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Sagi V, Murgatroyd F, Boersma LVA, Manlucu J, Knight BP, Leclercq C, Amin A, Birgersdotter-Green UM, Chan JYS, Roukoz H, Biffi M, Haqqani H, Denman R, Wiggenhorn C, Holmes TR, Lulic T, Friedman P, Crozier I. Comprehensive analysis of substernal lead removal: experience from EV ICD Pilot, Pivotal, and Continued Access Studies. Europace 2024; 26:euae225. [PMID: 39210643 PMCID: PMC11420630 DOI: 10.1093/europace/euae225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 08/20/2024] [Accepted: 08/25/2024] [Indexed: 09/04/2024] Open
Abstract
AIMS The extravascular implantable cardioverter-defibrillator (EV ICD) has been shown to be safe and effective for patients at risk of sudden cardiac death, but little is known about EV ICD lead removal in humans. This analysis aimed to characterize the EV ICD lead removal experience thus far. METHODS AND RESULTS This was a retrospective analysis of lead removals from the EV ICD Pilot, Pivotal, and Continued Access Studies. Patients with a successful EV ICD implant who underwent lead removal were included. The main objective was lead removal success. Ancillary objectives included characterizing technique used, procedure complications, and reimplantation status. An EV ICD system was successfully implanted in 347 patients across the 3 studies (25.9% female; 53.4 ± 13.3 years; left ventricular ejection fraction: 39.7 ± 15.9). Of these patients, 29 (8.4%) underwent lead removal with a mean lead dwell time of 12.6 ± 14.3 months (0.2-58.4). The main reason for lead removal was lead dislodgement (n = 9, 31.0%). Lead removal was successful in 27/29 (93.1%) cases [100% (19/19) success rate <1 year and 80% (8/10) success rate >1 year post-implant]. Simple traction was used in 22/26 (84.6%) and extraction tools in 4/26 (15.4%) successful cases where technique was known. No complications were reported for any of the removal procedures. All 11 EV ICD reimplant attempts were successful. CONCLUSION Complete removal of the EV ICD lead was successful in 93.1% of cases, and simple traction was sufficient in most instances. Based on these results, lead removal from the substernal space was safe and achievable up to 3 years post-implant.
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Affiliation(s)
- Venkata Sagi
- Baptist Heart Specialists, 836 Prudential Drive, Suite 1700, Jacksonville, FL 32207 USA
| | | | - Lucas V A Boersma
- Cardiology Department, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
- Cardiology Department, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jaimie Manlucu
- Division of Cardiology, London Health Sciences Centre, London, ON, Canada
| | - Bradley P Knight
- Division of Cardiology, Northwestern University, Chicago, IL, USA
| | | | - Anish Amin
- Riverside Methodist Hospital, Columbus, OH, USA
| | | | - Joseph Yat Sun Chan
- Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, P. R. China
| | - Henri Roukoz
- Cardiology Division, Electrophysiology Section, University of Minnesota, Minneapolis, MN, USA
| | - Mauro Biffi
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Haris Haqqani
- St. Vincent's Private Hospital Northside, Chermside, QLD, Australia
| | - Russell Denman
- St. Vincent's Private Hospital Northside, Chermside, QLD, Australia
| | | | - Thomas R Holmes
- Cardiac Rhythm Management, Medtronic Inc., Mounds View, MN, USA
| | - Thomas Lulic
- Cardiac Rhythm Management, Medtronic Inc., Mounds View, MN, USA
| | - Paul Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ian Crozier
- Christchurch Hospital, Christchurch, New Zealand
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2
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Moini C, Nguadi J, Rahim D, Lefoulon A, Poindron D, Fiore A, Folliguet T, Lellouche N. Extraction and Reimplantation of a Subcutaneous Implantable Cardioverter Defibrillator: Two Cases and a Review of the Literature. Cureus 2024; 16:e67737. [PMID: 39318900 PMCID: PMC11421584 DOI: 10.7759/cureus.67737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2024] [Indexed: 09/26/2024] Open
Abstract
For several years, implantable cardioverter defibrillators (ICDs) have been the cornerstone for the prevention of sudden cardiac death. However, the weakness of traditional transvenous ICD systems lies in the intravascular lead, which is prone to issues such as conductor fracture, insulation abrasion, risk of dislodgement, and infection. With the new generation of subcutaneous defibrillators, these risks are far less common. To date, the frequency of lead fracture is very low, and infection is much rarer. The management of these complications requires complete lead extraction. Traction is the reference procedure, sometimes necessitating the use of a dilating sheath. These techniques remain straightforward to perform without significant risk of procedural complications. Nevertheless, they must be carried out by an expert in cardiac pacing. We report here two cases with indications for lead extraction: one for lead dysfunction and the other for an infection related to a replacement procedure. The management approaches will be described, followed by a review of the literature.
