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Wörmann J, Strik M, Jurisic S, Stout K, Elrefai M, Becher N, Schaer B, van Stipdonk A, Srinivasan NT, Ploux S, Breitenstein A, Kron J, Roberts PR, Toennis T, Linz D, Dulai R, Hermes-Laufer J, Koneru J, Erküner Ö, Dittrich S, van den Bruck JH, Schipper JH, Sultan A, Rosenberger KD, Steven D, Lüker J. Occurrence of premature battery depletion in a large multicentre registry of subcutaneous cardioverter-defibrillator patients. Europace 2024; 26:euae170. [PMID: 38885309 PMCID: PMC11218560 DOI: 10.1093/europace/euae170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 05/27/2024] [Indexed: 06/20/2024] Open
Abstract
AIMS Subcutaneous implantable cardioverter-defibrillators (S-ICDs) have become established in preventing sudden cardiac death, with some advantages over transvenous defibrillator systems, including a lower incidence of lead failures. Despite technological advancements, S-ICD carriers may suffer from significant complications, such as premature battery depletion (PBD), that led to an advisory for nearly 40 000 patients. This multicentre study evaluated the incidence of PBD in a large set of S-ICD patients. METHODS AND RESULTS Data from patients implanted with S-ICD models A209 and A219 between October 2012 and July 2023 across nine centres in Europe and the USA were reviewed. Incidence and implications of PBD, defined as clinically observed sudden drop in battery longevity, were analysed and compared to PBD with the definition of battery depletion within 60 months. Prospectively collected clinical data were obtained retrospectively from medical records, device telemetry, and manufacturer reports. This registry is listed on ClinicalTrials.gov (NCT05713708). Of the 1112 S-ICD devices analysed, 547 (49.2%) were equipped with a potentially affected capacitor linked to PBD occurrence, currently under Food and Drug Administration advisory. The median follow-up time for all patients was 46 [inter-quartile range (IQR) 24-63] months. Clinically suspected PBD was observed in 159 (29.1%) of cases, with a median time to generator removal or replacement of 65 (IQR 55-72) months, indicative of significant deviations from expected battery lifespan. Manufacturer confirmation of PBD was made in 91.7% of devices returned for analysis. No cases of PBD were observed in devices that were not under advisory. CONCLUSION This manufacturer-independent analysis highlights a notable incidence of PBD in patients equipped with S-ICD models under advisory, and the rate of PBD in this study corresponds to the rate currently estimated by the manufacturer. To the best of our knowledge, this provides the largest contemporary peer-reviewed study cohort investigating the actual incidence of PBD in S-ICD patients. These findings emphasize the importance of post-market registries in collaboration between clinicians and the manufacturer to optimize safety and efficacy in S-ICD treatment.
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Affiliation(s)
- Jonas Wörmann
- Department of Electrophysiology, Heart Center at the University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Marc Strik
- CHU de Bordeaux, service de Cardiologie-électrophysiologie et stimulation cardiaque, INSERM, U 1045, F-33000 Bordeaux, France
| | - Stjepan Jurisic
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Kara Stout
- Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, USA
| | - Mohamed Elrefai
- Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom of Great Britain & Northern Ireland
| | - Nina Becher
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Beat Schaer
- Cardiology, University Hospital Basel, Basel, Switzerland
| | - Antonius van Stipdonk
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Neil T Srinivasan
- Department of Electrophysiology, The Essex Cardiothoracic Centre, Basildon, UK
- Circulatory Health Research Group, Medical Technology Research Centre, School of Medicine, Anglia Ruskin University, Chelmsford CM1 1SQ, UK
| | - Sylvain Ploux
- CHU de Bordeaux, service de Cardiologie-électrophysiologie et stimulation cardiaque, INSERM, U 1045, F-33000 Bordeaux, France
| | - Alexander Breitenstein
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Jordana Kron
- Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, USA
| | - Paul R Roberts
- Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom of Great Britain & Northern Ireland
| | - Tobias Toennis
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Dominik Linz
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Rajdip Dulai
