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Vamos M, Zsigmond EJ, Biffi M, Gausz FD, Keller N, Kupo P, Szili-Torok T, Ziacchi M, Benz AP, Spittler R, Vagvolgyi A. EFFICACY AND SAFETY OF THE SUBCUTANEOUS IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR IN PATIENTS WITH AND WITHOUT OBESITY: A META-ANALYSIS. Heart Rhythm 2024:S1547-5271(24)02902-3. [PMID: 39019386 DOI: 10.1016/j.hrthm.2024.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/25/2024] [Accepted: 07/11/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND The subcutaneous implantable cardioverter-defibrillator (S-ICD) has emerged as an alternative to transvenous systems for preventing sudden cardiac death. However, concerns have been raised regarding its efficacy and safety in obese individuals. OBJECTIVE This meta-analysis aims to evaluate the efficacy and safety of the S-ICD in patients with obesity by assessing the relationship between body mass index (BMI) and clinical outcomes. METHODS A comprehensive search of multiple databases was conducted for English-language peer-reviewed studies reporting clinical outcomes in S-ICD recipients with (BMI ≥30 kg/m2) and without obesity (BMI <30 kg/m2). Data on pre-implantation screening failure, defibrillation testing, complications, appropriate and inappropriate shocks, and survival were analysed using standard random-effect meta-analytical techniques. RESULTS Twenty-nine studies involving 20,486 patients were included. There was no statistically significant difference in the mean BMI values of patients with failed or successful preimplantation screening (mean difference -0.60 kg/m2, 95% CI -2.06 to 0.86). Obesity was associated with higher rates of failed defibrillation testing at ≤65J (OR 2.16, 95% CI 1.39-3.35), and mal-/suboptimal positioning occurred more frequently in obese compared to non-obese patients (OR 3.37, 95% CI 1.76-6.44). Increased BMI as a continuous variable (per increase in 1 kg/m2 BMI) was associated with elevated defibrillation thresholds (OR 1.05, 95% CI 1.03-1.08), a higher risk of complications (HR 1.04, 95% CI 1.02-1.05), a trend towards increased number of appropriate shocks (HR 1.02, 95% CI 1.00-1.04), and no significant increase in the risk for inappropriate shocks (HR 1.01, 95% CI 0.99-1.03). CONCLUSION This meta-analysis underscores the importance of considering obesity in S-ICD implantation decisions. While S-ICD remains effective in obese patients, attention to potential technical challenges and higher complication rates is warranted.
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Affiliation(s)
- Mate Vamos
- Cardiac Electrophysiology Division, Cardiology Center, Department of Internal Medicine, University of Szeged, Szeged, Hungary.
| | - Elod-Janos Zsigmond
- Central Hospital of Northern Pest - Military Hospital, Budapest, Hungary; Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
| | - Mauro Biffi
- Department of Cardiology, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Flora Diana Gausz
- Cardiac Electrophysiology Division, Cardiology Center, Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Nora Keller
- Central Pharmacy, Albert Szent-Györgyi Medical Centre, University of Szeged, Szeged, Hungary
| | - Peter Kupo
- Heart Institute, Medical School, University of Pecs, Pecs, Hungary
| | - Tamas Szili-Torok
- Cardiac Electrophysiology Division, Cardiology Center, Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Matteo Ziacchi
- Department of Cardiology, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Alexander P Benz
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Germany; Population Health Research Institute, McMaster University, Hamilton, Canada
| | - Raphael Spittler
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University, Germany
| | - Anna Vagvolgyi
- Endocrinology and Diabetology Center, Department of Internal Medicine, University of Szeged, Szeged, Hungary
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Dijkshoorn LA, Smeding L, Pepplinkhuizen S, de Veld JA, Knops RE, Olde Nordkamp LRA. Fifteen years of subcutaneous implantable cardioverter-defibrillator therapy: Where do we stand, and what will the future hold? Heart Rhythm 2024:S1547-5271(24)02741-3. [PMID: 38908460 DOI: 10.1016/j.hrthm.2024.06.028] [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: 04/02/2024] [Revised: 06/14/2024] [Accepted: 06/15/2024] [Indexed: 06/24/2024]
Abstract
The subcutaneous implantable cardioverter-defibrillator (S-ICD) has emerged as a feasible alternative to the transvenous ICD in the treatment of ventricular tachyarrhythmias in patients without indications for pacing or cardiac resynchronization therapy. Since its introduction, numerous innovations have been made and clinical experience has been gained, leading to its adoption in current practice and preference in certain populations. Moreover, emerging technologies like the extravascular ICD and the combination of the S-ICD with the leadless pacemaker offer new possibilities for the future. These advancements underscore the evolving role of the S-ICD in management of ventricular tachyarrhythmia. This review outlines implantation considerations, patient selection, and troubleshooting advancements in the last 15 years and provides insights into future perspectives.
