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Kohli U, von Alvensleben J, Srinivasan C. Subcutaneous Implantable Cardioverter Defibrillators in Pediatrics and Congenital Heart Disease. Card Electrophysiol Clin 2023; 15:e1-e16. [PMID: 38030336 DOI: 10.1016/j.ccep.2023.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Subcutaneous implantable cardioverter defibrillators (S-ICDs) are being used with increased frequency in children and patients with congenital heart disease. Vascular access complexities, intracardiac shunts, and specific anatomies make these devices particularly appealing for some of these patients. Alternative screening, implantation, and programming techniques should be considered based on patient size, body habitus, anatomy, procedural history, and preference. Appropriate and inappropriate shock rates are generally comparable to those seen with transvenous devices. Complications such as infection can occur, although their severity is likely to be less than that seen with transvenous devices. Technical advances are likely to further broaden S-ICD applicability.
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Affiliation(s)
- Utkarsh Kohli
- Division of Pediatric Cardiology, Department of Pediatrics, West Virginia University School of Medicine and West Virginia University Children's Heart Center, 64 Medical Center Drive, Robert C. Byrd Health Science Center, PO Box 9214, Morgantown, WV 26506-9214, USA.
| | - Johannes von Alvensleben
- Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, Aurora, CO 80045 720-777-1234, USA
| | - Chandra Srinivasan
- The Children's Hospital of Philadelphia; University of Perelman School of Medicine, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
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Guarracini F, Preda A, Bonvicini E, Coser A, Martin M, Quintarelli S, Gigli L, Baroni M, Vargiu S, Varrenti M, Forleo GB, Mazzone P, Bonmassari R, Marini M, Droghetti A. Subcutaneous Implantable Cardioverter Defibrillator: A Contemporary Overview. Life (Basel) 2023; 13:1652. [PMID: 37629509 PMCID: PMC10455445 DOI: 10.3390/life13081652] [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: 06/06/2023] [Revised: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023] Open
Abstract
The difference between subcutaneous implantable cardioverter defibrillators (S-ICDs) and transvenous ICDs (TV-ICDs) concerns a whole extra thoracic implantation, including a defibrillator coil and pulse generator, without endovascular components. The improved safety profile has allowed the S-ICD to be rapidly taken up, especially among younger patients. Reports of its role in different cardiac diseases at high risk of SCD such as hypertrophic and arrhythmic cardiomyopathies, as well as channelopathies, is increasing. S-ICDs show comparable efficacy, reliability, and safety outcomes compared to TV-ICD. However, some technical issues (i.e., the inability to perform anti-bradycardia pacing) strongly limit the employment of S-ICDs. Therefore, it still remains only an alternative to the traditional ICD thus far. This review aims to provide a contemporary overview of the role of S-ICDs compared to TV-ICDs in clinical practice, including technical aspects regarding device manufacture and implantation techniques. Newer outlooks and future perspectives of S-ICDs are also brought up to date.
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Affiliation(s)
- Fabrizio Guarracini
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Alberto Preda
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Eleonora Bonvicini
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Alessio Coser
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Marta Martin
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Silvia Quintarelli
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Lorenzo Gigli
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Matteo Baroni
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Sara Vargiu
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Marisa Varrenti
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Giovanni Battista Forleo
- Department of Thoracic Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Turin, Italy;
| | - Patrizio Mazzone
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Roberto Bonmassari
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Massimiliano Marini
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Andrea Droghetti
- Cardiology Unit, Luigi Sacco University Hospital, 20157 Milan, Italy;
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Uzunoglu EC, Liu K, Adrover P, Suryanarayana PG, Elayi CS, Catanzaro JN. Vector Configuration Screening Failure After Defibrillation Threshold Testing: Should we be concerned? HeartRhythm Case Rep 2023. [DOI: 10.1016/j.hrcr.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
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Świerżyńska E, Sterliński M, Syska P, Sadowski K, Szumowski Ł. Use of an exercise test to enhance sensing vector assessment and prevent inadequate subcutaneous implantable cardioverter-defibrillator discharges. J Electrocardiol 2021; 67:73-76. [PMID: 34090117 DOI: 10.1016/j.jelectrocard.2021.05.013] [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: 04/20/2021] [Accepted: 05/21/2021] [Indexed: 10/21/2022]
Abstract
Subcutaneous implantable cardioverter-defibrillators are a modern alternative to classic cardioverter-defibrillators. Prior to implantation of the device, qualification based on assessment of the heart's specific rhythm shape during a resting electrocardiogram examination must be performed. In the presented case, a patient with a subcutaneous implantable cardioverter-defibrillator experienced numerous discharges during exercise. An exercise test was performed, which revealed a bundle branch block that appeared during exercise. The wide QRS complex was double- or triple-counted by the device, resulting in an inaccurate heart rate estimation and multiple discharges. Optimising the sensing vectors during exercise solved this problem.