- Department of Electrophysiology, The Essex Cardiothoracic Centre, Basildon, UK
| | - Julia Hermes-Laufer
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Jay Koneru
- Cardiology, VCU Health Pauley Heart Center, Virginia Commonwealth University, Richmond, USA
| | - Ömer Erküner
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Sebastian Dittrich
- Department of Electrophysiology, Heart Center at the University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Jan-Hendrik van den Bruck
- Department of Electrophysiology, Heart Center at the University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Jan-Hendrik Schipper
- Department of Electrophysiology, Heart Center at the University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Arian Sultan
- Department of Electrophysiology, Heart Center at the University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Kerstin D Rosenberger
- Institute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Daniel Steven
- Department of Electrophysiology, Heart Center at the University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Jakob Lüker
- Department of Electrophysiology, Heart Center at the University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
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Wörmann J, Strik M, Jurisic S, Stout K, Elrefai M, Becher N, Schaer B, van Stipdonk A, Srinivasan NT, Ploux S, Breitenstein A, Kron J, Roberts PR, Toennis T, Linz D, Dulai R, Hermes-Laufer J, Koneru J, Erküner Ö, Dittrich S, van den Bruck JH, Schipper JH, Sultan A, Rosenberger KD, Steven D, Lüker J. Incidence, implications, and management of sense-B-noise failure in subcutaneous cardioverter-defibrillator patients: insights from a large multicentre registry. Europace 2024; 26:euae161. [PMID: 38861398 PMCID: PMC11212320 DOI: 10.1093/europace/euae161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 06/07/2024] [Indexed: 06/13/2024] Open
Abstract
AIMS Subcutaneous implantable cardioverter-defibrillators (S-ICDs) offer potentially distinct advantages over transvenous defibrillator systems. Recent randomized trials showed significantly lower lead failure rates than transvenous ICD. Still, S-ICDs remain associated with the risk of inappropriate shocks (IAS). While previous studies have reported varying causes of IAS, this study explores a rare cause of IAS, referred to as 'sense-B-noise.' It was recently described in case series, but its incidence has not been studied in a large cohort of S-ICD patients. METHODS AND RESULTS We retrospectively reviewed data from patients implanted with S-ICD models 1010, A209, and A219 between October 2009 and July 2023 across nine centres in Europe and the USA. The analysis concentrated on determining the incidence and understanding the implications of sense-B-noise events. Sense-B-noise represents a rare manifestation of distinct electrogram abnormalities within the primary and alternate sensing vectors. Data were collected from medical records, device telemetry, and manufacturer reports for investigation. This registry is registered on clinicaltrials.gov (NCT05713708). Subcutaneous implantable cardioverter-defibrillator devices of the 1158 patients were analysed. The median follow-up time for all patients was 46 (IQR 23-64) months. In 107 patients (9.2%) ≥1 IAS was observed during follow-up. Sense-B-noise failure was diagnosed in six (0.5 and 5.6% of all IAS) patients, in all patients, the diagnosis was made after an IAS episode. Median lead dwell time in the affected patients was 23 (2-70) months. To resolve the sense-B-noise defect, in three patients reprogramming to the secondary vector was undertaken, and two patients underwent system removal with subsequent S-ICD reimplantation due to low amplitude in the secondary vector. In one patient, the secondary vector was initially programmed, and subsequently, an S-ICD system exchange was performed due to T-wave-oversensing IAS episodes. CONCLUSION This multicentre analysis' findings shed light on a rare but clinically highly significant adverse event in S-ICD therapy. To our knowledge, we provide the first systematic multicentre analysis investigating the incidence of sense-B-noise. Due to being difficult to diagnose and limited options for resolution, management of sense-B-noise is challenging. Complete system exchange may be the only option for some patients. Educating healthcare providers involved in S-ICD patient care is crucial for ensuring accurate diagnosis and effective management of sense-B-noise issues.