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Affiliation(s)
- Cyrus Moini
- Cardiology, Groupe Hospitalier Sud Ile de France, Melun, FRA
- Cardiology, Antony Private Hospital, Antony, FRA
| | - Jaouad Nguadi
- Cardiology, Groupe Hospitalier Sud Ile de France, Melun, FRA
| | | | - Audrey Lefoulon
- Cardiology, Groupe Hospitalier Sud Ile de France, Melun, FRA
| | | | - Antonio Fiore
- Cardiac Surgery, Henri Mondor University Hospital, Creteil, FRA
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3
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Kataoka S, Yagishita D, Yazaki K, Sakai M, Hasegawa S, Higuchi S, Shoda M, Yamaguchi J. Double-device therapy in a patient with long QT syndrome. J Arrhythm 2024; 40:639-642. [PMID: 38939789 PMCID: PMC11199801 DOI: 10.1002/joa3.13027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/06/2024] [Accepted: 03/11/2024] [Indexed: 06/29/2024] Open
Abstract
A 26-year-old man with long QT syndrome (LQTS) underwent subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation. The patient exhibited sinus bradycardia relative to his age. The heart rate decreased, and the QT interval became longer with the administration of β-blockers, the first-line therapy for LQTS. The patient experienced frequent S-ICD discharges. Subsequently, a single-chamber pacemaker was implanted, and the 12-lead electrocardiogram showed atrial pacing and ventricular sensing at 60 beats per minute with a shorter QTc interval. After converting to "double-device therapy," the patient did not experience any ventricular arrhythmia events.
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Affiliation(s)
- Shohei Kataoka
- Department of CardiologyTokyo Women's Medical UniversityTokyoJapan
| | - Daigo Yagishita
- Department of CardiologyTokyo Women's Medical UniversityTokyoJapan
- Clinical Research Division for Heart Rhythm Management Department of CardiologyTokyo Women's Medical UniversityTokyoJapan
| | - Kyoichiro Yazaki
- Department of CardiologyTokyo Women's Medical UniversityTokyoJapan
| | - Masayuki Sakai
- Department of CardiologyTokyo Women's Medical UniversityTokyoJapan
| | - Shun Hasegawa
- Department of CardiologyTokyo Women's Medical UniversityTokyoJapan
| | - Satoshi Higuchi
- Department of CardiologyTokyo Women's Medical UniversityTokyoJapan
- Clinical Research Division for Heart Rhythm Management Department of CardiologyTokyo Women's Medical UniversityTokyoJapan
| | - Morio Shoda
- Department of CardiologyTokyo Women's Medical UniversityTokyoJapan
- Clinical Research Division for Heart Rhythm Management Department of CardiologyTokyo Women's Medical UniversityTokyoJapan
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4
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Kohli U, von Alvensleben J, Srinivasan C. Subcutaneous Implantable Cardioverter Defibrillators in Pediatrics and Congenital Heart Disease. Card Electrophysiol Clin 2023; 15:e1-e16. [PMID: 38030336 DOI: 10.1016/j.ccep.2023.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Subcutaneous implantable cardioverter defibrillators (S-ICDs) are being used with increased frequency in children and patients with congenital heart disease. Vascular access complexities, intracardiac shunts, and specific anatomies make these devices particularly appealing for some of these patients. Alternative screening, implantation, and programming techniques should be considered based on patient size, body habitus, anatomy, procedural history, and preference. Appropriate and inappropriate shock rates are generally comparable to those seen with transvenous devices. Complications such as infection can occur, although their severity is likely to be less than that seen with transvenous devices. Technical advances are likely to further broaden S-ICD applicability.