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Affiliation(s)
- Ewa Świerżyńska
- 1(st) Department of Arrhythmia, National Institute of Cardiology, 42 Alpejska St., 04-628 Warsaw, Poland; 1(st) Department of Cardiology, Doctoral School, Medical University of Warsaw, 61 Żwirki i Wigury St., 02-091 Warsaw, Poland.
| | - Maciej Sterliński
- 1(st) Department of Arrhythmia, National Institute of Cardiology, 42 Alpejska St., 04-628 Warsaw, Poland
| | - Paweł Syska
- 2(nd) Department of Arrhythmia, National Institute of Cardiology, 42 Alpejska St., 04-628 Warsaw, Poland
| | - Krzysztof Sadowski
- Department of Coronary Artery Disease and Cardiac Rehabilitation, National Institute of Cardiology, 42 Alpejska St., 04-628 Warsaw, Poland
| | - Łukasz Szumowski
- 1(st) Department of Arrhythmia, National Institute of Cardiology, 42 Alpejska St., 04-628 Warsaw, Poland
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Casu G, Silva E, Bisbal F, Viola G, Merella P, Lorenzoni G, Motta G, Bandino S, Berne P. Predictors of inappropriate shock in Brugada syndrome patients with a subcutaneous implantable cardiac defibrillator. J Cardiovasc Electrophysiol 2021; 32:1704-1711. [PMID: 33928706 DOI: 10.1111/jce.15059] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/23/2021] [Accepted: 04/19/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Subcutaneous implantable cardioverter defibrillators (S-ICDs) avoid complications secondary to transvenous leads, but inappropriate shocks (ISs) are frequent. Furthermore, IS data from patients with Brugada syndrome (BrS) with an S-ICD are scarce. OBJECTIVE We aimed to establish the frequency and predictors of IS in this population. METHODS We analyzed the clinical and electrocardiographic characteristics, automated screening test data, device programming, and IS occurrence in adult patients with BrS with an S-ICD. RESULTS Thirty-nine patients were enrolled (69% male, mean age at diagnosis 46 ± 13 years, mean age at implantation 48 ± 13 years). During a mean follow-up of 26 ± 21 months, 18% patients experienced IS. Patients with IS were younger at the time of diagnosis (36 ± 8 vs. 48 ± 13 years, p = .018) and S-ICD implantation (38 ± 9 vs. 50 ± 23 years, p = .019) and presented with spontaneous type 1 Brugada electrocardiogram pattern more frequently at diagnosis or during follow-up (71% vs. 25%, p = .018). During automated screening tests, patients with IS showed lower QRS voltage in the primary vector in the supine position (0.58 ± 0.26 vs. 1.10 ± 0.35 mV, p = .011) and lower defibrillator automated screening score in the primary vector in the supine (123 ± 165 vs. 554 ± 390 mV, p = .005) and standing (162 ± 179 vs. 486 ± 388 mV, p = .038) positions. Age at diagnosis was the only independent predictor of IS (hazard ratio = 0.873, 95% confidence interval: 0.767-0.992, p = .037). CONCLUSION IS was a frequent complication in patients with BrS with an S-ICD. Younger age was independently associated with IS. A more thorough screening process might help prevent IS in this population.