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Affiliation(s)
- Jonas Wörmann
- Department of Electrophysiology, Heart Center at the University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Marc Strik
- CHU de Bordeaux, service de Cardiologie-électrophysiologie et stimulation cardiaque, INSERM, U 1045, F-33000 Bordeaux, France
| | - Stjepan Jurisic
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Kara Stout
- Cardiology, VCU Health Pauley Heart Center, Richmond, VA, USA
| | - Mohamed Elrefai
- Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nina Becher
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Beat Schaer
- Cardiology, University Hospital Basel, Basel, Switzerland
| | - Antonius van Stipdonk
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Neil T Srinivasan
- Department of Electrophysiology, The Essex Cardiothoracic Centre, Basildon, UK
- Circulatory Health Research Group, Medical Technology Research Centre, School of Medicine, Anglia Ruskin University, Chelmsford CM1 1SQ, UK
| | - Sylvain Ploux
- CHU de Bordeaux, service de Cardiologie-électrophysiologie et stimulation cardiaque, INSERM, U 1045, F-33000 Bordeaux, France
| | - Alexander Breitenstein
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Jordana Kron
- Cardiology, VCU Health Pauley Heart Center, Richmond, VA, USA
| | - Paul R Roberts
- Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Tobias Toennis
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Dominik Linz
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Rajdip Dulai
- Department of Electrophysiology, The Essex Cardiothoracic Centre, Basildon, UK
| | - Julia Hermes-Laufer
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Jay Koneru
- Cardiology, VCU Health Pauley Heart Center, Richmond, VA, USA
| | - Ömer Erküner
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Sebastian Dittrich
- Department of Electrophysiology, Heart Center at the University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Jan-Hendrik van den Bruck
- Department of Electrophysiology, Heart Center at the University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Jan-Hendrik Schipper
- Department of Electrophysiology, Heart Center at the University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Arian Sultan
- Department of Electrophysiology, Heart Center at the University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Kerstin D Rosenberger
- Institute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Daniel Steven
- Department of Electrophysiology, Heart Center at the University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Jakob Lüker
- Department of Electrophysiology, Heart Center at the University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
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3
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Budrejko S, Zienciuk-Krajka A, Daniłowicz-Szymanowicz L, Kempa M. Comparison of Preoperative ECG Screening and Device-Based Vector Analysis in Patients Receiving a Subcutaneous Implantable Cardioverter-Defibrillator. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2186. [PMID: 38138289 PMCID: PMC10745078 DOI: 10.3390/medicina59122186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/06/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: Subcutaneous implantable cardioverter-defibrillators (S-ICDs) provide protection against sudden cardiac death from outside the cardiovascular system. ECG screening is a prerequisite for implantation, but the reproducibility of its results post-operatively in the device is only partial. We aimed to compare the results of ECG screening with device-based sensing vector analysis. Materials and Methods: We screened the hospital records of all S-ICD recipients in our clinic. All of them had pre-operative ECG screening performed (primary, secondary, and alternate vectors). The results were compared with device-based vector analysis to determine the relation of the pre- and post-operative vector availability. Results: Complete ECG screening and device-based vector analysis were obtained for 103 patients. At least two acceptable vectors were found in 97.1% of the patients pre-operatively and in 96.1% post-operatively. When comparing vectors in terms of agreement (OK or FAIL) pre- and post-operatively, in 89.3% of the patients, the result for the primary vector was the same in both situations; for the secondary, it was in 84.5%, and for the alternate, it was in 74.8% of patients, respectively. In 55.3% of patients, all three vectors were labeled the same (OK or FAIL); in 37.9%, two vectors had the same result, and in 6.8%, only one vector had the same result pre- and post-operatively. The number of available vectors was the same pre- and post-operatively in 62.1% of patients, while in 15.5%, it was lower, and in 22.3% of patients, it was higher than observed during screening. Conclusions: Routine clinical pre-operative screening allowed for a good selection of candidates for S-ICD implantation. All patients had at least one vector available post-operatively. The final number of vectors available in the device-based analysis in most patients was at least the same (or higher) than during screening. The repeatability of the positive result for a single vector was high.