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Affiliation(s)
- Utkarsh Kohli
- Division of Pediatric Cardiology, Department of Pediatrics, West Virginia University School of Medicine and West Virginia University Children's Heart Center, 64 Medical Center Drive, Robert C. Byrd Health Science Center, PO Box 9214, Morgantown, WV 26506-9214, USA.
| | - Johannes von Alvensleben
- Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, Aurora, CO 80045 720-777-1234, USA
| | - Chandra Srinivasan
- The Children's Hospital of Philadelphia; University of Perelman School of Medicine, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
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5
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Sugrue A, Ibrahim R, Lu M, Bhatia NK, Alkukhun L, Adewumi J, Schaller RD, Marchlinski FE, D'Souza B, Nazer B, Tzou W, Merchant FM, Frankel DS. Impact of Median Sternotomy on Safety and Efficacy of the Subcutaneous Implantable Cardioverter Defibrillator. Circ Arrhythm Electrophysiol 2023; 16:468-474. [PMID: 37485688 DOI: 10.1161/circep.123.011867] [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: 01/26/2023] [Accepted: 07/16/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Subcutaneous implantable cardioverter defibrillators (S-ICDs) are an attractive alternative to transvenous ICDs among those not requiring pacing. However, the risks of damage to the S-ICD electrode during sternotomy and adverse interactions with sternal wires remain unclear. We sought to determine the rates of damage to the S-ICD lead during sternotomy, inappropriate shocks from electrical noise due to interaction with sternal wires, and failure to terminate spontaneous or induced ventricular arrhythmias. METHODS Retrospective, multicenter study of patients undergoing sternotomy before or after S-ICD implantation. Clinical, procedural, and device-related data were collected by each center and analyzed by the coordinating center. These data were compared with a historical control cohort of nonsternotomy patients. RESULTS Of 196 identified patients (52±16 years, 47 women), 166 underwent S-ICD implantation after sternotomy and 30 sternotomy after S-ICD. There was no damage to any lead among those who underwent sternotomy after S-ICD. Defibrillation threshold testing was performed in 63% at implant, with 91% first shock success. During a median follow-up of 29 months (range, 1-188), S-ICD first shocks successfully terminated spontaneous ventricular arrhythmias in 31 of 32 patients (97%). Inappropriate shocks occurred in 22 patients, most commonly related to T wave oversensing (n=14). Compared with the nonsternotomy controls, there were no differences in rates of first shock success for induced or spontaneous arrhythmias or rate of inappropriate shocks. CONCLUSIONS Sternotomy before or after S-ICD does not confer additional risk relative to a historical control group without sternotomy.
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Affiliation(s)
- Alan Sugrue
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (A.S., R.D.S., F.E.M., B.D., B.N., D.S.F.)
| | - Rand Ibrahim
- Section of Cardiac Electrophysiology, Emory University School of Medicine, Atlanta, GA (R.I., M.L., N.K.B., F.M.M.)
| | - Marvin Lu
- Section of Cardiac Electrophysiology, Emory University School of Medicine, Atlanta, GA (R.I., M.L., N.K.B., F.M.M.)
| | - Neal K Bhatia
- Section of Cardiac Electrophysiology, Emory University School of Medicine, Atlanta, GA (R.I., M.L., N.K.B., F.M.M.)
| | - Laith Alkukhun
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland (L.A., B.N.)
| | - Joseph Adewumi
- Division of Cardiovascular Medicine, Cardiac Electrophysiology Section, University of Colorado Anschutz Medical Campus, Aurora (J.A., W.T.)
| | - Robert D Schaller
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (A.S., R.D.S., F.E.M., B.D., B.N., D.S.F.)
| | - Francis E Marchlinski
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (A.S., R.D.S., F.E.M., B.D., B.N., D.S.F.)
| | - Benjamin D'Souza
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (A.S., R.D.S., F.E.M., B.D., B.N., D.S.F.)
| | - Babak Nazer
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (A.S., R.D.S., F.E.M., B.D., B.N., D.S.F.)
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland (L.A., B.N.)
| | - Wendy Tzou
- Division of Cardiovascular Medicine, Cardiac Electrophysiology Section, University of Colorado Anschutz Medical Campus, Aurora (J.A., W.T.)
| | - Faisal M Merchant
- Section of Cardiac Electrophysiology, Emory University School of Medicine, Atlanta, GA (R.I., M.L., N.K.B., F.M.M.)
| | - David S Frankel
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (A.S., R.D.S., F.E.M., B.D., B.N., D.S.F.)
