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Rella V, Maurizi N, Bernardini A, Brasca FM, Salerno S, Meda M, Mariani D, Torchio M, Ravaro S, Cerea P, Castelletti S, Fumagalli C, Conte G, Auricchio A, Girolami F, Pieragnoli P, Carrassa GM, Parati G, Olivotto I, Perego GB, Cecchi F, Crotti L. Candidacy and long-term outcomes of subcutaneous implantable cardioverter-defibrillators in current practice in patients with hypertrophic cardiomyopathy. Int J Cardiol 2024; 409:132202. [PMID: 38795975 DOI: 10.1016/j.ijcard.2024.132202] [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: 01/31/2024] [Revised: 04/16/2024] [Accepted: 05/22/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND In patients with Hypertrophic Cardiomyopathy (HCM) S-ICD is usually the preferred option as pacing is generally not indicated. However, limited data are available on its current practice adoption and long-term follow-up. METHODS Consecutive HCM patients with S-ICD implanted between 2013 and 2021 in 3 international centers were enrolled in this observational study. Baseline, procedural and follow-up data were regularly collected. Efficacy and safety were compared with a cohort of HCM patients implanted with a tv-ICD. RESULTS Seventy patients (64% males) were implanted with S-ICD at 41 ± 15 years, whereas 168 patients with tv-ICD at 49 ± 16 years. For S-ICD patients, mean ESC SCD risk score was 4,5 ± 1.9%: 25 (40%) at low-risk, 17 (27%) at intermediate and 20 (33%) at high-risk. Patients were followed-up for 5.1 ± 2.3 years. Two patients (0.6 per 100-person-years, vs 0.4 per 100 person-years with tv-ICD, p = 0.45) received an appropriate shock on VF, 17 (24%) were diagnosed with de-novo AF. Inappropriate shocks occurred in 4 patients (1.2 per 100-person-years, vs 0.9 per 100 person-years with tv-ICD, p = 0.74), all before Smart-Pass algorithm implementation. Four patients experienced device-related adverse events (1.2 per 100-person-years, vs 1 per 100 person-years with tv-ICD, p = 0.35%). CONCLUSIONS S-ICDs were often implanted in patients with an overall low-intermediate ESC SCD risk, reflecting both the inclusion of additional risk markers and a lower decision threshold. S-ICDs in HCM patients followed for over 5 years showed to be effective in conversion of VF and safe. Greater scrutiny may be required to avoid overtreatment in patients with milder risk profiles.
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Affiliation(s)
- V Rella
- Istituto Auxologico Italiano IRCCS, Cardiomyopathy Unit, Department of Cardiology, San Luca Hospital, Milan, Italy
| | - N Maurizi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Service of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - A Bernardini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Santa Maria Nuova Hospital, Cardiology and Electrophysiology unit, Florence, Italy
| | - F M Brasca
- Istituto Auxologico Italiano IRCCS, Electrophysiology Unit, Department of Cardiology, San Luca Hospital, Milan, Italy
| | - S Salerno
- Istituto Auxologico Italiano IRCCS, Cardiomyopathy Unit, Department of Cardiology, San Luca Hospital, Milan, Italy
| | - M Meda
- Istituto Auxologico Italiano IRCCS, Cardiomyopathy Unit, Department of Cardiology, San Luca Hospital, Milan, Italy
| | - D Mariani
- Istituto Auxologico Italiano IRCCS, Cardiomyopathy Unit, Department of Cardiology, San Luca Hospital, Milan, Italy
| | - M Torchio
- Istituto Auxologico Italiano IRCCS, Laboratory of Cardiovascular Genetics, Milan, Italy
| | - S Ravaro
- Istituto Auxologico Italiano IRCCS, Cardiomyopathy Unit, Department of Cardiology, San Luca Hospital, Milan, Italy; Department of medicine and surgery, University Milano Bicocca, Milan, Italy
| | - P Cerea
- Istituto Auxologico Italiano IRCCS, Cardiomyopathy Unit, Department of Cardiology, San Luca Hospital, Milan, Italy
| | - S Castelletti
- Istituto Auxologico Italiano IRCCS, Cardiomyopathy Unit, Department of Cardiology, San Luca Hospital, Milan, Italy
| | - C Fumagalli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - G Conte
- Istituto Cardiocentro Ticino, Department of Cardiology, Lugano, Switzerland
| | - A Auricchio
- Istituto Cardiocentro Ticino, Department of Cardiology, Lugano, Switzerland
| | - F Girolami
- Pediatric Cardiology Unit, Meyer Children's Hospital IRCCS, 50139 Florence, Italy
| | - P Pieragnoli
- Electrophysiology unit, Department of Cardiology, Careggi University Hospital, Florence, Italy
| | - G M Carrassa
- Electrophysiology unit, Department of Cardiology, Careggi University Hospital, Florence, Italy
| | - G Parati
- Istituto Auxologico Italiano IRCCS, Cardiomyopathy Unit, Department of Cardiology, San Luca Hospital, Milan, Italy; Department of medicine and surgery, University Milano Bicocca, Milan, Italy
| | - I Olivotto
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Pediatric Cardiology Unit, Meyer Children's Hospital IRCCS, 50139 Florence, Italy
| | - G B Perego
- Istituto Auxologico Italiano IRCCS, Electrophysiology Unit, Department of Cardiology, San Luca Hospital, Milan, Italy
| | - F Cecchi
- Istituto Auxologico Italiano IRCCS, Cardiomyopathy Unit, Department of Cardiology, San Luca Hospital, Milan, Italy
| | - L Crotti
- Department of medicine and surgery, University Milano Bicocca, Milan, Italy; Istituto Auxologico Italiano IRCCS, Cardiomyopathy Unit, Center for Cardiac Arrhythmias of Genetic Origin, Laboratory of Cardiovascular Genetics, Milan, Italy.