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Affiliation(s)
- Szymon Budrejko
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdansk, Smoluchowskiego 17, 80-214 Gdansk, Poland; (A.Z.-K.); (L.D.-S.); (M.K.)
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4
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Migliore F, Biffi M, Viani S, Pittorru R, Francia P, Pieragnoli P, De Filippo P, Bisignani G, Nigro G, Dello Russo A, Pisanò E, Palmisano P, Rapacciuolo A, Silvetti MS, Lavalle C, Curcio A, Rordorf R, Lovecchio M, Valsecchi S, D’Onofrio A, Botto GL. Modern subcutaneous implantable defibrillator therapy in patients with cardiomyopathies and channelopathies: data from a large multicentre registry. Europace 2023; 25:euad239. [PMID: 37536671 PMCID: PMC10438213 DOI: 10.1093/europace/euad239] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/01/2023] [Indexed: 08/05/2023] Open
Abstract
AIMS Patients with cardiomyopathies and channelopathies are usually younger and have a predominantly arrhythmia-related prognosis; they have nearly normal life expectancy thanks to the protection against sudden cardiac death provided by the implantable cardioverter defibrillator (ICD). The subcutaneous ICD (S-ICD) is an effective alternative to the transvenous ICD and has evolved over the years. This study aimed to evaluate the rate of inappropriate shocks (IS), appropriate therapies, and device-related complications in patients with cardiomyopathies and channelopathies who underwent modern S-ICD implantation. METHODS AND RESULTS We enrolled consecutive patients with cardiomyopathies and channelopathies who had undergone implantation of a modern S-ICD from January 2016 to December 2020 and who were followed up until December 2022. A total of 1338 S-ICD implantations were performed within the observation period. Of these patients, 628 had cardiomyopathies or channelopathies. The rate of IS at 12 months was 4.6% [95% confidence interval (CI): 2.8-6.9] in patients with cardiomyopathies and 1.1% (95% CI: 0.1-3.8) in patients with channelopathies (P = 0.032). No significant differences were noted over a median follow-up of 43 months [hazard ratio (HR): 0.76; 95% CI: 0.45-1.31; P = 0.351]. The rate of appropriate shocks at 12 months was 2.3% (95% CI: 1.1-4.1) in patients with cardiomyopathies and 2.1% (95% CI: 0.6-5.3) in patients with channelopathies (P = 1.0). The rate of device-related complications was 0.9% (95% CI: 0.3-2.3) and 3.2% (95% CI: 1.2-6.8), respectively (P = 0.074). No significant differences were noted over the entire follow-up. The need for pacing was low, occurring in 0.8% of patients. CONCLUSION Modern S-ICDs may be a valuable alternative to transvenous ICDs in patients with cardiomyopathies and channelopathies. Our findings suggest that modern S-ICD therapy carries a low rate of IS. CLINICAL TRIAL REGISTRATION URL: http://clinicaltrials.gov/Identifier: NCT02275637.
