in which patient population should S-ICD be considered over TV-ICD.
Collapse
Affiliation(s)
| | - Saswata Roy
- Department of Gastroenterology, Musgrove Park hospital, Taunton, UK
| | - Mohammed Obeidat
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Amer Harky
- Faculty of Cardiothoracic surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| |
Collapse
|
6
|
Schukro C, Santer D, Prenner G, Stühlinger M, Martinek M, Teubl A, Moertl D, Schwarz S, Nürnberg M, Fiedler L, Hatala R, Khazen C. State-of-the-art consensus on non-transvenous implantable cardioverter-defibrillator therapy. Clin Cardiol 2020; 43:1084-1092. [PMID: 32794309 PMCID: PMC7533987 DOI: 10.1002/clc.23432] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 07/14/2020] [Accepted: 07/17/2020] [Indexed: 01/18/2023] Open
Abstract
Within the last decade, implantable cardioverter-defibrillator (ICD) systems with non-transvenous leads were developed in order to minimize complications related to the cardiovascular position of transvenous ICD leads. This national expert consensus gives an overview of potential indications for the implantation of non-transvenous ICD systems, and provides specific recommendations for implantation, follow-up, and complication management in patients with subcutaneous ICD. Regarding particular issues like the necessity for shock efficacy testing, or the clinical outcome as compared to transvenous ICD, randomized data are expected in the near future.
Collapse
Affiliation(s)
- Christoph Schukro
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - David Santer
- Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Günther Prenner
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Markus Stühlinger
- Department of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria
| | - Martin Martinek
- Department of Internal Medicine I, Ordensklinikum Linz Elisabethinen Hospital, Linz, Austria
| | - Alexander Teubl
- Department of Internal Medicine III, Wiener Neustadt State Hospital, Wiener Neustadt, Austria
| | - Deddo Moertl
- Department of Internal Medicine III, University Hospital St. Pölten, Austria
| | - Stefan Schwarz
- Department of Internal Medicine I, Kepler University Hospital Linz, Linz, Austria
| | - Michael Nürnberg
- Department of Internal Medicine III, Wilhelminen Hospital Vienna, Vienna, Austria
| | - Lukas Fiedler
- Department of Internal Medicine III, Wiener Neustadt State Hospital, Wiener Neustadt, Austria
| | - Robert Hatala
- Department of Arrhythmias and Cardiac Pacing, National Institute of Cardiovascular Diseases and Slovak Medical University, Bratislava, Slovakia
| | - Cesar Khazen
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| |
Collapse
|