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Quast AB, Baalman SW, Van der Stuijt W, Wilde AA, Knops RE. Minimal defibrillation thresholds and the correlation with implant position in subcutaneous implantable‐defibrillator patients. J Cardiovasc Electrophysiol 2019; 30:2441-2447. [DOI: 10.1111/jce.14171] [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: 05/02/2019] [Revised: 08/20/2019] [Accepted: 09/06/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Anne‐Floor B.E. Quast
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | - Sarah W.E. Baalman
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | - Willeke Van der Stuijt
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | - Arthur A.M. Wilde
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | - Reinoud E. Knops
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
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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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Sanghera R, Sanders R, Husby M, Bentsen JG. Development of the subcutaneous implantable cardioverter-defibrillator for reducing sudden cardiac death. Ann N Y Acad Sci 2014; 1329:1-17. [DOI: 10.1111/nyas.12550] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Rick Sanghera
- Cardiac Rhythm Management Division; Boston Scientific Corporation; Arden Hills Minnesota
| | - Richard Sanders
- Cardiac Rhythm Management Division; Boston Scientific Corporation; Arden Hills Minnesota
| | - Michael Husby
- Cardiac Rhythm Management Division; Boston Scientific Corporation; Arden Hills Minnesota
| | - James G. Bentsen
- Cardiac Rhythm Management Division; Boston Scientific Corporation; Arden Hills Minnesota
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McLeod CJ, Asirvatham SJ, Warnes CA, Ammash NM. Device therapy for arrhythmia management in adults with congenital heart disease. Expert Rev Med Devices 2014; 7:519-27. [DOI: 10.1586/erd.10.21] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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KUSCHYK JÜRGEN, MILASINOVIC GORAN, KÜHLKAMP VOLKER, ROBERTS PAULR, ZABEL MARKUS, MOLIN FRANCK, SHOROFSKY STEPHEN, STROMBERG KURTD, DEGROOT PAULJ, MURGATROYD FRANCISD. A Multicenter Study of Shock Pathways for Subcutaneous Implantable Defibrillators. J Cardiovasc Electrophysiol 2013; 25:29-35. [DOI: 10.1111/jce.12281] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 07/30/2013] [Accepted: 08/12/2013] [Indexed: 11/29/2022]
Affiliation(s)
- JÜRGEN KUSCHYK
- Department of Medicine-Cardiology; University Medical Centre; Mannheim Germany
| | - GORAN MILASINOVIC
- Clinical Centre of Serbia Institute for Cardiovascular Diseases; Belgrade Serbia
| | | | | | - MARKUS ZABEL
- Department of Cardiology; Georg-August-Universität; Heart Centre Göttingen Göttingen Germany
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Rowley CP, Lobodzinski SS, Gold MR. The Subcutaneous Defibrillator. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2012; 14:550-7. [DOI: 10.1007/s11936-012-0196-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Valero E, Pesce R. El cardiodesfibrilador totalmente subcutáneo. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2012; 82:230-4. [DOI: 10.1016/j.acmx.2012.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 06/11/2012] [Accepted: 06/21/2012] [Indexed: 11/15/2022] Open
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Affiliation(s)
- Christopher P. Rowley
- From the Division of Cardiology, Medical University of South Carolina, Charleston, SC
| | - Michael R. Gold
- From the Division of Cardiology, Medical University of South Carolina, Charleston, SC
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An alternative technique of implanting a nontransvenous implantable cardioverter-defibrillator system in adults with no or limited venous access to the heart. Heart Rhythm 2010; 7:1572-7. [DOI: 10.1016/j.hrthm.2010.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2010] [Accepted: 07/04/2010] [Indexed: 10/19/2022]