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Affiliation(s)
| | - Lonneke Smeding
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - Jolien A de Veld
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Reinoud E Knops
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
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de Guillebon M, Garcia R, Debeugny S, Bader H, Probst V, Bidegain N, Narayanan K, Mansourati J, Menet A, Pierre O, Marquié C, Guy-Moyat B, Mondoly P, Chevalier P, Badenco N, Behar N, Jesel-Morel L, Pierre B, Lellouche N, Deharo JC, Jacon P, Anselme F, Boveda S, Marijon E. Personalized screening before subcutaneous cardioverter-defibrillator implantation: Usefulness and outcomes in clinical practice-the S-ICD screening SIS prospective study. Heart Rhythm 2024:S1547-5271(24)02654-7. [PMID: 38810921 DOI: 10.1016/j.hrthm.2024.05.043] [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: 01/22/2024] [Revised: 05/05/2024] [Accepted: 05/20/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Electrocardiographic screening before subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation is unsuccessful in around 10% of cases. A personalized screening method, by slightly moving the electrodes, to obtain a better R/T ratio has been described to overcome traditional screening failure. OBJECTIVE The objectives of the SIS study were to assess to what extent a personalized screening method improves eligibility for S-ICD implantation and to evaluate the inappropriate shock rate after such screening success. METHODS All consecutive patients eligible for an S-ICD implantation were prospectively recruited across 20 French centers between December 2019 and January 2022. In case of traditional screening failure, patients received a second personalized screening. If at least 1 vector was positive, the personalized screening was considered successful, and the patient was eligible for implantation. RESULTS The study included 474 patients (mean age, 50.4 ± 14.1 years; 77.4% men). Traditional screening was successful in 456 (96.2%) cases. This figure rose to 98.3% (n = 466; P = .002) when personalized screening was performed. All patients implanted after successful personalized screening had correct signal detection on initial device interrogation. Nevertheless, after 1-year follow-up, 3 of the 7 patients (43%) implanted with personalized screening experienced inappropriate shock vs 18 of the 427 patients (4.2%) with traditional screening and S-ICD implantation (P = .003). CONCLUSION Traditional S-ICD screening was successful in our study in a high proportion of patients. Considering the small improvement in success of screening and a higher rate of inappropriate shock, a strategy of personalized screening cannot be routinely recommended. CLINICALTRIALS gov identifier: NCT04101253.
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Affiliation(s)
| | - Rodrigue Garcia
- Department of Cardiology, University Hospital of Poitiers, Poitiers, France
| | | | - Hugues Bader
- Department of Cardiology, Hospital of Pau, Pau, France
| | - Vincent Probst
- Department of Cardiology, University Hospital of Nantes, Nantes, France
| | | | - Kumar Narayanan
- Division of Cardiology, European Georges Pompidou Hospital, Paris, France; Cardiac Electrophysiology Section, Medicover Hospital, Hyderabad, India
| | | | - Aymeric Menet
- Department of Cardiology, Hospital of Saint Philibert, Lomme, France
| | | | | | - Benoît Guy-Moyat
- Department of Cardiology, University Hospital of Limoges, Limoges, France
| | - Pierre Mondoly
- Department of Cardiology, Center University Hospital of Toulouse, Toulouse, France
| | | | - Nicolas Badenco
- Department of Cardiology, University Hospital of la Pitié Salpétrière, Paris, France
| | - Nathalie Behar
- Department of Cardiology, University Hospital Pontchaillou, Rennes, France
| | | | - Bertrand Pierre
- Department of Cardiology, University Hospital of Tours, Tours, France
| | - Nicolas Lellouche
- Department of Cardiology, University Hospital of Créteil, Créteil, France
| | - Jean-Claude Deharo
- Department of Cardiology, University Hospital of Marseille, Marseille, France
| | - Peggy Jacon
- Department of Cardiology, University Hospital Grenoble Alpes, Grenoble, France
| | - Frédéric Anselme
- Department of Cardiology, University Hospital of Rouen, Rouen, France
| | - Serge Boveda
- Department of Cardiology, Pasteur Clinic, Toulouse, France
| | - Eloi Marijon
- Division of Cardiology, European Georges Pompidou Hospital, Paris, France.