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Affiliation(s)
- Federico Migliore
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Mauro Biffi
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - Stefano Viani
- Second Cardiology Division, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Raimondo Pittorru
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Pietro Francia
- Cardiology, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, University Sapienza, Rome, Italy
| | - Paolo Pieragnoli
- Arrhythmic Disease Unit, University of Florence, Florence, Italy
| | - Paolo De Filippo
- Cardiac Electrophysiology and Pacing Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Gerardo Nigro
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, Università Politecnica delle Marche, Ancona, Italy
| | - Ennio Pisanò
- Cardiology Unit, ‘Vito Fazzi’ Hospital, Lecce, Italy
| | | | - Antonio Rapacciuolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Massimo Stefano Silvetti
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Carlo Lavalle
- Cardiology Department, Policlinico Umberto I - La Sapienza University, Rome, Italy
| | - Antonio Curcio
- Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi Magna Graecia, Campus di Germaneto, Catanzaro, Italy
| | - Roberto Rordorf
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy
| | | | - Sergio Valsecchi
- Cardiac Rhythm Management Division, Boston Scientific, Milan, Italy
| | - Antonio D’Onofrio
- ‘Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie’, Monaldi Hospital, Naples, Italy
| | - Giovanni Luca Botto
- Department of Clinical cardiology and Electrophysiology ASST Rhodense, Rho and Garbagnate M.se, Milan, Italy
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Migliore F, Pittorru R, De Lazzari M, Cipriani A, Bauce B, Marra MP, Giacomin E, Dall'Aglio P, Accinelli S, Iliceto S, Corrado D. Third-generation subcutaneous implantable cardioverter defibrillator and intermuscular two-incision implantation technique in patients with Arrhythmogenic cardiomyopathy: 3-year follow-up. Int J Cardiol 2023; 382:33-39. [PMID: 37059308 DOI: 10.1016/j.ijcard.2023.04.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/07/2023] [Accepted: 04/11/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND Long-term data on the potential advantages of combining the third-generation subcutaneous implantable cardioverter defibrillator (S-ICD) with modern software upgrade including the "SMART Pass", modern programming strategies and the intermuscular (IM) two-incision implantation technique in arrhythmogenic cardiomyopathy (ACM) with different phenotypic variants are lacking. In this study we evaluated the long-term outcome of patients with ACM who underwent third-generation S-ICD (Emblem, Boston Scientific) and IM two-incision technique. METHODS The study population included 23 consecutive patients [70% male, median age 31 (24-46) years] diagnosed with ACM with different phenotypic variants who received third-generation S-ICD implantation with the IM two-incision technique. RESULTS During a median follow-up of 45.5 months [16-65], 4 patients (17.4%) received a at least one inappropriate shock (IS), with median annual event rate of 4.5%. Extra-cardiac oversensing (myopotential) during effort represented the only cause of IS. No IS due to T-wave oversensing (TWOS) were recorded. Only one patient (4.3%) experienced device-related complication consisting of premature cell battery depletion requiring device replacement. No device explantation because of need for anti-tachycardia pacing or ineffective therapy occurred. There was no significant difference between patients who did and did not experienced IS with regard to baseline clinical, ECG and technical characteristics. Five patients (21.7%) received appropriate shock on ventricular arrythmias. CONCLUSIONS According to our finding, although the third-generation S-ICD implanted with the IM two-incision technique appears to be associated with a low risk of complications and IS due to cardiac oversensing, the risk of IS due to myopotential mainly during effort should be considered.
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Affiliation(s)
- Federico Migliore
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
| | - Raimondo Pittorru
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Manuel De Lazzari
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Alberto Cipriani
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Barbara Bauce
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Martina Perazzolo Marra
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Enrico Giacomin
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Pietro Dall'Aglio
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Stefano Accinelli
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Sabino Iliceto
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Domenico Corrado
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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6
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Shockingly shiny shoes-Inappropriate discharge from a subcutaneous defibrillator. HeartRhythm Case Rep 2022; 9:101-104. [PMID: 36860754 PMCID: PMC9968909 DOI: 10.1016/j.hrcr.2022.11.009] [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: 11/27/2022] Open
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7
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Safety and Efficacy of Magnet Use to Temporarily Inhibit Inappropriate Subcutaneous Implantable Cardioverter Defibrillator Therapy in Emergency Situations: A Case Report. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2022. [DOI: 10.2478/jce-2022-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction: The subcutaneous implantable cardioverter defibrillator (S-ICD) represents a major advancement in ICD technology. Inappropriate shocks (IAS) occur in more than 3.1% of the population with S-ICD each year and are usually followed by admission to the emergency department (ED). In this setting, the disabling of IAS is mandatory during a pseudo-electrical storm (ES). This report describes the strategies that can be followed in order to temporarily inhibit IAS in critical care settings with the use of magnets.
Case presentation: An S-ICD was implanted more than 6 weeks prior to presentation in a 68-year-old man with hypertrophic cardiomyopathy. In the ED, the patient experienced 3 IAS in the last hour. A Medtronic magnet was applied to stop IAS, as the specific programmer was not available. The maneuver interrupted the IAS. In order to verify the universal magnetic response of the S-ICD, six different magnets and one smartphone with MagSafe technology were tested. All magnet models suspended arrhythmia detection and IAS, while the smartphone did not cause magnet interferences.