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2
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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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Green N, Chen Y, O'Mahony C, Elliott PM, Barriales-Villa R, Monserrat L, Anastasakis A, Biagini E, Gimeno JR, Limongelli G, Pavlou M, Omar RZ. A cost-effectiveness analysis of hypertrophic cardiomyopathy sudden cardiac death risk algorithms for implantable cardioverter defibrillator decision-making. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2024; 10:285-293. [PMID: 37660245 DOI: 10.1093/ehjqcco/qcad050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/22/2023] [Accepted: 08/31/2023] [Indexed: 09/04/2023]
Abstract
AIMS To conduct a contemporary cost-effectiveness analysis examining the use of implantable cardioverter defibrillators (ICDs) for primary prevention in patients with hypertrophic cardiomyopathy (HCM). METHODS A discrete-time Markov model was used to determine the cost-effectiveness of different ICD decision-making rules for implantation. Several scenarios were investigated, including the reference scenario of implantation rates according to observed real-world practice. A 12-year time horizon with an annual cycle length was used. Transition probabilities used in the model were obtained using Bayesian analysis. The study has been reported according to the Consolidated Health Economic Evaluation Reporting Standards checklist. RESULTS Using a 5-year SCD risk threshold of 6% was cheaper than current practice and has marginally better total quality adjusted life years (QALYs). This is the most cost-effective of the options considered, with an incremental cost-effectiveness ratio of £834 per QALY. Sensitivity analyses highlighted that this decision is largely driven by what health-related quality of life (HRQL) is attributed to ICD patients and time horizon. CONCLUSION We present a timely new perspective on HCM-ICD cost-effectiveness, using methods reflecting real-world practice. While we have shown that a 6% 5-year SCD risk cut-off provides the best cohort stratification to aid ICD decision-making, this will also be influenced by the particular values of costs and HRQL for subgroups or at a local level. The process of explicitly demonstrating the main factors, which drive conclusions from such an analysis will help to inform shared decision-making in this complex area for all stakeholders concerned.
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Affiliation(s)
- Nathan Green
- Department of Statistical Science, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
| | - Yang Chen
- Institute of Health Informatics, Faculty of Population Health Sciences, University College London, London WC1E 6BT, UK
| | - Constantinos O'Mahony
- Institute of Cardiovascular Science, University College London, Gower St, London WC1E 6BT, UK
- St Bartholomew's Hospital, London EC1A 7BE, UK
| | - Perry M Elliott
- Institute of Cardiovascular Science, University College London, Gower St, London WC1E 6BT, UK
- St Bartholomew's Hospital, London EC1A 7BE, UK
| | - Roberto Barriales-Villa
- Unidad de Cardiopatías Familiares, Cardiology Service, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC, CIBERCV), A Coruña 15006, Spain
| | - Lorenzo Monserrat
- Unidad de Cardiopatías Familiares, Cardiology Service, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC, CIBERCV), A Coruña 15006, Spain
| | - Aristides Anastasakis
- Unit of Inherited and Rare Cardiovascular Diseases, Onassis Cardiac Surgery Centre, Leof. Andrea Siggrou 356, Kallithea 176 74, Greece
| | - Elena Biagini
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, Bologna 40138, Italy
| | - Juan Ramon Gimeno
- Cardiac Department, University Hospital Virgen Arrixaca, Murcia-Cartagenas, El Palmar, Murcia 30120, Spain
| | - Giuseppe Limongelli
- Monaldi Hospital, Second University of Naples, Via Leonardo Bianchi 1, Naples 80131, Italy
| | - Menelaos Pavlou
- Clinical Research Informatics Unit, University College London Hospitals, London NW1 2DA, UK
| | - Rumana Z Omar
- Clinical Research Informatics Unit, University College London Hospitals, London NW1 2DA, UK
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4
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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 for the transvenous ICD in the treatment of ventricular tachyarrhythmias in patients without pacing or cardiac resynchronization therapy indications. Since its introduction, numerous innovations have been made and clinical experience was gained leading to its adoption in current practice and preference in certain populations. Moreover, emerging technologies like the extravascular ICD or the combination of the S-ICD with the leadless pacemaker offer new possibilities for the future. These advancements underscore the S-ICD's evolving role in ventricular tachyarrhythmia management. This review outlines implantation considerations, patient selection and troubleshooting advancements in the last 15 years and also provides insights into future perspectives.
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Affiliation(s)
- L A Dijkshoorn
- Department of Cardiology, Amsterdam UMC, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands
| | - L Smeding
- Department of Cardiology, Amsterdam UMC, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands
| | - S Pepplinkhuizen
- Department of Cardiology, Amsterdam UMC, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands
| | - J A de Veld
- Department of Cardiology, Amsterdam UMC, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands
| | - R E Knops
- Department of Cardiology, Amsterdam UMC, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands
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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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Kuschyk J, Sattler K, Fastenrath F, Rudic B, Akin I. [Treatment with cardiac electronic implantable devices]. Herz 2024; 49:233-246. [PMID: 38709278 DOI: 10.1007/s00059-024-05246-1] [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] [Accepted: 03/19/2024] [Indexed: 05/07/2024]
Abstract
Cardiac device therapy provides not only treatment options for bradyarrhythmia but also advanced treatment for heart failure and preventive measures against sudden cardiac death. In heart failure treatment it enables synergistic reverse remodelling and reduces pharmacological side effects. Cardiac resynchronization therapy (CRT) has revolutionized the treatment of reduced left ventricular ejection fraction (LVEF) and left bundle branch block by decreasing the mortality and morbidity with improvement of the quality of life and resilience. Conduction system pacing (CSP) as an alternative method of physiological stimulation can improve heart function and reduce the risk of pacemaker-induced cardiomyopathy. Leadless pacers and subcutaneous/extravascular defibrillators offer less invasive options with lower complication rates. The prevention of infections through preoperative and postoperative strategies enhances the safety of these therapies.