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Magnani S, Ali H, Cappato R. Ten years of subcutaneous defibrillator therapy: Consolidated clinical evidence and future perspectives. J Cardiovasc Electrophysiol 2024; 35:601-607. [PMID: 38287171 DOI: 10.1111/jce.16171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 01/31/2024]
Abstract
The subcutaneous implantable cardioverter defibrillator (S-ICD) was developed as an alternative to the traditional transvenous implantable cardioverter defibrillator (TV-ICD), aiming to provide easier implantation, simplified detection algorithm of malignant ventricular arrhythmias and prevention from placing components in the cardiovascular system. The S-ICD is implanted subcutaneously or intramuscularly with the generator placed in the left midaxillary line and the lead tunneled subcutaneously in the left para-sternal region. Preimplant electrocardiogram screening is recommended to prevent implantation in patients at high risk of T wave over-sensing. Currently, the S-ICD is unsuitable for patients requiring pacing or cardiac resynchronization. Since the beginning, the S-ICD underwent extensive preclinical investigation until the first prospective multicentre trial demonstrating high efficacy and safety led to market release. While earlier studies focused on younger patients with higher ejection fraction, more recent studies showed favorable outcomes even in patients with comorbidities similar to those typically observed in patients receiving TV-ICD. The development of second and third generation devices has contributed to reduce inappropriate shocks and overcome previous limitations. The aim of this paper is to review the evidence in the literature over the past decade supporting S-ICD as a valid alternative to TV-ICD in terms of safety and efficacy, highlighting the improvements in technology, as well as outcomes.
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Affiliation(s)
- Silvia Magnani
- Arrhythmia and Electrophysiology Center, IRCCS Multimedica, Milan, Italy
| | - Hussam Ali
- Arrhythmia and Electrophysiology Center, IRCCS Multimedica, Milan, Italy
| | - Riccardo Cappato
- Arrhythmia and Electrophysiology Center, IRCCS Multimedica, Milan, Italy
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5
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Molina-Lerma M, Cabrera-Borrego E, Rivera-Lopez R, Sánchez-Millán P, Peña Mellado J, Arriaga Jiménez A, Álvarez M. Comparison of automated subcutaneous defibrillator screening between different pacing sites in cardiac pacing device carriers. Europace 2023; 25:euad352. [PMID: 38019960 PMCID: PMC10751811 DOI: 10.1093/europace/euad352] [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: 08/18/2023] [Revised: 09/19/2023] [Accepted: 11/22/2023] [Indexed: 12/01/2023] Open
Abstract
AIMS The compatibility of cardiac pacing with the presence of a subcutaneous implantable cardioverter-defibrillator (S-ICD) has been investigated, but S-ICD screening test results have not been compared among different pacing sites. The objective was to compare S-ICD screening results among different cardiac pacing sites and to assess the electrocardiographic predictors of success. METHODS AND RESULTS This prospective single-centre study conducted automated S-ICD screening in 102 carriers of cardiac pacing devices in conduction system (CSP), biventricular (BVP), right ventricular outflow tract (RVOT), or right ventricular apex (RVA) pacing sites. The study included 102 patients: 40 with CSP (20 left bundle pacing and 20 His bundle pacing), 21 with BVP, and 20 and 21 with RVOT and RVA pacing, respectively. The percentage of positive screenings was significantly higher for CSP (97.5%) than for the other patient groups (BVP 71.4%, RVOT 70%, and RVA 19%). In multivariate analysis, positive screening was associated with a narrower QRS (OR 0.95 [0.92-0.98] P = 0.001) and higher R/T ratio in precordial leads (1.76 [1.18-2.61]). CONCLUSION A higher S-ICD eligibility rate of cardiac pacing device carriers was obtained in CSP than in conventional pacing (RVA or RVOT) or BVP. The presence of narrower paced QRS width and paced corrected QT interval and of higher R/T ratio in precordial and limb leads are electrocardiographic predictors of a positive response to screening.