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Affiliation(s)
- Gavino Casu
- Cardiology Department, Ospedale San Francesco, Nuoro, Italy.,Biomedical Science PhD Course, University of Sassari, Sassari, Italy
| | - Etelvino Silva
- Hospital Universitario Puerta del Mar, Cadiz, Spain.,Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Grupo GADICOR, Hospital Universitario Puerta del Mar, Universidad de Cádiz, Cádiz, Spain
| | - Felipe Bisbal
- Heart Institute (iCor), University Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Graziana Viola
- Cardiology Department, Ospedale San Francesco, Nuoro, Italy
| | | | | | - Giovanni Motta
- Cardiology Department, Ospedale San Francesco, Nuoro, Italy
| | | | - Paola Berne
- Cardiology Department, Ospedale San Francesco, Nuoro, Italy
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A Historical Perspective of Cardiac Implantable Electronic Device Infection: How a Menace Can Drive Technological and Clinical Improvement. HEARTS 2021. [DOI: 10.3390/hearts2020016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In recent decades there has been a relevant increase in the implantation rate of cardiac implantable electronic devices (CIEDs), albeit with relevant geographical inhomogeneities. Despite the positive impact on clinical outcomes, the possibility of major complications is not negligible, particularly with respect to CIED infections. CIED infections significantly affect morbidity and mortality, especially in instances of delayed diagnosis and appropriate treatment. In the present review, we will start to depict the factors underlying the development of CIED infection as well as the difficulties related to its diagnosis and treatment. We will explain the reasons underlying the need to focus on prophylaxis rather than treatment, in view of the poor outcomes despite improvements in lead extraction procedures. This will lead to the consideration of management of this complication in a hub-spoke manner, and to our analysis of the several technological and procedural improvements developed to minimize this complication. These include prolongation of CIED longevity, the development of leadless devices, and integrated prophylactic approaches. We will conclude with a discussion regarding new devices and strategies under development. This complete excursus will provide the reader with a new perspective on how a major complication can drive technological improvements.
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Jing R, Jin H, Hua W, Yang S, Hu Y, Zhang S. Association Between Subcutaneous Implantable Cardioverter Defibrillator Preimplantation Screening and the Response to Cardiac Resynchronization Therapy. Korean Circ J 2020; 50:1062-1073. [PMID: 33150752 PMCID: PMC7707981 DOI: 10.4070/kcj.2019.0420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 07/26/2020] [Accepted: 08/25/2020] [Indexed: 11/12/2022] Open
Abstract
Background and Objectives Preimplantation QRS-T morphology screening (TMS) is a composite tool for selecting subcutaneous implantable cardioverter defibrillator (S-ICD) candidates. However, its role in predicting the patient's response to cardiac resynchronization therapy (CRT) is uncertain. Methods A total of 55 consecutive de novo CRT candidates were enrolled between January 2016 and March 2017. Electrocardiogram (ECG) and TMS were performed before and soon after implantation. The ECG parameters were recorded, including QRS duration and morphology (such as ΔQRS_Index, QTc during biventricular pacing mode [BiV pacing QTc], and QRS/T ratio during biventricular pacing mode [BiV pacing QRS/T ratio]). TMS monitored three sensory vectors of the S-ICD. Six months after implantation, the responses to CRT were evaluated. Results Thirty-nine patients (70.9%) passed the TMS during biventricular pacing mode. At the six-month follow-up, the number of responders and super-responders was significantly higher in the passing group than in the non-passing group (responders: 31/39 [79.5%] vs. 5/16 [31.3%], p<0.001; super-responders: 9/39 [23.1%] vs. 1/16 [6.3%], p=0.020). The super-response rate was higher among patients who passed all three vectors than among those who passed 1 or 2 vectors (3 vs. 2 vectors, p=0.018; 3 vs. 1 vector, p=0.003). A smaller left atrial diameter, vectors that passed TMS during biventricular pacing mode, and larger ΔQRS_Index values were independently associated with good CRT response. Conclusions Our study demonstrated that patients on CRT who pass the TMS during biventricular pacing mode are more likely to respond and super-respond to CRT.