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Affiliation(s)
- Jürgen Kuschyk
- I. Medizinische Klinik, Kardiologie, Angiologie, Hämostaseologie und Internistische Intensivmedizin, Sektion für Invasive Kardiologie und Elektrophysiologie, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
| | - Katherine Sattler
- I. Medizinische Klinik, Sektion für Invasive Kardiologie und Elektrophysiologie, Universitätsmedizin Mannheim, Mannheim, Deutschland
| | - Fabian Fastenrath
- I. Medizinische Klinik, Sektion für Invasive Kardiologie und Elektrophysiologie, Universitätsmedizin Mannheim, Mannheim, Deutschland
| | - Boris Rudic
- I. Medizinische Klinik, Sektion für Invasive Kardiologie und Elektrophysiologie, Universitätsmedizin Mannheim, Mannheim, Deutschland
| | - Ibrahim Akin
- I. Medizinische Klinik, Sektion für Invasive Kardiologie und Elektrophysiologie, Universitätsmedizin Mannheim, Mannheim, Deutschland
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7
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Gasperetti A, Schiavone M, Milstein J, Compagnucci P, Vogler J, Laredo M, Breitenstein A, Gulletta S, Martinek M, Casella M, Kaiser L, Santini L, Rovaris G, Curnis A, Biffi M, Kuschyk J, Di Biase L, Tilz R, Tondo C, Forleo GB. Differences in underlying cardiac substrate among S-ICD recipients and its impact on long-term device-related outcomes: Real-world insights from the iSUSI registry. Heart Rhythm 2024; 21:410-418. [PMID: 38246594 DOI: 10.1016/j.hrthm.2023.12.007] [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: 10/18/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Outcome comparisons among subcutaneous implantable cardioverter-defibrillator (S-ICD) recipients with nonischemic cardiomyopathies are scarce. OBJECTIVE The aim of this study was to evaluate differences in device-related outcomes among S-ICD recipients with different structural substrates. METHODS Patients enrolled in the i-SUSI (International SUbcutaneouS Implantable cardioverter defibrillator registry) project were grouped according to the underlying substrate (ischemic vs nonischemic) and subgrouped into dilated cardiomyopathy, hypertrophic cardiomyopathy, Brugada syndrome (BrS), arrhythmogenic right ventricular cardiomyopathy (ARVC). The main outcome of our study was to compare the rates of appropriate and inappropriate shocks and device-related complications. RESULTS Among 1698 patients, the most common underlying substrate was ischemic (31.7%), followed by dilated cardiomyopathy (20.5%), BrS (10.8%), hypertrophic cardiomyopathy (8.5%), and ARVC (4.4%). S-ICD for primary prevention was more common in the nonischemic cohort (70.9% vs 65.4%; P = .037). Over a median (interquartile range) follow-up of 26.5 (12.6-42.8) months, no differences were observed in appropriate shocks between ischemic and nonischemic patients (4.8%/y vs 3.9%/y; log-rank, P = .282). ARVC (9.0%/y; hazard ratio [HR] 2.492; P = .001) and BrS (1.8%/y; HR 0.396; P = .008) constituted the groups with the highest and lowest rates of appropriate shocks, respectively. Device-related complications did not differ between groups (ischemic: 6.4%/y vs nonischemic: 6.1%/y; log-rank, P = .666), nor among underlying substrates (log-rank, P = .089). Nonischemic patients experienced higher rates of inappropriate shocks than did ischemic S-ICD recipients (4.4%/y vs 3.0%/y; log-rank, P = .043), with patients with ARVC (9.9%/y; P = .001) having the highest risk, even after controlling for confounders (adjusted HR 2.243; confidence interval 1.338-4.267; P = .002). CONCLUSION Most S-ICD recipients were primary prevention nonischemic cardiomyopathy patients. Among those, patients with ARVC tend to receive the most frequent appropriate and inappropriate shocks and patients with BrS the least frequent appropriate shocks.
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Affiliation(s)
- Alessio Gasperetti
- Cardiology Unit, Luigi Sacco University Hospital, Milan, Italy; Department of Cardiology, Johns Hopkins University, Baltimore, Maryland.
| | - Marco Schiavone
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Jenna Milstein
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Ancona, Italy
| | - Julia Vogler
- Department of Rhythmology, University Heart Center Lübeck, Lubeck, Germany
| | - Mikael Laredo
- Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière and Sorbonne Université, Paris, France
| | | | - Simone Gulletta
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Martin Martinek
- Ordensklinikum Linz Elisabethinen Internal Medicine 2 with Cardiology, Angiology, and Intensive Care Medicine, Linz, Austria
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Ancona, Italy
| | - Lukas Kaiser
- Department of Cardiology and Critical Care Medicine, St. George Klinik Asklepios, Hamburg, Germany
| | - Luca Santini
- Cardiology Unit, Ospedale G.B. Grassi, Ostia, Rome, Italy
| | - Giovanni Rovaris
- Cardiology Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | | | - Mauro Biffi
- Cardiology Unit, IRCCS, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Jürgen Kuschyk
- Cardiology Unit, University Medical Centre Mannheim, Manheim, Germany
| | - Luigi Di Biase
- Cardiac Arrhythmia Center, Division of Cardiology at Montefiore-Einstein Center, Bronx, New York
| | - Roland Tilz
- Department of Rhythmology, University Heart Center Lübeck, Lubeck, Germany
| | - Claudio Tondo
- Department of Clinical Electrophysiology & Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
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8
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Taguchi Y, Ishikawa T, Matsumoto K, Narikawa M, Okazaki Y, Miyagawa S, Horigome A, Hosoda J. Subcutaneous air entrapment after subcutaneous implantable cardioverter defibrillator implantation evaluated by computed tomography. Pacing Clin Electrophysiol 2024; 47:496-502. [PMID: 38462721 DOI: 10.1111/pace.14962] [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: 12/26/2023] [Revised: 01/30/2024] [Accepted: 02/20/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Inappropriate shock (IAS) caused by subcutaneous air entrapment (AE) in an early period after subcutaneous implantable cardioverter defibrillator (S-ICD) implantation has been reported, however, no detailed data on air volume are available. We evaluated the subcutaneous air volume after implantation and its absorption rate one week after implantation. METHODS Patients who underwent S-ICD implantation in our hospital received chest CT scans immediately after implantation and followed up 1 week later. The total subcutaneous air volume, air around the generator, the distal electrode, and the proximal electrode within 3 cm were calculated using a three-dimensional workstation. Fat areas at the level of the lower edge of the generator were also analyzed. RESULT Fifteen patients received CT immediately after implantation. The mean age was 45.6 ± 17.9 (66.7% of men), and the mean body mass index was 24.3 ± 3.3. The three-incision technique was applied in seven patients and two-incision technique was in the latter eight patients. The mean total subcutaneous air volume was 18.54 ± 7.50 mL. Air volume around the generator, the distal electrode, and the proximal electrode were 11.05 ± 5.12, 0.72 ± 0.72, and 0.88 ± 0.87 mL, respectively. Twelve patients received a follow-up CT 1 week later. The mean total subcutaneous air was 0.25 ± 0.45 mL, showing a 98.7% absorption rate. CONCLUSION Although subcutaneous air was observed in all patients after S-ICD implantation, most of the air was absorbed within 1 week, suggesting a low occurrence of AE-related IAS after a week postoperation.