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Affiliation(s)
- Manuel Molina-Lerma
- Arrhythmia Unit, Hospital Universitario Virgen de las Nieves, Avenida de las Fuerzas Armadas, 18014 Granada, Spain
- Biohealth Research Institute ibs. GRANADA, Av. de Madrid, 15, 18012 Granada, Spain
| | - Eva Cabrera-Borrego
- Arrhythmia Unit, Hospital Universitario Virgen de las Nieves, Avenida de las Fuerzas Armadas, 18014 Granada, Spain
- Biohealth Research Institute ibs. GRANADA, Av. de Madrid, 15, 18012 Granada, Spain
| | - Ricardo Rivera-Lopez
- Arrhythmia Unit, Hospital Universitario Virgen de las Nieves, Avenida de las Fuerzas Armadas, 18014 Granada, Spain
- Biohealth Research Institute ibs. GRANADA, Av. de Madrid, 15, 18012 Granada, Spain
| | - Pablo Sánchez-Millán
- Arrhythmia Unit, Hospital Universitario Virgen de las Nieves, Avenida de las Fuerzas Armadas, 18014 Granada, Spain
- Biohealth Research Institute ibs. GRANADA, Av. de Madrid, 15, 18012 Granada, Spain
| | - Jesús Peña Mellado
- Arrhythmia Unit, Hospital Universitario Virgen de las Nieves, Avenida de las Fuerzas Armadas, 18014 Granada, Spain
- Biohealth Research Institute ibs. GRANADA, Av. de Madrid, 15, 18012 Granada, Spain
| | - Antonio Arriaga Jiménez
- Arrhythmia Unit, Hospital Universitario Virgen de las Nieves, Avenida de las Fuerzas Armadas, 18014 Granada, Spain
- Biohealth Research Institute ibs. GRANADA, Av. de Madrid, 15, 18012 Granada, Spain
| | - Miguel Álvarez
- Arrhythmia Unit, Hospital Universitario Virgen de las Nieves, Avenida de las Fuerzas Armadas, 18014 Granada, Spain
- Biohealth Research Institute ibs. GRANADA, Av. de Madrid, 15, 18012 Granada, Spain
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6
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Conte G, Cattaneo F, de Asmundis C, Berne P, Vicentini A, Namdar M, Scalone A, Klersy C, Caputo ML, Demarchi A, Özkartal T, Salghetti F, Casu G, Passarelli I, Mameli S, Shah D, Burri H, De Ferrari G, Brugada P, Auricchio A. Impact of SMART Pass filter in patients with ajmaline-induced Brugada syndrome and subcutaneous implantable cardioverter-defibrillator eligibility failure: results from a prospective multicentre study. Europace 2022; 24:845-854. [PMID: 34499723 PMCID: PMC9071063 DOI: 10.1093/europace/euab230] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 08/11/2021] [Indexed: 12/03/2022] Open
Abstract
AIMS Ajmaline challenge can unmask subcutaneous implantable cardioverter-defibrillator (S-ICD) screening failure in patients with Brugada syndrome (BrS) and non-diagnostic baseline electrocardiogram (ECG). The efficacy of the SMART Pass (SP) filter, a high-pass filter designed to reduce cardiac oversensing (while maintaining an appropriate sensing margin), has not yet been assessed in patients with BrS. The aim of this prospective multicentre study was to investigate the effect of the SP filter on dynamic Brugada ECG changes evoked by ajmaline and to assess its value in reducing S-ICD screening failure in patients with drug-induced Brugada ECGs. METHODS AND RESULTS The S-ICD screening with conventional automated screening tool (AST) was performed during ajmaline challenge in subjects with suspected BrS. The S-ICD recordings were obtained before, during and after ajmaline administration and evaluated by the means of a simulation model that emulates the AST behaviour with and without SP filter. A patient was considered suitable for S-ICD if at least one sensing vector was acceptable in all tested postures. A sensing vector was considered acceptable in the presence of QRS amplitude >0.5 mV, QRS/T-wave ratio >3.5, and sense vector score >100. Of the 126 subjects (mean age: 42 ± 14 years, males: 61%, sensing vectors: 6786), 46 (36%) presented with an ajmaline-induced Brugada type 1 ECG. Up to 30% of subjects and 40% of vectors failed the screening during the appearance of Brugada type 1 ECG evoked by ajmaline. The S-ICD screening failure rate was not significantly reduced in patients with Brugada ECGs when SP filter was enabled (30% vs. 24%). Similarly, there was only a trend in reduction of vector-failure rate attributable to the SP filter (from 40% to 36%). The most frequent reason for screening failure was low QRS amplitude or low QRS/T-wave ratio. None of these patients was implanted with an S-ICD. CONCLUSION Patients who pass the sensing screening during ajmaline can be considered good candidates for S-ICD implantation, while those who fail might be susceptible to sensing issues. Although there was a trend towards reduction of vector sensing failure rate when SP filter was enabled, the reduction in S-ICD screening failure in patients with Brugada ECGs did not reach statistical significance. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov Unique Identifier NCT04504591.