Conclusions: This report demonstrates the safety and efficacy of all clinical magnet models in inhibiting IAS. In case of pseudo-ES, any type of magnet allows ED providers to easily and rapidly disable the functionality of the devices when appropriate.
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8
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Elliott MK, Sidhu BS, Mehta VS, Gould J, Martic D, Rinaldi CA. The importance of leadless pacemaker positioning in relation to subcutaneous implantable cardioverter-defibrillator sensing in completely leadless cardiac resynchronization and defibrillation systems. HeartRhythm Case Rep 2021; 7:628-632. [PMID: 34552857 PMCID: PMC8441212 DOI: 10.1016/j.hrcr.2021.06.006] [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: 11/23/2022] Open
Affiliation(s)
- Mark K Elliott
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Baldeep Singh Sidhu
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Vishal S Mehta
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Justin Gould
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Dejana Martic
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Tsutsui K, Kato R, Asano S, Ikeda Y, Mori H, Tawara M, Tanaka S, Hasegawa S, Nakano S, Iwanaga S, Muramatsu T, Matsumoto K. Myopotential Oversensing Is a Major Cause of Inappropriate Shock in Subcutaneous Implantable Defibrillator in Japan. Int Heart J 2020; 61:913-921. [PMID: 32921668 DOI: 10.1536/ihj.20-129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Previous study has identified marked differences in patient characteristics and causes of inappropriate shock (IAS) between Japan and the Western societies in terms of subcutaneous implantable cardioverter-defibrillator (S-ICD). However, evidence of IAS in Asian populations including Japan has been limited to one observational study.Thus, we conducted a single-center registry study that tracks the postoperative course of 61 consecutive patients who received S-ICD from February 2016 to January 2020. Our findings showed that IAS occurred in 9.8% of the study population (6/61), which is comparable to the previously reported incidence. Remarkably, T-wave oversensing did not result in an IAS (0/6). Instead, myopotential oversensing was determined to have caused the most IAS events (4/6), while atrial fibrillation ranked second (2/6). A provocation maneuver (e.g., abdominal clench, push-ups, lifting a heavy item) reproduced myopotential noise disguised as R-waves, which should potentially trigger an IAS if uninterrupted. R-wave amplitude of the IAS group appeared relatively low compared to that of the non-IAS group although this finding was not tested significant. Furthermore, no temporal changes were noted in R-wave amplitude between the time of implantation and IAS events, suggesting that it is neither constantly low nor acutely dropped R-wave amplitude but a relatively high noise level that drives IAS. All the myopotential-IAS patients were found to be male. Right-sided lead implantation was associated with a higher incidence of IAS.This study highlights the fact that IAS continues to occur due to myopotential noise oversensing instead of T-wave oversensing. To minimize the risk of IAS, it is desirable to search and secure high R-wave voltage.