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Affiliation(s)
- Yuka Taguchi
- Department of Cardiology, Yokohama City University Graduate School of Medicine, Yokohama-City, Japan
| | - Toshiyuki Ishikawa
- Department of Cardiology, Yokohama City University Graduate School of Medicine, Yokohama-City, Japan
| | - Katsumi Matsumoto
- Department of Cardiology, Yokohama City University Graduate School of Medicine, Yokohama-City, Japan
| | - Masatoshi Narikawa
- Department of Cardiology, Yokohama City University Graduate School of Medicine, Yokohama-City, Japan
| | - Yoshinori Okazaki
- Department of Cardiology, Yokohama City University Graduate School of Medicine, Yokohama-City, Japan
| | - Shuichi Miyagawa
- Department of Cardiology, Yokohama City University Graduate School of Medicine, Yokohama-City, Japan
| | - Akira Horigome
- Department of Cardiology, Yokohama City University Graduate School of Medicine, Yokohama-City, Japan
| | - Junya Hosoda
- Department of Cardiology, Yokohama City University Graduate School of Medicine, Yokohama-City, Japan
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9
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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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10
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Eckardt L, Veltmann C. More than 30 years of Brugada syndrome: a critical appraisal of achievements and open issues. Herzschrittmacherther Elektrophysiol 2024; 35:9-18. [PMID: 38085327 DOI: 10.1007/s00399-023-00983-y] [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] [Accepted: 11/10/2023] [Indexed: 02/21/2024]
Abstract
Over the last three decades, what is referred to as Brugada syndrome (BrS) has developed from a clinical observation of initially a few cases of sudden cardiac death (SCD) in the absence of structural heart disease with ECG signs of "atypical right bundle brunch block" to a predominantly electrocardiographic, and to a lesser extent genetic, diagnosis. Today, BrS is diagnosed in patients without overt structural heart disease and a spontaneous Brugada type 1 ECG pattern regardless of symptoms. The diagnosis of BrS is less clear in those with an only transient or drug-induced type 1 Brugada pattern, but should be considered in the presence of an arrhythmic syncope, family history of BrS, or family history of sudden death. In addition to survived cardiac arrest, syncope is probably the single most decisive risk marker for future arrhythmias. For asymptomatic BrS, risk stratification remains challenging. General recommendations to lower the risk in BrS include avoidance of drugs/agents known to induce and/or increase right precordial ST-segment elevation, including treatment of fever with antipyretic drugs. Several ECG markers that have been associated with an increased risk of SCD have been incorporated into a recently published risk score for BrS. The aim of this article is to provide an overview of the status of risk stratification and to illustrate open issues und gaps in evidence in BrS.
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Affiliation(s)
- Lars Eckardt
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany.
- Klinik für Kardiologie II-Rhythmologie, Universitätsklinikum Münster, Münster, Germany.
| | - Christian Veltmann
- Heart Center Bremen, Electrophysiology Bremen, Klinikum Links der Weser, Bremen, Germany
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11
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Block M, Klein HU. [History of the implantable cardioverter-defibrillator in Germany]. Herzschrittmacherther Elektrophysiol 2024; 35:55-67. [PMID: 38421401 PMCID: PMC10923992 DOI: 10.1007/s00399-024-01001-5] [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] [Accepted: 02/06/2024] [Indexed: 03/02/2024]
Abstract
The implantable cardioverter-defibrillator (ICD) was a breakthrough in the prevention of sudden cardiac death. After years of technical development in the USA, Michel Mirowski succeeded in proving reliable automatic defibrillation of ventricular tachyarrhythmias through initial human implantations in 1980, despite many obstacles. Nearly 4 years later, the first patients received ICDs at multiple centers in Germany. Subsequently, outside the USA, Germany became the country with highest implantation rates. The absolute number of implantations remained small as long as implantations required epicardial defibrillation electrodes and therefore thoracotomy by cardiac surgeons. Pacemaker-like implantation using a transvenous defibrillation electrode with a pectoral ICD became feasible in the early 1990s pushing implantation rates to the next level. Technical advancements were accompanied by clinical research in Germany, and often, the first-in-human studies were conducted in Germany. In 1991, the first guidelines for indications were established in the USA and Germany. Several randomized studies on indications were published between 1996 and 2009, mostly led by American teams with German participation, but also under German leadership (CASH, CAT, DINAMIT, IRIS). The DANISH study in 2016 questioned the results of these long-standing studies. Instead of providing ICDs to patients using a broad indication, future efforts aim to identify patients who, despite optimal medical therapy, cardiac resynchronization therapy (CRT), and/or catheter ablation, need protection against sudden cardiac death. Risk scores incorporating myocardial scars in magnetic resonance imaging (MRI) and genetic information are expected to contribute to more individualized and effective indications.