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Bardy GH, Smith WM, Hood MA, Crozier IG, Melton IC, Jordaens L, Theuns D, Park RE, Wright DJ, Connelly DT, Fynn SP, Murgatroyd FD, Sperzel J, Neuzner J, Spitzer SG, Ardashev AV, Oduro A, Boersma L, Maass AH, Van Gelder IC, Wilde AA, van Dessel PF, Knops RE, Barr CS, Lupo P, Cappato R, Grace AA. An entirely subcutaneous implantable cardioverter-defibrillator. N Engl J Med 2010; 363:36-44. [PMID: 20463331 DOI: 10.1056/nejmoa0909545] [Citation(s) in RCA: 537] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Implantable cardioverter-defibrillators (ICDs) prevent sudden death from cardiac causes in selected patients but require the use of transvenous lead systems. To eliminate the need for venous access, we designed and tested an entirely subcutaneous ICD system. METHODS First, we conducted two short-term clinical trials to identify a suitable device configuration and assess energy requirements. We evaluated four subcutaneous ICD configurations in 78 patients who were candidates for ICD implantation and subsequently tested the best configuration in 49 additional patients to determine the subcutaneous defibrillation threshold in comparison with that of the standard transvenous ICD. Then we evaluated the long-term use of subcutaneous ICDs in a pilot study, involving 6 patients, which was followed by a trial involving 55 patients. RESULTS The best device configuration consisted of a parasternal electrode and a left lateral thoracic pulse generator. This configuration was as effective as a transvenous ICD for terminating induced ventricular fibrillation, albeit with a significantly higher mean (+/-SD) energy requirement (36.6+/-19.8 J vs. 11.1+/-8.5 J). Among patients who received a permanent subcutaneous ICD, ventricular fibrillation was successfully detected in 100% of 137 induced episodes. Induced ventricular fibrillation was converted twice in 58 of 59 patients (98%) with the delivery of 65-J shocks in two consecutive tests. Clinically significant adverse events included two pocket infections and four lead revisions. After a mean of 10+/-1 months, the device had successfully detected and treated all 12 episodes of spontaneous, sustained ventricular tachyarrhythmia. CONCLUSIONS In small, nonrandomized studies, an entirely subcutaneous ICD consistently detected and converted ventricular fibrillation induced during electrophysiological testing. The device also successfully detected and treated all 12 episodes of spontaneous, sustained ventricular tachyarrhythmia. (ClinicalTrials.gov numbers, NCT00399217 and NCT00853645.)
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Affiliation(s)
- Gust H Bardy
- Seattle Institute for Cardiac Research, Seattle, WA, USA.
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Finite element modeling of subcutaneous implantable defibrillator electrodes in an adult torso. Heart Rhythm 2010; 7:692-8. [PMID: 20230927 DOI: 10.1016/j.hrthm.2010.01.030] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Accepted: 01/10/2010] [Indexed: 11/23/2022]
Abstract
BACKGROUND Total subcutaneous implantable subcutaneous defibrillators are in development, but optimal electrode configurations are not known. OBJECTIVE We used image-based finite element models (FEM) to predict the myocardial electric field generated during defibrillation shocks (pseudo-DFT) in a wide variety of reported and innovative subcutaneous electrode positions to determine factors affecting optimal lead positions for subcutaneous implantable cardioverter-defibrillators (S-ICD). METHODS An image-based FEM of an adult man was used to predict pseudo-DFTs across a wide range of technically feasible S-ICD electrode placements. Generator location, lead location, length, geometry and orientation, and spatial relation of electrodes to ventricular mass were systematically varied. Best electrode configurations were determined, and spatial factors contributing to low pseudo-DFTs were identified using regression and general linear models. RESULTS A total of 122 single-electrode/array configurations and 28 dual-electrode configurations were simulated. Pseudo-DFTs for single-electrode orientations ranged from 0.60 to 16.0 (mean 2.65 +/- 2.48) times that predicted for the base case, an anterior-posterior configuration recently tested clinically. A total of 32 of 150 tested configurations (21%) had pseudo-DFT ratios </=1, indicating the possibility of multiple novel, efficient, and clinically relevant orientations. Favorable alignment of lead-generator vector with ventricular myocardium and increased lead length were the most important factors correlated with pseudo-DFT, accounting for 70% of the predicted variation (R(2) = 0.70, each factor P < .05) in a combined general linear model in which parameter estimates were calculated for each factor. CONCLUSION Further exploration of novel and efficient electrode configurations may be of value in the development of the S-ICD technologies and implant procedure. FEM modeling suggests that the choice of configurations that maximize shock vector alignment with the center of myocardial mass and use of longer leads is more likely to result in lower DFT.