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Affiliation(s)
- Giulio Conte
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
- Centre for Computational Medicine in Cardiology, Faculty of Informatics, Università della Svizzera Italiana, Lugano, Switzerland
- Faculty of Biomedical Sciences, USI, Lugano, Switzerland
| | - Fabio Cattaneo
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel—Postgraduate program Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
| | - Paola Berne
- Cardiology Department, Ospedale San Francesco, Nuoro, Italy
| | - Alessandro Vicentini
- Elettrofisiologia ed Elettrostimolazione, Divisione di Cardiologia, IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Mehdi Namdar
- Cardiology Department, University Hospital of Geneva, Switzerland
| | | | - Catherine Klersy
- Service of Biometry and Clinical Epidemiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Andrea Demarchi
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Tardu Özkartal
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Francesca Salghetti
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel—Postgraduate program Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
| | - Gavino Casu
- Cardiology Department, Ospedale San Francesco, Nuoro, Italy
| | - Ilaria Passarelli
- Elettrofisiologia ed Elettrostimolazione, Divisione di Cardiologia, IRCCS Policlinico S. Matteo, Pavia, Italy
| | | | - Dipen Shah
- Cardiology Department, University Hospital of Geneva, Switzerland
| | - Haran Burri
- Cardiology Department, University Hospital of Geneva, Switzerland
| | - Gaetano De Ferrari
- Elettrofisiologia ed Elettrostimolazione, Divisione di Cardiologia, IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Pedro Brugada
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel—Postgraduate program Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
| | - Angelo Auricchio
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
- Centre for Computational Medicine in Cardiology, Faculty of Informatics, Università della Svizzera Italiana, Lugano, Switzerland
- Faculty of Biomedical Sciences, USI, Lugano, Switzerland
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Francia P, Olivotto I, Lambiase PD, Autore C. Implantable cardioverter-defibrillators for hypertrophic cardiomyopathy: The Times They Are a-Changin'. Europace 2021; 24:1384-1394. [PMID: 34966939 DOI: 10.1093/europace/euab309] [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: 09/18/2021] [Accepted: 12/01/2021] [Indexed: 11/14/2022] Open
Abstract
The implantable cardioverter-defibrillator (ICD) is a life-saving therapy in patients with hypertrophic cardiomyopathy (HCM) at high risk of sudden cardiac death. The heterogeneity of clinical scenarios in HCM and the availability of ICDs with distinct characteristics emphasizes the need for selecting the right device for the right patient. There is growing awareness that unnecessarily complex devices can lead to short- and long-term complications without adding significant clinical benefits. Young patients have the greatest potential years of life gained from the ICD but are also most exposed to device-related complications. This increases the complexity of decision-making of ICD prescription in these often otherwise well patients in whom device selection should be tailored to preserve survival benefit without introducing morbidity. In the light of the multiple clinical phenotypes characterizing HCM, the present article offers evidence-based perspectives helpful in predicting the individual impact of the ICD and choosing the most appropriate device.