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12
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Li Y, Chen Y, Wang J, Xu J, Li R, Qiu Z, Jiang L, Shen F, Jiang S, Li B, Chu Y, He L, Pu L, Han X, Long X, Xue X, Tao J, Wu Y, Guo T, Yuan Y, Wang X, Wang J, Xu J, Zhao Y, Zhang Z, Hua W, Su Y, Tang B. Performance of Subcutaneous Implantable Cardioverter Defibrillator (S-ICD) in Chinese Population with Primary Prevention Indications: A Prospective Observational Cohort Study. Med Sci Monit 2024; 30:e942747. [PMID: 38400538 PMCID: PMC10900845 DOI: 10.12659/msm.942747] [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: 10/02/2023] [Accepted: 11/20/2023] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND International studies have shown that use of a subcutaneous implantable cardioverter defibrillator (S-ICD) could reduce lead-related complications while maintaining adequate defibrillation performance; however, data from the Chinese population or other Asian groups are limited. MATERIAL AND METHODS SCOPE is a prospective, multicenter, observational cohort study. Two hundred patients with primary prevention indication for sudden cardiac death (SCD), who are candidates for S-ICD, will be enrolled. From the same population, another 200 patients who are candidates for transvenous implantable cardioverter defibrillator (TV-ICD) will be enrolled after being matched for age, sex, SCD high-risk etiology (ischemic cardiomyopathy, and non-ischemic cardiomyopathy, ion channel disease, and other) and atrial fibrillation in a 1: 1 ratio with enrolled S-ICD patients. All the patients will be followed for 18 months under standard of care. RESULTS The primary endpoint is proportion of patients free from inappropriate shock (IAS) at 18 months in the S-ICD group. The lower 95% confidence bound of the proportion will be compared with a performance goal of 90.3%, which was derived from the previous meta-analysis. The comparisons between S-ICD and TV-ICD on IAS, appropriate shock, and complications will be used as secondary endpoints without formal assumptions. CONCLUSIONS This is the first prospective multicenter study focusing on the long-term performance of S-ICD in a Chinese population. By comparing with the data derived from international historical studies and a matched TV-ICD group, data from SCOPE will allow for the assessment of S-ICD in the Chinese population in a contemporary real-world implantation level and programming techniques, which will help us to further modify the device implantation and programming protocol in this specific population in the future.
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Affiliation(s)
- Yaodong Li
- Department of Cardiovascular, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, PR China
| | - Yangxin Chen
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, PR China
| | - Jingfeng Wang
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, PR China
| | - Jian Xu
- Department of Cardiology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui, PR China
| | - Ruogu Li
- Department of Cardiology, Shanghai Chest Hospital, Shanghai, PR China
| | - Zhaohui Qiu
- Department of Cardiology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Lingyun Jiang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Farong Shen
- Department of Cardiology, Zhejiang Qiushi Cardiovascular Hospital, Hangzhou, Zhejiang, PR China
| | - Shubin Jiang
- Department of Cardiology, The Fourth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, PR China
| | - Bin Li
- Department of Cardiology, Meizhou People’s Hospital, Meizhou, Guangdong, PR China
| | - Yingjie Chu
- Department of Cardiology, Henan People’s Hospital, Zhengzhou, Henan, PR China
| | - Lang He
- Department of Cardiology, Zhejiang Greentown Cardiovascular Hospital, Hangzhou, Zhejiang, PR China
| | - Lijin Pu
- Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, PR China
| | - Xuebin Han
- Department of Cardiology, Shanxi Province Cardiovascular Hospital, Taiyuan, Shanxi, PR China
| | - Xianping Long
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, PR China
| | - Xiaolin Xue
- Department of Cardiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, PR China
| | - Jianhong Tao
- Department of Cardiology, Sichuan Provincial People’s Hospital, Chengdu, Sichuan, PR China (mainland)
| | - Yongquan Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, PR China
| | - Tao Guo
- Department of Cardiology, Fuwai Yunnan Cardiovascular Hospital, Kunming, Yunnan, PR China
| | - Yiqiang Yuan
- Department of Cardiology, Henan Provincial Chest Hospital, Zhengzhou, Henan, PR China
| | - Xianqing Wang
- Department of Cardiology, Fuwai Central China Cardiovascular Hospital, Zhengzhou, Henan, PR China
| | - Jiang Wang
- Department of Cardiology, Xinqiao Hospital, Chongqing, PR China
| | - Jing Xu
- Department of Cardiology, Tianjing Chest Hospital, Tianjin, PR China
| | - Yujie Zhao
- Department of Cardiology, Zhengzhou Cardiovascular Hospital, Zhengzhou, Henan, PR China
| | - Zhihui Zhang
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, PR China
| | - Wei Hua
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China
| | - Yangang Su
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, PR China
| | - Baopeng Tang
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, PR China
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13
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Kloppe A, Winter J, Prull M, Aweimer A, El-Battrawy I, Hanefeld C, O'Connor S, Mügge A, Schiedat F. Subcutaneous cardioverter defibrillator implanted intermuscularly in patients with end-stage renal disease requiring hemodialysis: 5-year follow-up. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01767-1. [PMID: 38383674 DOI: 10.1007/s10840-024-01767-1] [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: 11/15/2023] [Accepted: 02/01/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND The aim of the present study was to evaluate the long-term safety and effectiveness of the subcutaneous implantable cardioverter defibrillator (S-ICD) when implanted intermuscularly in patients with end-stage renal disease and hemodialysis. METHODS This study is a retrospective analysis of 21 consecutive patients implanted with S-ICDs at three experienced centers in Germany with comorbid renal insufficiency requiring hemodialysis, as well as being at risk of sudden cardiac death. The S-ICD was placed intermuscularly in all patients. Follow-ups (FUs) were performed every 6 months. RESULTS The mean ± standard deviation FU duration was 60.0 ± 11.4 months, with a range of 39 to 78 months. There were no deaths due to arrhythmia, or device-associated infections and complications. Four patients (19.1%) died during FU due to respiratory insufficiency during dialysis, systolic heart failure, septic infection of the urogenital tract, and colorectal cancer, respectively. There were six non-device-related hospitalizations with a duration of 12.7 ± 5.1 days and a hospitalization rate of 4.1 per 100 patient years. CONCLUSIONS In the long-term FU of this small population of seriously compromised hemodialysis patients at risk of sudden cardiac death, the intermuscularly implanted S-ICD system was safe and effective. No arrhythmic complications, device-associated infections, or complications compromised survival. These data are encouraging and support testing in a larger group of similarly compromised patients.