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6
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Guarracini F, Preda A, Bonvicini E, Coser A, Martin M, Quintarelli S, Gigli L, Baroni M, Vargiu S, Varrenti M, Forleo GB, Mazzone P, Bonmassari R, Marini M, Droghetti A. Subcutaneous Implantable Cardioverter Defibrillator: A Contemporary Overview. Life (Basel) 2023; 13:1652. [PMID: 37629509 PMCID: PMC10455445 DOI: 10.3390/life13081652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023] Open
Abstract
The difference between subcutaneous implantable cardioverter defibrillators (S-ICDs) and transvenous ICDs (TV-ICDs) concerns a whole extra thoracic implantation, including a defibrillator coil and pulse generator, without endovascular components. The improved safety profile has allowed the S-ICD to be rapidly taken up, especially among younger patients. Reports of its role in different cardiac diseases at high risk of SCD such as hypertrophic and arrhythmic cardiomyopathies, as well as channelopathies, is increasing. S-ICDs show comparable efficacy, reliability, and safety outcomes compared to TV-ICD. However, some technical issues (i.e., the inability to perform anti-bradycardia pacing) strongly limit the employment of S-ICDs. Therefore, it still remains only an alternative to the traditional ICD thus far. This review aims to provide a contemporary overview of the role of S-ICDs compared to TV-ICDs in clinical practice, including technical aspects regarding device manufacture and implantation techniques. Newer outlooks and future perspectives of S-ICDs are also brought up to date.
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Affiliation(s)
- Fabrizio Guarracini
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Alberto Preda
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Eleonora Bonvicini
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Alessio Coser
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Marta Martin
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Silvia Quintarelli
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Lorenzo Gigli
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Matteo Baroni
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Sara Vargiu
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Marisa Varrenti
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Giovanni Battista Forleo
- Department of Thoracic Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Turin, Italy;
| | - Patrizio Mazzone
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Roberto Bonmassari
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Massimiliano Marini
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Andrea Droghetti
- Cardiology Unit, Luigi Sacco University Hospital, 20157 Milan, Italy;
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7
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De Filippo P, Migliore F, Palmisano P, Nigro G, Ziacchi M, Rordorf R, Pieragnoli P, Di Grazia A, Ottaviano L, Francia P, Pisanò E, Tola G, Giammaria M, D’Onofrio A, Botto GL, Zucchelli G, Ferrari P, Lovecchio M, Valsecchi S, Viani S. Procedure, management, and outcome of subcutaneous implantable cardioverter-defibrillator extraction in clinical practice. Europace 2023; 25:euad158. [PMID: 37350404 PMCID: PMC10288180 DOI: 10.1093/europace/euad158] [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: 04/07/2023] [Accepted: 05/31/2023] [Indexed: 06/24/2023] Open
Abstract
AIMS Subcutaneous implantable cardioverter-defibrillator (S-ICD) therapy is expanding rapidly. However, there are few data on the S-ICD extraction procedure and subsequent patient management. The aim of this analysis was to describe the procedure, management, and outcome of S-ICD extractions in clinical practice. METHODS AND RESULTS We enrolled consecutive patients who required complete S-ICD extraction at 66 Italian centres. From 2013 to 2022, 2718 patients undergoing de novo implantation of an S-ICD were enrolled. Of these, 71 required complete S-ICD system extraction (17 owing to infection). The S-ICD system was successfully extracted in all patients, and no complications were reported; the median procedure duration was 40 (25th-75th percentile: 20-55) min. Simple manual traction was sufficient to remove the lead in 59 (84%) patients, in whom lead-dwelling time was shorter [20 (9-32) months vs. 30 (22-41) months; P = 0.032]. Hospitalization time was short in the case of both non-infectious [2 (1-2) days] and infectious indications [3 (1-6) days]. In the case of infection, no patients required post-extraction intravenous antibiotics, the median duration of any antibiotic therapy was 10 (10-14) days, and the re-implantation was performed during the same procedure in 29% of cases. No complications arose over a median of 21 months. CONCLUSION The S-ICD extraction was safe and easy to perform, with no complications. Simple traction of the lead was successful in most patients, but specific tools could be needed for systems implanted for a longer time. The peri- and post-procedural management of S-ICD extraction was free from complications and not burdensome for patients and healthcare system. CLINICAL TRIAL REGISTRATION URL: http://clinicaltrials.gov/Identifier: NCT02275637.