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Affiliation(s)
- Kenta Tsutsui
- Department of Cardiovascular Medicine, Saitama International Medical Center, Faculty of Medicine, Saitama Medical University
| | - Ritsushi Kato
- Department of Cardiovascular Medicine, Saitama International Medical Center, Faculty of Medicine, Saitama Medical University
| | - Sou Asano
- Department of Cardiovascular Medicine, Saitama International Medical Center, Faculty of Medicine, Saitama Medical University
| | - Yoshifumi Ikeda
- Department of Cardiovascular Medicine, Saitama International Medical Center, Faculty of Medicine, Saitama Medical University
| | - Hitoshi Mori
- Department of Cardiovascular Medicine, Saitama International Medical Center, Faculty of Medicine, Saitama Medical University
| | - Mai Tawara
- Department of Cardiovascular Medicine, Saitama International Medical Center, Faculty of Medicine, Saitama Medical University
| | - Sayaka Tanaka
- Department of Cardiovascular Medicine, Saitama International Medical Center, Faculty of Medicine, Saitama Medical University
| | - Saki Hasegawa
- Department of Cardiovascular Medicine, Saitama International Medical Center, Faculty of Medicine, Saitama Medical University
| | - Shintaro Nakano
- Department of Cardiovascular Medicine, Saitama International Medical Center, Faculty of Medicine, Saitama Medical University
| | - Siro Iwanaga
- Department of Cardiovascular Medicine, Saitama International Medical Center, Faculty of Medicine, Saitama Medical University
| | - Toshihiro Muramatsu
- Department of Cardiovascular Medicine, Saitama International Medical Center, Faculty of Medicine, Saitama Medical University
| | - Kazuo Matsumoto
- Department of Cardiovascular Medicine, Saitama International Medical Center, Faculty of Medicine, Saitama Medical University
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10
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Over- and undersensing-pitfalls of arrhythmia detection with implantable devices and wearables. Herzschrittmacherther Elektrophysiol 2020; 31:273-287. [PMID: 32767089 PMCID: PMC7412442 DOI: 10.1007/s00399-020-00710-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/08/2020] [Indexed: 01/30/2023]
Abstract
Cardiac implantable electronic devices (CIEDs) are a cornerstone of arrhythmia and heart failure detection as well as management. In recent years new kinds of devices have emerged which can be used subcutaneously or worn on the skin. In particular for large-scale arrhythmia monitoring, small, unobtrusive gadgets seem positioned to upend paradigms and care delivery. However, the performance of CIEDs and wearables is only as good as their sensing and detection capacities. Whether for pacing, defibrillation or diagnostic monitoring, the device must be able to process and filter the sensed signal to reduce noise and to exclude irrelevant physiological signals. The demands on sensing and detection quality will differ depending on how the information is applied. With a pacemaker or implantable cardioverter/defibrillator, withheld or erroneous therapy can have severe consequences and accurate and reliable detection of cardiac function is crucial. Monitoring devices are usually used in risk assessment and management, with greater tolerance for isolated artefacts or lower quality of readings. This review discusses sensing and detection and the performance to date by CIEDs as well as subcutaneous and wearable devices.
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11
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Ishida Y, Sasaki S, Toyama Y, Nishizaki K, Shoji Y, Kinjo T, Itoh T, Horiuchi D, Kimura M, Gold MR, Tomita H. A novel screening test for inappropriate shocks due to myopotentials from the subcutaneous implantable cardioverter–defibrillator. Heart Rhythm O2 2020; 1:27-34. [PMID: 34113857 PMCID: PMC8183885 DOI: 10.1016/j.hroo.2020.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background The subcutaneous implantable cardioverter-defibrillator (S-ICD) is effective in preventing sudden cardiac death. Compared with transvenous ICDs, S-ICDs have a lower rate of inappropriate shocks (IASs) for supraventricular arrhythmias, but such shocks for T-wave oversensing (TWO) and extracardiac myopotentials are more common. No screening tests to identify patients at risk for IAS due to myopotential interference (MPI) currently are available. Objective The purpose of this study was to assess the efficacy of a tube exercise test (TET) developed to detect MPI post S-ICD implantation. Methods TET includes 3 different maneuvers using an exercise tube. S-ICD electrograms were recorded to assess MPI while patients performed each of the maneuvers. Results TET was performed in 43 patients, and MPI was observed in 12 patients (28%). In 10 of the 12 TET-positive patients, the positive vector corresponded with a vector that did not show TWO on standard S-ICD preoperative screening. During median follow-up of 672 days (interquartile range 465–805 days), 3 patients (7%) experienced IAS due to MPI. Importantly, the vector at the time of IAS in all 3 patients passed standard preoperative screening for TWO but was positive with TET. Sensitivity and specificity of TET were 100% and 78%, respectively, and positive and negative predictive values were 25% and 100%, respectively. Conclusion Postimplant screening for MPI identified patients at increased risk for IAS. TET may be helpful for guiding optimal programming to prevent IAS.