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Affiliation(s)
- Ran Jing
- The Cardiac Arrhythmia Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Han Jin
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Wei Hua
- The Cardiac Arrhythmia Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Shengwen Yang
- The Cardiac Arrhythmia Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yiran Hu
- The Cardiac Arrhythmia Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu Zhang
- The Cardiac Arrhythmia Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Martignani C, Massaro G, Mazzotti A, Pegreffi F, Ziacchi M, Biffi M, Porcellini G, Boriani G, Diemberger I. Shoulder Function After Cardioverter-Defibrillator Implantation: 5-Year Follow-up. Ann Thorac Surg 2019; 110:608-614. [PMID: 31862496 DOI: 10.1016/j.athoracsur.2019.10.063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 09/24/2019] [Accepted: 10/11/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Implantable cardioverter-defibrillator (ICD) represents the main tool for prevention of sudden cardiac death. Different kinds of postimplant complications have been described; however, little is known about shoulder functional impairment and its impact on quality of life. METHODS Patients with standard indications for elective prepectoral subcutaneous ICD insertion were enrolled during a 1-year period. The impact of ICD implantation on shoulder motility, pain, general disability, and quality of life was evaluated prospectively at baseline, and after 2 weeks, 3 months, 1 year, and 5 years using the Constant score, the Numeric Pain Rating Scale, the Disabilities of the Arm, Shoulder, and Hand scale, and the Short Form-36 Health Survey questionnaire. RESULTS A total of 50 patients underwent insertion of single, dual chamber, or biventricular ICDs. Two weeks after implantation, functional impairment and mild pain were observed in ipsilateral shoulder movements, with a reduction in the Short Form-36 Health Survey score. Shoulder functional impairment improved at the third-month evaluations, with almost normalization at 1-year and 5-year assessments, as well as pain and quality of life. CONCLUSIONS Prepectoral subcutaneous ICD implantation may be associated with ipsilateral shoulder functional impairment that regresses partially after 3 months and completely at 1-year and 5-year assessments. The less invasive implantation technique and the relatively small size of modern ICDs, independently from types and volumes, may be relevant to the degree of postimplantation shoulder functional impairment and recovery time. Shoulder function should be assessed at routine checks, especially soon after ICD implantation because of potential functional impairment and subsequent impact on quality of life.
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Affiliation(s)
- Cristian Martignani
- Institute of Cardiology, Department of Experimental, Diagnostic, and Speciality Medicine, Policlinico S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
| | - Giulia Massaro
- Institute of Cardiology, Department of Experimental, Diagnostic, and Speciality Medicine, Policlinico S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Andrea Mazzotti
- Institute of Cardiology, Department of Experimental, Diagnostic, and Speciality Medicine, Policlinico S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | - Matteo Ziacchi
- Institute of Cardiology, Department of Experimental, Diagnostic, and Speciality Medicine, Policlinico S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Mauro Biffi
- Institute of Cardiology, Department of Experimental, Diagnostic, and Speciality Medicine, Policlinico S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giuseppe Porcellini
- Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica University, Cattolica, Italy
| | - Giuseppe Boriani
- Cardiovascular Division, Modena University Hospital, University of Modena and Reggio Emilia, Modena, Italy
| | - Igor Diemberger
- Institute of Cardiology, Department of Experimental, Diagnostic, and Speciality Medicine, Policlinico S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Diemberger I, Migliore F, Ricciardi G, Ottaviano L, Tavoletta V, Francia P, Viani S, Capucci A, de Filippo P, Nigro G, Caravati F, Palmisano P, Ziacchi M, Lovecchio M, Valsecchi S, Bongiorni MG, Biffi M. Time to therapy delivery and effectiveness of the subcutaneous implantable cardioverter-defibrillator. Heart Rhythm 2019; 16:1531-1537. [DOI: 10.1016/j.hrthm.2019.05.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Indexed: 11/25/2022]
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Migliore F, Pelliccia F, Autore C, Bertaglia E, Cecchi F, Curcio A, Bontempi L, Curnis A, De Filippo P, D’Onofrio A, Francia P, Maurizi N, Musumeci B, Proclemer A, Zorzi A, Corrado D. Subcutaneous implantable cardioverter defibrillator in cardiomyopathies and channelopathies. J Cardiovasc Med (Hagerstown) 2018; 19:633-642. [DOI: 10.2459/jcm.0000000000000712] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Bögeholz N, Pauls P, Güner F, Bode N, Fischer A, Dechering D, Frommeyer G, Köbe J, Wasmer K, Eckardt L, Reinke F. Direct comparison of the novel automated screening tool (AST) versus the manual screening tool (MST) in patients with already implanted subcutaneous ICD. Int J Cardiol 2018; 265:90-96. [DOI: 10.1016/j.ijcard.2018.02.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 02/03/2018] [Accepted: 02/08/2018] [Indexed: 12/01/2022]
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12
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Subcutaneous implantable cardioverter defibrillator eligibility according to a novel automated screening tool and agreement with the standard manual electrocardiographic morphology tool. J Interv Card Electrophysiol 2018; 52:61-67. [PMID: 29502193 DOI: 10.1007/s10840-018-0326-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 02/06/2018] [Indexed: 11/26/2022]
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13
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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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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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