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Affiliation(s)
- Pietro Francia
- Division of Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza University, Rome, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital. Dept of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Pier D Lambiase
- Institute of Cardiovascular Science, UCL Department of Cardiology, Barts Heart Centre, London, UK
| | - Camillo Autore
- Division of Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza University, Rome, Italy
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8
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John LA, Karimianpour A, Gold MR. The Role of Subcutaneous ICDs in the Prevention of Sudden Cardiac Death. US CARDIOLOGY REVIEW 2021. [DOI: 10.15420/usc.2021.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The ICD is an important therapy in the prevention of sudden cardiac death. The transvenous-ICD (TV-ICD) has been the primary device used for this purpose. However, mechanical and infectious complications occur with traditional TV-ICDs increasing morbidity and mortality. The subcutaneous-ICD (S-ICD) system was developed to circumvent some of these complications, but S-ICDs have their inherent set of limitations as well. These include inappropriate shock delivery, lack of bradycardia, antitachycardia or CRT pacing therapy and shorter device longevity. The S-ICD is now included in guidelines as an acceptable alternative to TV-ICDs among patients without pacing indications. This review discusses the rationale for S-ICDs by reviewing studies including the PRAETORIAN, PAS and UNTOUCHED trials.
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Affiliation(s)
- Leah A John
- Division of Cardiology, Medical University of South Carolina, Charleston, SC
| | | | - Michael R Gold
- Division of Cardiology, Medical University of South Carolina, Charleston, SC
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9
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Wang L, Haq KT, Tereshchenko LG. To the editor: S-ICD eligibility in adult congenital heart disease. ESC Heart Fail 2021; 8:3440-3441. [PMID: 34036723 PMCID: PMC8318419 DOI: 10.1002/ehf2.13449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/08/2021] [Accepted: 05/16/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Linda Wang
- Knight Cardiovascular Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, UHN62, Portland, OR, USA
| | - Kazi T Haq
- Knight Cardiovascular Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, UHN62, Portland, OR, USA
| | - Larisa G Tereshchenko
- Knight Cardiovascular Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, UHN62, Portland, OR, USA
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10
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Caliskan K, Theuns DAMJ, Szili-Torok T. Emerging electromagnetic interferences between implantable cardioverter-defibrillators and left ventricular assist devices: Authors' reply. Europace 2020; 22:1911-1912. [PMID: 33020843 DOI: 10.1093/europace/euaa240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- Kadir Caliskan
- Department of Cardiology, Thorax Center, Erasmus Medical Center, Room RG 431, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Dominic A M J Theuns
- Department of Cardiology, Thorax Center, Erasmus Medical Center, Room RG 431, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Tamas Szili-Torok
- Department of Cardiology, Thorax Center, Erasmus Medical Center, Room RG 431, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
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11
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Prevention of Sudden Cardiac Death: Focus on the Subcutaneous Implantable Cardioverter-Defibrillator. High Blood Press Cardiovasc Prev 2020; 27:291-297. [DOI: 10.1007/s40292-020-00394-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/02/2020] [Indexed: 11/26/2022] Open
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12
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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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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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Boersma LV, El-Chami MF, Bongiorni MG, Burke MC, Knops RE, Aasbo JD, Lambiase PD, Deharo JC, Russo AM, Dinerman J, Shaik N, Barr CS, Carter N, Appl U, Brisben AJ, Stein KM, Gold MR. Understanding Outcomes with the EMBLEM S-ICD in Primary Prevention Patients with Low EF Study (UNTOUCHED): Clinical characteristics and perioperative results. Heart Rhythm 2019; 16:1636-1644. [DOI: 10.1016/j.hrthm.2019.04.048] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Indexed: 10/26/2022]
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15
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Sakhi R, Theuns DA, Cosgun D, Michels M, Schinkel AF, Kauling RM, Roos-Hesselink JW, Yap SC. Usefulness of a standard 12-lead electrocardiogram to predict the eligibility for a subcutaneous defibrillator. J Electrocardiol 2019; 55:123-127. [DOI: 10.1016/j.jelectrocard.2019.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 05/06/2019] [Accepted: 05/21/2019] [Indexed: 10/26/2022]
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16
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Pfenniger A, Knight BP. Evolution of extravascular implantable defibrillator technologies. Prog Cardiovasc Dis 2019; 62:249-255. [PMID: 31004606 DOI: 10.1016/j.pcad.2019.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 04/15/2019] [Indexed: 11/30/2022]
Abstract
The implantable cardioverter-defibrillator (ICD) has been successfully treating patients with lethal ventricular arrhythmias for decades. The main acute and chronic complications of this therapy modality are related to the use of a transvenous lead. An entirely extravascular ICD concept was developed over the last 20 years, with emergence of the subcutaneous ICD (S-ICD). This device was approved for clinical use seven years ago, and accumulating real-life experience confirms its safety and efficacy. The main limitations related to this system include the lack of pacing capabilities for bradycardia, tachycardia or resynchronization therapy, a large size, and relatively high energy requirements for effective defibrillation. This review article summarizes current knowledge and potential future developments of the extravascular ICD technologies.
