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Kloppe A, Winter J, Prull M, Aweimer A, El-Battrawy I, Hanefeld C, O'Connor S, Mügge A, Schiedat F. Subcutaneous cardioverter defibrillator implanted intermuscularly in patients with end-stage renal disease requiring hemodialysis: 5-year follow-up. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01767-1. [PMID: 38383674 DOI: 10.1007/s10840-024-01767-1] [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: 11/15/2023] [Accepted: 02/01/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND The aim of the present study was to evaluate the long-term safety and effectiveness of the subcutaneous implantable cardioverter defibrillator (S-ICD) when implanted intermuscularly in patients with end-stage renal disease and hemodialysis. METHODS This study is a retrospective analysis of 21 consecutive patients implanted with S-ICDs at three experienced centers in Germany with comorbid renal insufficiency requiring hemodialysis, as well as being at risk of sudden cardiac death. The S-ICD was placed intermuscularly in all patients. Follow-ups (FUs) were performed every 6 months. RESULTS The mean ± standard deviation FU duration was 60.0 ± 11.4 months, with a range of 39 to 78 months. There were no deaths due to arrhythmia, or device-associated infections and complications. Four patients (19.1%) died during FU due to respiratory insufficiency during dialysis, systolic heart failure, septic infection of the urogenital tract, and colorectal cancer, respectively. There were six non-device-related hospitalizations with a duration of 12.7 ± 5.1 days and a hospitalization rate of 4.1 per 100 patient years. CONCLUSIONS In the long-term FU of this small population of seriously compromised hemodialysis patients at risk of sudden cardiac death, the intermuscularly implanted S-ICD system was safe and effective. No arrhythmic complications, device-associated infections, or complications compromised survival. These data are encouraging and support testing in a larger group of similarly compromised patients.
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Affiliation(s)
- Axel Kloppe
- Department of Cardiology, Intensive Medicine and Angiology, Marienhospital Gelsenkirchen, Academic Hospital of the Ruhr University Bochum, Virchowstraße 122, 45886, Gelsenkirchen, Germany
- Department of Cardiology and Angiology, University Hospital Bergmannsheil Bochum, Ruhr University Bochum, Bochum, Germany
| | - Joachim Winter
- Department of Cardiovascular Surgery, Heinrich Heine University, Dusseldorf, Germany
| | - Magnus Prull
- Department of Cardiology, Augusta Hospital Bochum, Bochum, Germany
| | - Assem Aweimer
- Department of Cardiology and Angiology, University Hospital Bergmannsheil Bochum, Ruhr University Bochum, Bochum, Germany
| | - Ibrahim El-Battrawy
- Department of Cardiology and Angiology, University Hospital Bergmannsheil Bochum, Ruhr University Bochum, Bochum, Germany
- Department of Molecular and Experimental Cardiology, Institut Für Forschung Und Lehre (IFL), Ruhr University Bochum, Bochum, Germany
| | - Christoph Hanefeld
- Department of Cardiology, Katholische Kliniken Bochum, Ruhr University Bochum, Bochum, Germany
| | - Stephen O'Connor
- Department of Biomedical Engineering, City, University of London, London, UK
| | - Andreas Mügge
- Department of Cardiology and Angiology, University Hospital Bergmannsheil Bochum, Ruhr University Bochum, Bochum, Germany
- Department of Cardiology, Katholische Kliniken Bochum, Ruhr University Bochum, Bochum, Germany
| | - Fabian Schiedat
- Department of Cardiology, Intensive Medicine and Angiology, Marienhospital Gelsenkirchen, Academic Hospital of the Ruhr University Bochum, Virchowstraße 122, 45886, Gelsenkirchen, Germany.
- Department of Cardiology and Angiology, University Hospital Bergmannsheil Bochum, Ruhr University Bochum, Bochum, Germany.
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Mitacchione G, Migliore F. Co-presence of subcutaneous implantable cardioverter-defibrillator and leadless pacemaker in high-risk infection patients: are we out of the woods? J Interv Card Electrophysiol 2024:10.1007/s10840-023-01726-2. [PMID: 38227124 DOI: 10.1007/s10840-023-01726-2] [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: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 01/17/2024]
Affiliation(s)
| | - Federico Migliore
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani 2, Padua, Italy.
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Calvagna GM, Valsecchi S. Simultaneous subcutaneous implantable cardioverter-defibrillator and leadless pacemaker implantation for patients at high risk of infection: a retrospective case series report. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01684-9. [PMID: 37938506 DOI: 10.1007/s10840-023-01684-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/25/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND The subcutaneous implantable cardioverter defibrillator (S-ICD) and leadless pacemaker (LP) are alternative options for patients at high risk of infection requiring ICD and pacing therapy. In this analysis, we described the simultaneous implantation of S-ICD and LP in patients with high infectious risk. METHODS The study cohort comprised patients referred to our institution for ICD implantation due to high-risk factors of infection. RESULTS Between 2018 and 2022, 13 patients were referred, including 11 with infected ICD and 2 for first ICD implantation in the presence of high-risk factors. In cases of infected ICD, successful extraction was performed using a mechanical dilatation technique. Reimplantation was delayed until resolution of infection with antibiotic therapy. The devices were implanted during a single procedure, with S-ICD implantation following LP placement for verification of sensing adequacy through surface ECG screening. Suitable vectors for sensing during inhibited and ventricular pacing were identified in all patients. Defibrillation testing was effective, and no issues with double counting or undersensing were observed. The postoperative period was uneventful, and during a median follow-up of 35 months, no complications or infections were reported. The median ventricular pacing percentage was 5%, and a single inappropriate shock episode due to myopotential interference was reported and resolved by reprogramming the sensing vector. CONCLUSION Simultaneous implantation of S-ICD and LP is feasible and safe in patients at high risk of infection requiring both ICD and pacing therapy. This combined approach provides an effective solution for these patients.
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Ali H, Foresti S, De Ambroggi G, Cappato R, Lupo P. Practical Considerations for Cardiac Electronic Devices Reimplantation Following Transvenous Lead Extraction Due to Related Endocarditis. J Clin Med 2023; 12:6908. [PMID: 37959373 PMCID: PMC10649089 DOI: 10.3390/jcm12216908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
Despite progress in implantation technology and prophylactic measures, infection complications related to cardiac implantable electronic devices (CIED) are still a major concern with negative impacts on patient outcomes and the health system's resources. Infective endocarditis (IE) represents one of the most threatening CIED-related infections associated with high mortality rates and requires prompt diagnosis and management. Transvenous lead extraction (TLE), combined with prolonged antibiotic therapy, has been validated as an effective approach to treat patients with CIED-related IE. Though early complete removal is undoubtedly recommended for CIED-related IE or systemic infection, device reimplantation still represents a clinical challenge in these patients at high risk of reinfection, with many gaps in the current knowledge and international guidelines. Based on the available literature data and authors' experience, this review aims to address the practical and clinical considerations regarding CIED reimplantation following lead extraction for related IE, focusing on the reassessment of CIED indication, procedure timing, and the reimplanted CIED type and site. A tailored, multidisciplinary approach involving clinical cardiologists, electrophysiologists, cardiac imaging experts, cardiac surgeons, and infectious disease specialists is crucial to optimize these patients' management and clinical outcomes.
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Affiliation(s)
- Hussam Ali
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, 20099 Sesto San Giovanni, Italy; (S.F.); (G.D.A.); (R.C.); (P.L.)
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