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Affiliation(s)
- Axel Kloppe
- Department of Cardiology, Intensive Medicine and Angiology, Marienhospital Gelsenkirchen, Academic Hospital of the Ruhr University Bochum, Virchowstraße 122, 45886, Gelsenkirchen, Germany
- Department of Cardiology and Angiology, University Hospital Bergmannsheil Bochum, Ruhr University Bochum, Bochum, Germany
| | - Joachim Winter
- Department of Cardiovascular Surgery, Heinrich Heine University, Dusseldorf, Germany
| | - Magnus Prull
- Department of Cardiology, Augusta Hospital Bochum, Bochum, Germany
| | - Assem Aweimer
- Department of Cardiology and Angiology, University Hospital Bergmannsheil Bochum, Ruhr University Bochum, Bochum, Germany
| | - Ibrahim El-Battrawy
- Department of Cardiology and Angiology, University Hospital Bergmannsheil Bochum, Ruhr University Bochum, Bochum, Germany
- Department of Molecular and Experimental Cardiology, Institut Für Forschung Und Lehre (IFL), Ruhr University Bochum, Bochum, Germany
| | - Christoph Hanefeld
- Department of Cardiology, Katholische Kliniken Bochum, Ruhr University Bochum, Bochum, Germany
| | - Stephen O'Connor
- Department of Biomedical Engineering, City, University of London, London, UK
| | - Andreas Mügge
- Department of Cardiology and Angiology, University Hospital Bergmannsheil Bochum, Ruhr University Bochum, Bochum, Germany
- Department of Cardiology, Katholische Kliniken Bochum, Ruhr University Bochum, Bochum, Germany
| | - Fabian Schiedat
- Department of Cardiology, Intensive Medicine and Angiology, Marienhospital Gelsenkirchen, Academic Hospital of the Ruhr University Bochum, Virchowstraße 122, 45886, Gelsenkirchen, Germany.
- Department of Cardiology and Angiology, University Hospital Bergmannsheil Bochum, Ruhr University Bochum, Bochum, Germany.
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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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15
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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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Dasgupta S, Mah DY. Lead Management in Patients with Congenital Heart Disease. Card Electrophysiol Clin 2023; 15:481-491. [PMID: 37865521 DOI: 10.1016/j.ccep.2023.06.003] [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] [Indexed: 10/23/2023]
Abstract
Pediatric patients with congenital heart disease present unique challenges when it comes to cardiac implantable electronic devices. Pacing strategy is often determined by patient size/weight and operator experience. Anatomic considerations, including residual shunts, anatomic obstructions and barriers, and abnormalities in the native conduction system, will affect the type of CIED implanted. Given the young age of patients, it is important to have an "eye on the future" when making pacemaker/defibrillator decisions, as one can expect several generator changes, lead revisions, and potential lead extractions during their lifetime.
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Affiliation(s)
- Soham Dasgupta
- Division of Pediatric Cardiology, Department of Pediatrics, Norton Children's Hospital, University of Louisville, 231 East Chestnut Street, Louisville, KY 40202, USA
| | - Douglas Y Mah
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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Zhang L, Li X, Liang Y, Wang J, Li M, Pan L, Chen X, Qin S, Bai J, Wang W, Su Y, Ge J. Real-world evidence for the use of subcutaneous implantable cardioverter-defibrillators in China: A single-center experience. Herz 2023; 48:462-469. [PMID: 37540305 DOI: 10.1007/s00059-023-05192-4] [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: 10/22/2022] [Revised: 05/26/2023] [Accepted: 05/27/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Subcutaneous implantable cardioverter-defibrillators (S-ICDs) have been shown to be non-inferior to transvenous ICDs in the prevention of sudden cardiac death (SCD), but there is still a lack of evidence from clinical trials in China. We investigated whether S‑ICD implantation in the Chinese population is safe and feasible and should be promoted in the future. METHODS Consecutive patients undergoing S‑ICD implantation at our center were enrolled in this retrospective study. Data were collected within the median follow-up period of 554 days. Data concerning patient selection, implantation procedures, complications, and episodes of shock were analyzed. RESULTS In total, 70.2% of all 47 patients (median age = 39 years) were included for secondary prevention of SCD with different etiologies. Vector screening showed that 98% of patients were with > 1 appropriate vector in all postures. An intraoperative defibrillation test was not performed on six patients because of the high risk of disease deterioration, while all episodes of ventricular fibrillation induced post implantation were terminated by one shock. As expected, no severe complications (e.g., infection and device-related complications) were observed, except for one case of delayed healing of the incision. Overall, 15 patients (31.9%) experienced appropriate shocks (AS) with all episodes terminated by one shock. Two patients (4.3%) experienced inappropriate shocks (IAS) due to noise oversensing, resulting in a high Kaplan-Meier IAS-free rate of 95.7%. CONCLUSION Based on appropriate patient selection and standardized implantation procedures, this real-world study confirmed the safety and efficacy of S‑ICD in Chinese patients, indicating that it may help to promote the prevention of SCD in China.