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Affiliation(s)
- Yuji Ishida
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Shingo Sasaki
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuichi Toyama
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kimitaka Nishizaki
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yoshihiro Shoji
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takahiko Kinjo
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Taihei Itoh
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Daisuke Horiuchi
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Masaomi Kimura
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Michael R. Gold
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Hirofumi Tomita
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
- Address reprint requests and correspondence: Dr Hirofumi Tomita, Department of Cardiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan.
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12
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Zoppo F, Mangiameli D, Perazza L, Lardieri G. Ventricular tachycardia oversensing in S‐ICD patients: Case‐based brief review. Pacing Clin Electrophysiol 2020; 43:261-265. [DOI: 10.1111/pace.13871] [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: 09/30/2019] [Revised: 12/20/2019] [Accepted: 12/29/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Franco Zoppo
- Unità di Elettrofisiologia—U.O.C. di Cardiologia Ospedale Civile Gorizia Italy
| | - Daniele Mangiameli
- Unità di Elettrofisiologia—U.O.C. di Cardiologia Ospedale Civile Gorizia Italy
| | - Luca Perazza
- Unità di Elettrofisiologia—U.O.C. di Cardiologia Ospedale Civile Gorizia Italy
| | - Gerardina Lardieri
- Unità di Elettrofisiologia—U.O.C. di Cardiologia Ospedale Civile Gorizia Italy
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13
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Arias MA, Pachón M, Sánchez-Iglesias I, Loughlin G, Martín-Sierra C, Puchol A, Sabatel F, Rodríguez-Padial L. Impact of routine right parasternal electrocardiographic screening in assessing eligibility for subcutaneous implantable cardioverter-defibrillator. J Cardiovasc Electrophysiol 2019; 31:103-111. [PMID: 31724763 DOI: 10.1111/jce.14275] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 10/21/2019] [Accepted: 11/06/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Between 7% and 15% of patients with an indication for an implantable cardioverter-defibrillator (ICD) are not eligible for implantation of a subcutaneous implantable cardioverter-defibrillator (S-ICD) on the basis of the result of the conventional left parasternal electrocardiographic screening (LPES). Our objective was to determine the impact of systematically performing right parasternal electrocardiographic screening (RPES) in addition to conventional LPES, in terms of increasing both the total percentage of potentially eligible patients for S-ICD implantation and the number of suitable vectors per patient. METHODS AND RESULTS Consecutive patients from the outpatient device clinic who already had an implanted ICD, and no requirement for pacing were enrolled. Conventional left parasternal electrode position and right parasternal electrode positions were used. The automatic screening tool was used to analyze the recordings. Screenings were performed in the supine and standing positions. Overall, 209 patients were included. The mean age was 63.4 ± 13 years, 59.8% had ischemic heart disease, mean QRS duration was 100 ± 31 ms, and 69.9% had a primary prevention ICD indication. Based on conventional isolated LPES, 12.9% of patients were not eligible for S-ICD compared with 11.5% based on RPES alone (P = .664). Considering LPES and RPES together, only 7.2% of patients were not eligible for S-ICD (P < .001). Moreover, the number of patients with more than one suitable vector increased from 66.5% with isolated LPES to 82.3% (23.7% absolute increase [P < .001]). CONCLUSION Adding an automated RPES to the conventional automated LPES increased patient eligibility for the S-ICD significantly. Moreover, combined screening increased the number of suitable vectors per eligible patient.
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Affiliation(s)
- Miguel A Arias
- Arrhythmia Unit, Department of Cardiology, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - Marta Pachón
- Arrhythmia Unit, Department of Cardiology, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - Iván Sánchez-Iglesias
- Department of Psychobiology and Behavioral Sciences Methods, Complutense University of Madrid, Madrid, Spain
| | - Gerard Loughlin
- Arrhythmia Unit, Department of Cardiology, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - Cristina Martín-Sierra
- Arrhythmia Unit, Department of Cardiology, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - Alberto Puchol
- Arrhythmia Unit, Department of Cardiology, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - Fernando Sabatel
- Arrhythmia Unit, Department of Cardiology, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - Luis Rodríguez-Padial
- Arrhythmia Unit, Department of Cardiology, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
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