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Gupta A, Al-Ahmad A, Wang PJ. Subcutaneous Implantable Cardioverter-Defibrillator Technology. Card Electrophysiol Clin 2009; 1:147-154. [PMID: 28770781 DOI: 10.1016/j.ccep.2009.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The advent of subcutaneous implantable cardioverter-defibrillator (ICD) systems represents a paradigm shift for the detection and therapy of ventricular tachyarrhythmias. Despite advances in transvenous lead technology, problems remain that notably include requirement for technical expertise; periprocedural complications during implantation and explantation; and long-term lead failure. Although subcutaneous ICD systems may mitigate some of these risks, they provide new shortcomings, such as inability to provide pacing therapy for bradyarrhythmias, ventricular tachyarrhythmias, and cardiac resynchronization. Ongoing clinical evaluation and development are required before the role of subcutaneous ICDs as an adjunctive or primary therapy can be defined. This article examines studies investigating the subcutaneous ICD and discusses its possible advantages and disadvantages as compared with current transvenous ICD systems.
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Affiliation(s)
- Anurag Gupta
- Department of Internal Medicine, Division of Cardiovascular Medicine, Cardiac Arrhythmia Service, Stanford University School of Medicine, 300 Pasteur Drive, Room H2146, Stanford, CA 94305-5233, USA
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Jolley M, Triedman J, Westin CF, Weinstein DM, MacLeod R, Brooks D. Image based modeling of defibrillation in children. CONFERENCE PROCEEDINGS : ... ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL CONFERENCE 2008; 2006:2564-7. [PMID: 17946966 DOI: 10.1109/iembs.2006.259549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Volume imaging, defibrillation electrode models, and finite element modeling are employed in patient-specific procedural modeling in pediatric patients with cardiac arrhythmias. Due to variable size and anatomy, these patients may not be well-served by devices designed for adult defibrillation. A pipeline for rapid creation of image based models that can be interactively interrogated to determine optimal defibrillation scenarios and preliminary proof-of-concept work are presented. This approach has potential clinical applications for therapy planning and broad applications for finite element modeling in anatomical models. Clinical studies investigating the effects of body size, habitus, and anatomical variation on myocardial voltage gradients are planned.
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Affiliation(s)
- Matthew Jolley
- Dept. of Cardiology, Children's Hosp. Boston, and Laboratory of Mathematics in Imaging, Harvard Medical School, MA 02115, USA.
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Lieberman R, Havel WJ, Rashba E, DeGroot PJ, Stromberg K, Shorofsky SR. Acute defibrillation performance of a novel, non-transvenous shock pathway in adult ICD indicated patients. Heart Rhythm 2008; 5:28-34. [DOI: 10.1016/j.hrthm.2007.08.030] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2007] [Accepted: 08/24/2007] [Indexed: 11/16/2022]
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Kleemann T, Becker T, Doenges K, Vater M, Senges J, Schneider S, Saggau W, Weisse U, Seidl K. Annual rate of transvenous defibrillation lead defects in implantable cardioverter-defibrillators over a period of >10 years. Circulation 2007; 115:2474-80. [PMID: 17470696 DOI: 10.1161/circulationaha.106.663807] [Citation(s) in RCA: 438] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The number of patients with longer follow-up after implantation of an implantable cardioverter-defibrillator is increasing continuously. Defibrillation lead failure is a typical long-term complication. Therefore, the long-term reliability of implantable cardioverter-defibrillator leads has become an increasing concern. The aim of the present study was to assess the annual rate of transvenous defibrillation lead defects related to follow-up time after lead implantation. METHODS AND RESULTS A total of 990 consecutive patients who underwent first implantation of an implantable cardioverter-defibrillator between 1992 and May 2005 were analyzed. Median follow-up time was 934 days (interquartile range, 368 to 1870). Overall, 148 defibrillation leads (15%) failed during the follow-up. The estimated lead survival rates at 5 and 8 years after implantation were 85% and 60%, respectively. The annual failure rate increased progressively with time after implantation and reached 20% in 10-year-old leads (P<0.001). Lead defects affected newer as well as older models. Patients with lead defects were 3 years younger at implantation and more often female. Multiple lead implantation was associated with a trend to a higher rate of defibrillation lead defects (P=0.06). The major lead complications were insulation defects (56%), lead fractures (12%), loss of ventricular capture (11%), abnormal lead impedance (10%), and sensing failure (10%). CONCLUSIONS An increasing annual lead failure rate is noted primarily during long-term follow-up and reached 20% in 10-year-old leads. Patients with lead defects are younger and more often female.
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