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Affiliation(s)
- Lei Zhang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Xietu Road, 1069, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Xiao Li
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Xietu Road, 1069, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yixiu Liang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Xietu Road, 1069, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Jingfeng Wang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Xietu Road, 1069, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Minghui Li
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Xietu Road, 1069, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Lei Pan
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Xietu Road, 1069, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Xueying Chen
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Xietu Road, 1069, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Shengmei Qin
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Xietu Road, 1069, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Jin Bai
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Xietu Road, 1069, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Wei Wang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Xietu Road, 1069, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yangang Su
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Xietu Road, 1069, Shanghai, China.
- National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China.
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Xietu Road, 1069, Shanghai, China.
- National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China.
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Korthals D, Eckardt L. The new European Society of Cardiology guideline for the management of cardiomyopathies: key messages for cardiac electrophysiologists. Herzschrittmacherther Elektrophysiol 2023; 34:311-323. [PMID: 37973628 PMCID: PMC10682323 DOI: 10.1007/s00399-023-00975-y] [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: 09/29/2023] [Accepted: 10/04/2023] [Indexed: 11/19/2023]
Abstract
Electrocardiographic findings and arrhythmias are common in cardiomyopathies. Both may be an early indication of a specific diagnosis or may occur due to myocardial fibrosis and/or reduced contractility. Brady- and tachyarrhythmias significantly contribute to increased morbidity and mortality in patients with cardiomyopathies. Antiarrhythmic therapy including risk stratification is often challenging and plays a major role for these patients. Thus, an "electrophysiological" perspective on guidelines on cardiomyopathies may be warranted. As the European Society of Cardiology (ESC) has recently published a new guideline for the management of cardiomyopathies, this overview aims to present key messages of these guidelines. Innovations include a new phenotype-based classification system with emphasis on a multimodal imaging approach for diagnosis and risk stratification. The guideline includes detailed chapters on dilated and hypertrophic cardiomyopathy and their phenocopies, arrhythmogenic right ventricular cardiomyopathy, and restrictive cardiomyopathy as well as syndromic and metabolic cardiomyopathies. Patient pathways guide clinicians from the initial presentation to diagnosis. The role of cardiovascular magnetic resonance imaging and genetic testing during diagnostic work-up is stressed. Concepts of rhythm and rate control for atrial fibrillation have led to new recommendations, and the role of defibrillator therapy in primary prevention is discussed in detail. Whilst providing general guidelines for management, the primary objective of the guideline is to ascertain the disease etiology and disease-specific, individualized management.
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Affiliation(s)
- Dennis Korthals
- Department of Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
| | - Lars Eckardt
- Department of Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
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Calvagna GM, Valsecchi S. Simultaneous subcutaneous implantable cardioverter-defibrillator and leadless pacemaker implantation for patients at high risk of infection: a retrospective case series report. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01684-9. [PMID: 37938506 DOI: 10.1007/s10840-023-01684-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/25/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND The subcutaneous implantable cardioverter defibrillator (S-ICD) and leadless pacemaker (LP) are alternative options for patients at high risk of infection requiring ICD and pacing therapy. In this analysis, we described the simultaneous implantation of S-ICD and LP in patients with high infectious risk. METHODS The study cohort comprised patients referred to our institution for ICD implantation due to high-risk factors of infection. RESULTS Between 2018 and 2022, 13 patients were referred, including 11 with infected ICD and 2 for first ICD implantation in the presence of high-risk factors. In cases of infected ICD, successful extraction was performed using a mechanical dilatation technique. Reimplantation was delayed until resolution of infection with antibiotic therapy. The devices were implanted during a single procedure, with S-ICD implantation following LP placement for verification of sensing adequacy through surface ECG screening. Suitable vectors for sensing during inhibited and ventricular pacing were identified in all patients. Defibrillation testing was effective, and no issues with double counting or undersensing were observed. The postoperative period was uneventful, and during a median follow-up of 35 months, no complications or infections were reported. The median ventricular pacing percentage was 5%, and a single inappropriate shock episode due to myopotential interference was reported and resolved by reprogramming the sensing vector. CONCLUSION Simultaneous implantation of S-ICD and LP is feasible and safe in patients at high risk of infection requiring both ICD and pacing therapy. This combined approach provides an effective solution for these patients.
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Ali H, Foresti S, De Ambroggi G, Cappato R, Lupo P. Practical Considerations for Cardiac Electronic Devices Reimplantation Following Transvenous Lead Extraction Due to Related Endocarditis. J Clin Med 2023; 12:6908. [PMID: 37959373 PMCID: PMC10649089 DOI: 10.3390/jcm12216908] [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: 08/28/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
Despite progress in implantation technology and prophylactic measures, infection complications related to cardiac implantable electronic devices (CIED) are still a major concern with negative impacts on patient outcomes and the health system's resources. Infective endocarditis (IE) represents one of the most threatening CIED-related infections associated with high mortality rates and requires prompt diagnosis and management. Transvenous lead extraction (TLE), combined with prolonged antibiotic therapy, has been validated as an effective approach to treat patients with CIED-related IE. Though early complete removal is undoubtedly recommended for CIED-related IE or systemic infection, device reimplantation still represents a clinical challenge in these patients at high risk of reinfection, with many gaps in the current knowledge and international guidelines. Based on the available literature data and authors' experience, this review aims to address the practical and clinical considerations regarding CIED reimplantation following lead extraction for related IE, focusing on the reassessment of CIED indication, procedure timing, and the reimplanted CIED type and site. A tailored, multidisciplinary approach involving clinical cardiologists, electrophysiologists, cardiac imaging experts, cardiac surgeons, and infectious disease specialists is crucial to optimize these patients' management and clinical outcomes.
