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Gutierrez O, Cline M, Amin AK. Feasibility and efficacy of extravascular implantable cardioverter-defibrillators in two patients with class III obesity. HeartRhythm Case Rep 2024; 10:561-563. [PMID: 39155899 PMCID: PMC11328540 DOI: 10.1016/j.hrcr.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2024] Open
Affiliation(s)
- Omar Gutierrez
- MedOne Healthcare Partners, Department of Hospital Medicine, Columbus, Ohio
| | | | - Anish K. Amin
- OhioHealth Heart & Vascular Physicians, Section of Cardiac Electrophysiology, Department of Cardiology, Riverside Methodist Hospital, Columbus, Ohio
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Vamos M, Zsigmond EJ, Biffi M, Gausz FD, Keller N, Kupo P, Szili-Torok T, Ziacchi M, Benz AP, Spittler R, Vagvolgyi A. Efficacy and safety of the subcutaneous implantable cardioverter-defibrillator in patients with and without obesity: A meta-analysis. Heart Rhythm 2024:S1547-5271(24)02902-3. [PMID: 39019386 DOI: 10.1016/j.hrthm.2024.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/25/2024] [Accepted: 07/11/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND The subcutaneous implantable cardioverter-defibrillator (S-ICD) has emerged as an alternative to transvenous systems for prevention of sudden cardiac death. However, concerns have been raised regarding its efficacy and safety in obese individuals. OBJECTIVE The purpose of this study was to perform a meta-analysis to evaluate the efficacy and safety of the S-ICD in patients with obesity by assessing the relationship between body mass index (BMI) and clinical outcomes. METHODS A comprehensive search of multiple databases was conducted for English-language peer-reviewed studies reporting clinical outcomes in S-ICD recipients with (BMI ≥30 kg/m2) and without obesity (BMI <30 kg/m2). Data on preimplantation screening failure, defibrillation testing, complications, appropriate and inappropriate shocks, and survival were analyzed using standard, random-effects, meta-analytical techniques. RESULTS Twenty-nine studies involving 20,486 patients were included. There was no statistically significant difference in mean BMI values of patients with failed or successful preimplantation screening (mean difference -0.60 kg/m2; 95% confidence interval [CI] -2.06 to 0.86). Obesity was associated with higher rates of failed defibrillation testing at ≤65 J (odds ratio [OR] 2.16; 95% CI 1.39-3.35), and malpositioning/suboptimal positioning occurred more frequently in obese compared to nonobese patients (OR 3.37; 95% CI 1.76-6.44). Increased BMI as a continuous variable (per increase in 1 kg/m2 BMI) was associated with elevated defibrillation thresholds (OR 1.05; 95% CI 1.03-1.08); higher risk of complications (hazard ratio [HR] 1.04; 95% CI 1.02-1.05); a trend toward an increased number of appropriate shocks (HR 1.02; 95% CI 1.00-1.04); and no significant increase in the risk of inappropriate shocks (HR 1.01; 95% CI 0.99-1.03). CONCLUSION This meta-analysis underscores the importance of considering obesity in S-ICD implantation decisions. Although S-ICD remains effective in obese patients, attention to potential technical challenges and higher complication rates is warranted.
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Affiliation(s)
- Mate Vamos
- Cardiac Electrophysiology Division, Cardiology Center, Department of Internal Medicine, University of Szeged, Szeged, Hungary.
| | - Elod-Janos Zsigmond
- Central Hospital of Northern Pest-Military Hospital, Budapest, Hungary; Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Mauro Biffi
- Department of Cardiology, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Flora Diana Gausz
- Cardiac Electrophysiology Division, Cardiology Center, Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Nora Keller
- Central Pharmacy, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary
| | - Peter Kupo
- Heart Institute, Medical School, University of Pecs, Pecs, Hungary
| | - Tamas Szili-Torok
- Cardiac Electrophysiology Division, Cardiology Center, Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Matteo Ziacchi
- Department of Cardiology, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Alexander P Benz
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany; Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Raphael Spittler
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany
| | - Anna Vagvolgyi
- Endocrinology and Diabetology Center, Department of Internal Medicine, University of Szeged, Szeged, Hungary
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Rillo M, Palamà Z, My G, Punzi R, Aurelio A, Aloisio A, Giannattasio C, My L. S-ICD: Is it time for radiological follow-ups? J Cardiovasc Electrophysiol 2021; 32:2752-2754. [PMID: 34405479 DOI: 10.1111/jce.15208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 07/29/2021] [Accepted: 08/09/2021] [Indexed: 12/24/2022]
Affiliation(s)
- Mariano Rillo
- Electrophysiology Service, Division of Cardiology, Casa di Cura Villa Verde, Taranto, Italy
| | - Zefferino Palamà
- Electrophysiology Service, Division of Cardiology, Casa di Cura Villa Verde, Taranto, Italy
| | - Giulia My
- Cardiology Unit, Casa di Cura "Villa Verde", Taranto, Italy
| | - Raffaele Punzi
- Electrophysiology Service, Division of Cardiology, Casa di Cura Villa Verde, Taranto, Italy
| | - Andrea Aurelio
- Cardiology Unit, Casa di Cura "Villa Verde", Taranto, Italy
| | - Angelo Aloisio
- Cardiology Unit, Casa di Cura "Villa Verde", Taranto, Italy
| | | | - Luigi My
- Cardiology Unit, Casa di Cura "Villa Verde", Taranto, Italy