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Affiliation(s)
- Paolo De Filippo
- Cardiac Electrophysiology and Pacing Unit, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo 24127, Italy
| | - Federico Migliore
- Department of Cardiac, Thoracic Vascular Sciences and Public Health University of Padova, Padova, Italy
| | - Pietro Palmisano
- Cardiology Unit, ‘Card. G. Panico’ Hospital, Tricase (Le), Italy
| | - Gerardo Nigro
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli,’ Monaldi Hospital, Naples, Italy
| | - Matteo Ziacchi
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Roberto Rordorf
- Arrhythmia and Electrophysiology Unit, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy
| | - Paolo Pieragnoli
- Institute of Internal Medicine and Cardiology, University Hospital of Florence, Florence, Italy
| | - Angelo Di Grazia
- Cardiology Department, Policlinico ‘G. Rodolico—San Marco’, Catania, Italy
| | - Luca Ottaviano
- Arrhythmia and Electrophysiology unit, Arrhythmia and Electrophysiology Unit, Cardiothoracic Department, IRCCS Galeazzi-S. Ambrogio, Milan, Italy
| | - Pietro Francia
- Cardiology, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, University Sapienza, Rome, Italy
| | - Ennio Pisanò
- Cardiology Division, U.O.S.V.D. Cardiac Electrophysiology, ‘Vito Fazzi’ Hospital, Lecce, 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-Garbagnate Milanese (MI), Italy
| | - Giulio Zucchelli
- Second Cardiology Division, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Paola Ferrari
- Cardiac Electrophysiology and Pacing Unit, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo 24127, Italy
| | | | | | - Stefano Viani
- Second Cardiology Division, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
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8
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Gasperetti A, Schiavone M, Vogler J, Laredo M, Fastenrath F, Palmisano P, Ziacchi M, Angeletti A, Mitacchione G, Kaiser L, Compagnucci P, Breitenstein A, Arosio R, Vitali F, De Bonis S, Picarelli F, Casella M, Santini L, Pignalberi C, Lavalle C, Pisanò E, Ricciardi D, Calò L, Curnis A, Bertini M, Gulletta S, Dello Russo A, Badenco N, Tondo C, Kuschyk J, Tilz R, Forleo GB, Biffi M. The need for a subsequent transvenous system in patients implanted with subcutaneous implantable cardioverter-defibrillator. Heart Rhythm 2022; 19:1958-1964. [PMID: 35781042 DOI: 10.1016/j.hrthm.2022.06.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The absence of pacing capabilities may reduce the appeal of subcutaneous implantable cardioverter-defibrillator (S-ICD) devices for patients at risk for conduction disorders or with antitachycardia pacing (ATP)/cardiac resynchronization (CRT) requirements. Reports of rates of S-ICD to transvenous implantable cardioverter-defibrillator (TV-ICD) system switch in real-world scenarios are limited. OBJECTIVE The purpose of this study was to investigate the need for a subsequent transvenous (TV) device in patients implanted with an S-ICD and its predictors. METHODS All patients implanted with an S-ICD were enrolled from the multicenter, real-world iSUSI (International SUbcutaneouS Implantable cardioverter defibrillator) Registry. The need for a TV device and its clinical reason, and appropriate and inappropriate device therapies were assessed. Logistic regression with Firth penalization was used to assess the association between baseline and procedural characteristics and the overall need for a subsequent TV device. RESULTS A total of 1509 patients were enrolled (age 50.8 ± 15.8 years; 76.9% male; 32.0% ischemic; left ventricular ejection fraction 38% [30%-60%]). Over 26.5 [13.4-42.9] months, 155 (10.3%) and 144 (9.3%) patients experienced appropriate and inappropriate device therapies, respectively. Forty-one patients (2.7%) required a TV device (13 bradycardia; 10 need for CRT; 10 inappropriate shocks). Body mass index (BMI) >30 kg/m2 and chronic kidney disease (CKD) were associated with need for a TV device (odds ratio [OR] 2.57 [1.37-4.81], P = .003; and OR 2.67 [1.29-5.54], P = .008, respectively). CONCLUSION A low rate (2.7%) of conversion from S-ICD to a TV device was observed at follow-up, with need for antibradycardia pacing, ATP, or CRT being the main reasons. BMI >30 kg/m2 and CKD predicted all-cause need for a TV device.
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Affiliation(s)
- Alessio Gasperetti
- Cardiology Unit, Luigi Sacco University Hospital, Milan, Italy; Università degli Studi di Milano, Milan, Italy; Johns Hopkins University, Baltimore, Maryland; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy.