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Affiliation(s)
- Anna Pfenniger
- Division of Cardiology, Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States of America
| | - Bradley P Knight
- Division of Cardiology, Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States of America.
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Bögeholz N, Willy K, Niehues P, Rath B, Dechering DG, Frommeyer G, Kochhäuser S, Löher A, Köbe J, Reinke F, Eckardt L. Spotlight on S-ICD™ therapy: 10 years of clinical experience and innovation. Europace 2019; 21:1001-1012. [DOI: 10.1093/europace/euz029] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 02/09/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Subcutaneous ICD (S-ICD™) therapy has been established in initial clinical trials and current international guideline recommendations for patients without demand for pacing, cardiac resynchronization, or antitachycardia pacing. The promising experience in ‘ideal’ S-ICD™ candidates increasingly encourages physicians to provide the benefits of S-ICD™ therapy to patients in clinical constellations beyond ‘classical’ indications of S-ICD™ therapy, which has led to a broadening of S-ICD™ indications in many centres. However, the decision for S-ICD™ implantation is still not covered by controlled randomized trials but rather relies on patient series or observational studies. Thus, this review intends to give a contemporary update on available empirical evidence data and technical advancements of S-ICD™ technology and sheds a spotlight on S-ICD™ therapy in recently discovered fields of indication beyond ideal preconditions. We discuss the eligibility for S-ICD™ therapy in Brugada syndrome as an example for an adverse and dynamic electrocardiographic pattern that challenges the S-ICD™ sensing and detection algorithms. Besides, the S-ICD™ performance and defibrillation efficacy in conditions of adverse structural remodelling as exemplified for hypertrophic cardiomyopathy is discussed. In addition, we review recent data on potential device interactions between S-ICD™ systems and other implantable cardio-active systems (e.g. pacemakers) including specific recommendations, how these could be prevented. Finally, we evaluate limitations of S-ICD™ therapy in adverse patient constitutions, like distinct obesity, and present contemporary strategies to assure proper S-ICD™ performance in these patients. Overall, the S-ICD™ performance is promising even for many patients, who may not be ‘classical’ candidates for this technology.
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Affiliation(s)
- Nils Bögeholz
- Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany
| | - Kevin Willy
- Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany
| | - Philipp Niehues
- Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany
| | - Benjamin Rath
- Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany
| | - Dirk G Dechering
- Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany
| | - Gerrit Frommeyer
- Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany
| | - Simon Kochhäuser
- Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany
| | - Andreas Löher
- Department of Cardiothoracic Surgery, University Hospital of Muenster, Muenster, Germany
| | - Julia Köbe
- Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany
| | - Florian Reinke
- Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany
| | - Lars Eckardt
- Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany
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18
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Editorial: Automating subcutaneous ICD screening and future sensing refinements. Int J Cardiol 2018; 272:215-216. [PMID: 30087039 DOI: 10.1016/j.ijcard.2018.07.144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 07/30/2018] [Indexed: 11/23/2022]
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