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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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Quast AFBE, Baalman SWE, Brouwer TF, Smeding L, Wilde AAM, Burke MC, Knops RE. A novel tool to evaluate the implant position and predict defibrillation success of the subcutaneous implantable cardioverter-defibrillator: The PRAETORIAN score. Heart Rhythm 2019; 16:403-410. [PMID: 30292861 DOI: 10.1016/j.hrthm.2018.09.029] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Suboptimal positioning of the subcutaneous implantable cardioverter-defibrillator (S-ICD) increases the defibrillation threshold and risk of conversion failure. OBJECTIVE Our objective is to develop a tool to evaluate the implant position and predict defibrillation success of the S-ICD: the PRAETORIAN score. METHODS The PRAETORIAN score is based on clinical and computer modeling knowledge of determinants affecting the defibrillation threshold: subcoil fat, subgenerator fat, and anterior positioning of the S-ICD generator. The score evaluates these determinants on the postoperative anterior-posterior and lateral chest radiographs and has 3 categories: 30-<90 points representing a low risk, 90-<150 points representing an intermediate risk, and ≥150 points representing a high risk of conversion failure. The score was developed using 2 separate S-ICD data sets for derivation and validation. The performance metrics are the positive and negative predictive values. RESULTS The development data set consisted of 181 patients with S-ICD, and the validation cohort consisted of 321 patients from the S-ICD Investigational Device Exemption trial. The distribution of scores was 93%-98% low risk (<90 points), 2%-5% intermediate risk (90-<150 points), and 1% high risk (≥150 points). The positive predictive value for an intermediate or high PRAETORIAN score for a failed conversion test was 51%, while a low PRAETORIAN score predicted a successful conversion in 99.8% of patients. CONCLUSION The PRAETORIAN score allows the identification of patients with high defibrillation thresholds by using the routine chest radiograph and provides feedback to implanters on S-ICD positioning. The PRAETORIAN-DFT trial will prospectively validate the score by randomizing to standard conversion testing vs using the score without conversion testing.
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Affiliation(s)
- Anne-Floor B E Quast
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Sarah W E Baalman
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Tom F Brouwer
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Lonneke Smeding
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Arthur A M Wilde
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Martin C Burke
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; CorVita Science Foundation, Chicago, Illinois
| | - Reinoud E Knops
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Wakabayashi Y, Mitsuhashi T, Fujita H, Momomura S. Usefulness of lead repositioning from left to right sternal border for a patient with subcutaneous implantable cardioverter defibrillator showing high defibrillation threshold. J Arrhythm 2019; 35:133-135. [PMID: 30805054 PMCID: PMC6373652 DOI: 10.1002/joa3.12145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/20/2018] [Accepted: 11/02/2018] [Indexed: 11/22/2022] Open
Abstract
A 62-year-old man with Brugada syndrome underwent subcutaneous implantable cardioverter defibrillator implantation. The lead was positioned along the left sternal border and defibrillation threshold (DFT) testing was performed. However, ventricular fibrillation (VF) was not terminated with 65 J and 80 J shocks. Shock impedance was 82 ohms. We repositioned the lead to the right sternal border and performed DFT testing again, followed by the VF termination with a 65 J shock. Shock impedance was 59 ohms. The positional relationship among the lead, generator, and heart was changed by lead repositioning, which may have contributed to improved shock impedance and DFT.
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Affiliation(s)
- Yasushi Wakabayashi
- Division of Cardiovascular MedicineSaitama Medical CenterJichi Medical UniversitySaitamaJapan
| | - Takeshi Mitsuhashi
- Division of Cardiovascular MedicineSaitama Medical CenterJichi Medical UniversitySaitamaJapan
| | - Hideo Fujita
- Division of Cardiovascular MedicineSaitama Medical CenterJichi Medical UniversitySaitamaJapan
| | - Shin‐ichi Momomura
- Division of Cardiovascular MedicineSaitama Medical CenterJichi Medical UniversitySaitamaJapan
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Hayase J, Do DH, Boyle NG. Defibrillation Threshold Testing: Current Status. Arrhythm Electrophysiol Rev 2018; 7:288-293. [PMID: 30588318 DOI: 10.15420/aer.2018.54.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 11/15/2018] [Indexed: 11/04/2022] Open
Abstract
When the transvenous ICD initially came into use for primary and secondary prevention of sudden cardiac death, defibrillation threshold (DFT) testing was universally performed. However, DFT testing is no longer routinely recommended for transvenous ICD implantation except in certain situations. Risk scores can help guide the decision to perform DFT testing. The subcutaneous ICD represents an area of uncertainty, with limited data available regarding the role of DFT testing in these devices. Current guidelines give a class I recommendation for performing DFT testing at the time of implant. Further studies are needed before this recommendation can be safely dismissed.
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Affiliation(s)
- Justin Hayase
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA Los Angeles, CA, USA
| | - Duc H Do
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA Los Angeles, CA, USA
| | - Noel G Boyle
- UCLA Cardiac Arrhythmia Center, UCLA Health System, David Geffen School of Medicine at UCLA Los Angeles, CA, USA
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