| | | | - Julia Vogler
- Department of Rhythmology, Herzzentrum Lubeck, Lubeck, Germany
| | | | - Fabian Fastenrath
- Cardiology Unit, University Medical Centre Mannheim, Manheim, Germany
| | | | - Matteo Ziacchi
- Cardiology Unit, IRCCS, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Andrea Angeletti
- Cardiology Unit, IRCCS, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Gianfranco Mitacchione
- Cardiology Unit, Luigi Sacco University Hospital, Milan, Italy; Cardiology Unit, Spedali Civili Brescia, Brescia, Italy
| | | | - Paolo Compagnucci
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy; Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti, Ancona, Italy
| | | | | | - Francesco Vitali
- Cardiological Center, S. Anna University Hospital, Ferrara, Italy
| | - Silvana De Bonis
- Department of Cardiology, Castrovillari Hospital, Cosenza, Italy
| | | | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti, Ancona, Italy
| | - Luca Santini
- Cardiology Unit, Ospedale G.B. Grassi, Ostia, Italy
| | | | | | - Ennio Pisanò
- Cardiac Electrophysiology Unit, Vito Fazzi Hospital, Lecce, Italy
| | | | | | | | - Matteo Bertini
- Cardiological Center, S. Anna University Hospital, Ferrara, Italy
| | - Simone Gulletta
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Antonio Dello Russo
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy; Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti, Ancona, Italy
| | | | - Claudio Tondo
- Heart Rhythm Center, Monzino Cardiology Center, IRCCS, Milan, Italy
| | - Jürgen Kuschyk
- Cardiology Unit, University Medical Centre Mannheim, Manheim, Germany
| | - Roland Tilz
- Department of Rhythmology, Herzzentrum Lubeck, Lubeck, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | | | - Mauro Biffi
- Cardiology Unit, IRCCS, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
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9
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Muacevic A, Adler JR. Effects and Complications of Subcutaneous Implantable Cardioverter-Defibrillator in the Prevention of Sudden Cardiac Death: A Narrative Review. Cureus 2022; 14:e30170. [PMID: 36397900 PMCID: PMC9648676 DOI: 10.7759/cureus.30170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/11/2022] [Indexed: 01/25/2023] Open
Abstract
An implantable cardioverter-defibrillator (ICD) is one of those devices that is a big boom for the prevention of sudden deaths due to heart failure. This particular device has been in use for just a couple of years, but its impact in the domain has brought about a considerable change in the way a specific issue of the cardiovascular system is tackled. Although subcutaneous or hypodermic implantable cardioverter-defibrillator (S-ICD) is considered to be a better alternative as far as transvenous implantable cardioverter-defibrillator (TV-ICD) is concerned, the former, being a newer introduction in the market, needs to be assessed in depth to clearly understand its effects and complications. Various types of research have been conducted on the efficacy of this device, and in most of the studies, the supremacy of this device is clearly evident when compared with other devices that are used for the same purpose. Better innovations in subcutaneous or hypodermic implantable cardioverter-defibrillators would enable them to be manufactured in a more efficient and cost-effective way so that a huge lot of people are benefited from this device. This review article is a whole peep into the various studies done in this domain, thereby providing adequate scientific insights about subcutaneous or hypodermic implantable cardioverter-defibrillators in a very simple and comprehensive manner.
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10
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Rordorf R. The ATLAS Randomised Clinical Trial: What do the Superiority Results
Mean for Subcutaneous ICD Therapy and Sudden Cardiac Death Prevention as a Whole? Arrhythm Electrophysiol Rev 2022; 11. [DOI: 10.15420/aer.2022.11.s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/08/2022] [Indexed: 11/04/2022] Open
Abstract
This review sets out the key evidence comparing subcutaneous ICDs (S-ICDs) and transvenous ICDs and uses it to empower clinical cardiologists and those who implant ICDs to make optimum patient selections for S-ICD use. The evidence demonstrates that clinical trials performed until recently have proven the performance of S-ICDs. However, the latest data now available from the ATLAS randomised controlled trial have added new insights to this body of evidence. ATLAS demonstrates the superiority of S-ICDs over transvenous ICDs regarding lead-related complications, findings that point to promising opportunities for patients who are at risk of sudden cardiac death.
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Affiliation(s)
- Roberto Rordorf
- Arrhythmias and Electrophysiology Unit, Policlinico San Matteo Foundation, Pavia, Italy
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11
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Friedli A, Burri H. S-ICDs: advantages and opportunities for improvement. Expert Rev Med Devices 2022; 19:237-245. [PMID: 35289702 DOI: 10.1080/17434440.2022.2054335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The subcutaneous implantable cardioverter defibrillator (S-ICD) is currently in its third generation and has been adopted in guidelines and in mainstream clinical practice. Considerable improvements have been made since the introduction of this device over a decade ago. AREAS COVERED A literature search was undertaken in Pubmed on articles relating to the S-ICD. EXPERT OPINION The therapy has been proven to be safe and effective and is a valuable option in selected patients. Nevertheless, there remain many shortcomings of the S-ICD which are discussed in this review, and which hopefully will be addressed by future generations of the device.
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Affiliation(s)
- Axel Friedli
- Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland
| | - Haran Burri
- Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland
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12
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Thompson AE, Marshall M, Lentz L, Mazzetti H. Three-Year Extraction Experience of a Novel Substernal Extravascular Defibrillation Lead in Sheep. Pacing Clin Electrophysiol 2022; 45:314-322. [PMID: 35048393 PMCID: PMC9302635 DOI: 10.1111/pace.14451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/09/2021] [Accepted: 01/02/2022] [Indexed: 11/28/2022]
Abstract
Background The extravascular implantable cardioverter‐defibrillator (EV ICD) with lead implantation in the substernal space may provide an alternative to transvenous and subcutaneous systems. This is the first‐reported chronic extraction experience for EV ICD leads. The aim of the study is to evaluate the chronic encapsulation and extractability of EV ICD leads. Methods Two EV ICD leads and one transvenous lead were implanted in each of 24 mature sheep. A subset of animals was evaluated yearly for histology and lead extractability. Extractions were performed using simple traction or extraction tools. Histology evaluated the encapsulating tissue. Results At 1 year, extraction was performed successfully for two of five EV ICD leads with traction alone using ≤3.1 kg‐force (kgf) and the remainder extracted successfully with extraction tools; no transvenous leads were removed with traction alone. At 2 years, no EV ICD or transvenous leads were extracted with traction alone, while at 3 years, one of eight EV ICD leads and two of four transvenous leads were extracted with traction (0.8 and ≤2.3 kgf, respectively). There was one observation of hemopericardium resulting in tamponade with EV ICD extraction but without injury to cardiovascular structures and related to the unique implant tract. Among transvenous leads, inversion of the ventricle with loss of cardiac output resulted in abandonment of traction for two animals. Conclusions Chronic extraction of EV ICD leads from the substernal space was successfully performed using traction and simple tools through 3 years in sheep with one observation of hemopericardium that did not originate from cardiovascular injury.
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13
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Migliore F, Del Monte A, Kohlscheen E. Subcutaneous implantable cardioverter-defibrillator lead extraction using non-powered mechanical sheath: a potential technique when simple traction is ineffective. J Cardiovasc Med (Hagerstown) 2021; 22:e43-e44. [PMID: 34608002 DOI: 10.2459/jcm.0000000000001196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Federico Migliore
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health
| | - Alvise Del Monte
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health
| | - Eva Kohlscheen
- Plastic Surgery Institute, University of Padova, Padova, Italy
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14
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Allison JD, Sabeh MK, Mela T. Novel Use of a Rotating Mechanical Dilator Sheath for S-ICD Lead Extraction. JACC Case Rep 2021; 3:1415-1418. [PMID: 34557683 PMCID: PMC8446045 DOI: 10.1016/j.jaccas.2021.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/04/2021] [Accepted: 06/15/2021] [Indexed: 11/18/2022]
Abstract
A 53-year-old man with a subcutaneous implantable cardioverter-defibrillator (S-ICD) presented with inappropriate shocks. He underwent device extraction, and the lead was freed using a rotating mechanical dilator sheath. As patients with S-ICDs get older, extractions will become more complicated and more common. We have described a novel method of S-ICD lead extraction. (Level of Difficulty: Advanced.).
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Affiliation(s)
- John D. Allison
- Cardiac Arrythmia Service, Corrigan Minehan Heart Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Address for correspondence: Dr John David Allison, Jr, Cardiac Arrythmia Service, Cardiology Division, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 8, Boston, Massachusetts 02114, USA. @jdallisonjr
| | - M. Khaled Sabeh
- Allegheny Health Network, St. Vincent Hospital, Erie, Pennsylvania, USA
| | - Theofanie Mela
- Cardiac Arrythmia Service, Corrigan Minehan Heart Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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15
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Long-term complications in patients implanted with subcutaneous implantable cardioverter-defibrillators: Real-world data from the extended ELISIR experience. Heart Rhythm 2021; 18:2050-2058. [PMID: 34271173 DOI: 10.1016/j.hrthm.2021.07.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/21/2021] [Accepted: 07/07/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Recently, the Food and Drug Administration issued a recall for the subcutaneous implantable cardioverter-defibrillator (S-ICD) because of the possibility of lead ruptures and accelerated battery depletion. OBJECTIVE The aim of this study was to evaluate device-related complications over time in a large real-world multicenter S-ICD cohort. METHODS Patients implanted with an S-ICD from January 2015 to June 2020 were enrolled from a 19-institution European registry (Experience from the Long-term Italian S-ICD registry [ELISIR]; ClinicalTrials.gov identifier NCT0473876). Device-related complication rates over follow-up were collected. Last follow-up of patients was performed after the Boston Scientific recall issue. RESULTS A total of 1254 patients (median age 52.0 [interquartile range 41.0-62.2] years; 973 (77.6%) men; 387 (30.9%) ischemic) was enrolled. Over a follow-up of 23.2 (12.8-37.8) months, complications were observed in 117 patients (9.3%) for a total of 127 device-related complications (23.6% managed conservatively and 76.4% required reintervention). Twenty-seven patients (2.2%) had unanticipated generator replacement after 3.6 (3.3-3.9) years, while 4 (0.3%) had lead rupture. Body mass index (hazard ratio [HR] 1.063 [95% confidence interval 1.028-1.100]; P < .001), chronic kidney disease (HR 1.960 [1.191-3.225]; P = .008), and oral anticoagulation (HR 1.437 [1.010-2.045]; P = .043) were associated with an increase in overall complications, whereas older age (HR 0.980 [0.967-0.994]; P = .007) and procedure performed in high-volume centers (HR 0.463 [0.300-0.715]; P = .001) were protective factors. CONCLUSION The overall complication rate over 23.2 months of follow-up in a multicenter S-ICD cohort was 9.3%. Early unanticipated device battery depletions occurred in 2.2% of patients, while lead fracture was observed in 0.3%, which is in line with the expected rates reported by Boston Scientific.
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16
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Rordorf R, Casula M, Pezza L, Fortuni F, Sanzo A, Savastano S, Vicentini A. Subcutaneous versus transvenous implantable defibrillator: An updated meta-analysis. Heart Rhythm 2020; 18:382-391. [PMID: 33212250 DOI: 10.1016/j.hrthm.2020.11.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Implantable cardioverter-defibrillator (ICD) placement is a well-established therapy for prevention of sudden cardiac death. The subcutaneous implantable cardioverter-defibrillator (S-ICD) was specifically designed to overcome some of the complications related to the transvenous implantable cardioverter-defibrillator (TV-ICD), such as lead complications and systemic infections. Evidence on the comparison of S-ICD vs TV-ICD are limited. OBJECTIVE The purpose of this study was to conduct an updated meta-analysis comparing S-ICD vs TV-ICD. METHODS Electronic databases were searched for studies directly comparing clinical outcomes and complications between S-ICD and TV-ICD. The primary outcome was the composite of clinically relevant complications (lead, pocket, major procedural complications; device-related infections) and inappropriate shocks. Secondary outcomes included death and the individual components of the primary outcome. RESULTS Thirteen studies comprising 9073 patients were included in the analysis. Mean left ventricular ejection fraction was 40% ± 10%; 30% of patients were female; and 73% had an ICD implanted for primary prevention. There was no statistically significant difference in the risk of the primary outcome between S-ICD and TV-ICD (odds ratio [OR] 0.80; 95% confidence interval [CI] 0.53-1.19). Patients with S-ICD had lower risk of lead complications (OR 0.14; 95% CI 0.06-0.29; P <.00001) and major procedural complications (OR 0.18; 95% CI 0.06-0.57; P = .003) but higher risk of pocket complications (OR 2.18; 95% CI 1.30-3.66; P = .003) compared to those with TV-ICD. No significant differences were found for the other outcomes. CONCLUSION In patients with an indication for ICD without the need for pacing, TV-ICD and S-ICD are overall comparable in terms of the composite of clinically relevant device-related complications and inappropriate shock.
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Affiliation(s)
- Roberto Rordorf
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy.
| | - Matteo Casula
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy; Department of Molecular Medicine, Unit of Cardiology, University of Pavia, Pavia, Italy
| | - Laura Pezza
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy; Department of Molecular Medicine, Unit of Cardiology, University of Pavia, Pavia, Italy
| | - Federico Fortuni
- Department of Molecular Medicine, Unit of Cardiology, University of Pavia, Pavia, Italy
| | - Antonio Sanzo
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy
| | - Simone Savastano
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy
| | - Alessandro Vicentini
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy
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17
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Mitacchione G, Schiavone M, Gasperetti A, Viecca M, Curnis A, Forleo GB. Neglected lead tip erosion: An unusual case of S‐ICD inappropriate shock. J Cardiovasc Electrophysiol 2020; 31:3322-3325. [DOI: 10.1111/jce.14746] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 09/11/2020] [Accepted: 09/14/2020] [Indexed: 11/27/2022]
Affiliation(s)
| | - Marco Schiavone
- Department of Cardiology Luigi Sacco University Hospital Milan Italy
| | | | - Maurizio Viecca
- Department of Cardiology Luigi Sacco University Hospital Milan Italy
| | - Antonio Curnis
- Department of Cardiology Spedali Civili Hospital University of Brescia Brescia Italy
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