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Affiliation(s)
- Hussam Ali
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, 20099 Sesto San Giovanni, Italy; (S.F.); (G.D.A.); (R.C.); (P.L.)
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21
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Morton MB, Mariani JA, Kistler PM, Patel H, Voskoboinik A. Transvenous versus subcutaneous implantable cardioverter defibrillators in young cardiac arrest survivors. Intern Med J 2023; 53:1956-1962. [PMID: 37929818 DOI: 10.1111/imj.16259] [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: 05/16/2023] [Accepted: 09/25/2023] [Indexed: 11/07/2023]
Abstract
Secondary prevention implantable cardioverter defibrillators (ICDs) are indicated in young patients presenting with aborted sudden cardiac death (SCD) because of ventricular arrhythmias. Transvenous-ICDs (TV-ICDs) are effective, established therapies supported by evidence. The significant morbidity associated with transvenous leads led to the development of the newer subcutaneous-ICD (S-ICD). This review discusses the clinical considerations when selecting an ICD for the young patient presenting with out-of-hospital cardiac arrest. The major benefits of TV-ICDs are their ability to pace (antitachycardia pacing [ATP], bradycardia support and cardiac resynchronisation therapy [CRT]) and the robust evidence base supporting their use. Other benefits include a longer battery life. Significant complications associated with transvenous leads include pneumothorax and tamponade during insertion and infection and lead failure in the long term. Comparatively, S-ICDs, by virtue of having no intravascular leads, prevent these complications. S-ICDs have been associated with a higher incidence of inappropriate shocks. Patients with an indication for bradycardia pacing, CRT or ATP (documented ventricular tachycardia) are seen as unsuitable for a S-ICD. If venous access is unsuitable or undesirable, S-ICDs should be considered given the patient is appropriately screened. There is a need for further randomised controlled trials to directly compare the two devices. TV-ICDs are an effective therapy for preventing SCD limited by significant lead-related complications. S-ICDs are an important development hindered largely by an inability to pace. Young patients stand to gain the most from a S-ICD as the cumulative risk of lead-related complications is high. A clinical framework to aid decision-making is presented.
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Affiliation(s)
- Matthew B Morton
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Justin A Mariani
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Peter M Kistler
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Hitesh Patel
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Aleksandr Voskoboinik
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Cardiology, Western Health, Melbourne, Victoria, Australia
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22
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Weiss R, Knight BP, El-Chami M, Aasbo J, Hanon S, Sadhu A, Sidhu M, Brisben AJ, Carter N, Burke MC, Gold M. Impact of Age on Subcutaneous Implantable Cardioverter-Defibrillator in a Large Patient Cohort: Mid-Term Follow-Up. JACC Clin Electrophysiol 2023; 9:2132-2145. [PMID: 37676200 DOI: 10.1016/j.jacep.2023.06.013] [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: 10/18/2022] [Revised: 05/26/2023] [Accepted: 06/25/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND The subcutaneous implantable cardioverter-defibrillator (S-ICD) is an accepted alternative to transvenous (TV) ICD to provide defibrillation therapy to treat life-threatening ventricular tachyarrhythmias in high-risk patients. S-ICD outcomes by age group have not been reported. OBJECTIVES In this study, the authors sought to report S-ICD outcomes in different age groups in a multicenter S-ICD post-approval study (PAS) involving the largest cohort of patients ever reported. METHODS Patients were prospectively enrolled in the S-ICD PAS and stratified based on age: young, aged 15-34 years; adult, aged 35-69 years; and elderly, aged ≥70 years. Patient characteristics and clinical outcomes through 3 years of follow up after implantation were compared. RESULTS The S-ICD PAS enrolled 1,637 patients. Elderly patients were more likely to receive an S-ICD as a replacement of a TV-ICD (15.1% elderly vs 12.3% adult vs 7.4% young). Secondary prevention indication decreased with age (32.7% young vs 22.2% adult vs 20.5% elderly). Mortality rate was significantly higher in the elderly group (24.0% elderly vs 13.0% adult vs 7.4% young; P < 0.0001), whereas the complication rate did not differ significantly (12.3% young vs 11.3% adult vs 8.1% elderly). Rates of appropriate shock (12.7% young vs 13.0% adult vs 13.8% elderly) and inappropriate shock (7.8% young vs 9.1% adult vs 8.8% elderly) rates did not differ between groups (P = 0.96 and P = 0.98, respectively). CONCLUSIONS Implant complications and appropriate and inappropriate shock rates were similar among age groups. S-ICD for secondary prevention was more common in the young group. Replacing a TV-ICD for an S-ICD increases with age. (S-ICD System Post-Approval Study; NCT01736618).
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Affiliation(s)
- Raul Weiss
- Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
| | | | | | - Johan Aasbo
- Baptist Health Lexington, Lexington, Kentucky, USA
| | - Sam Hanon
- Mount Sinai-Beth Israel Medical Center, New York, New York, USA
| | - Ashish Sadhu
- Phoenix Cardiovascular Research Group, Phoenix, Arizona, USA
| | | | - Amy J Brisben
- Boston Scientific Corporation, Saint Paul, Minnesota, USA
| | - Nathan Carter
- Boston Scientific Corporation, Saint Paul, Minnesota, USA
| | | | - Michael Gold
- Medical University of South Carolina, Charleston, South Carolina, USA
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23
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Francia P, Ziacchi M, Adduci C, Ammendola E, Pieragnoli P, De Filippo P, Rapacciuolo A, Rella V, Migliore F, Viani S, Musumeci MB, Biagini E, Lovecchio M, Baldini R, Falasconi G, Autore C, Biffi M, Cecchi F. Clinical course of hypertrophic cardiomyopathy patients implanted with a transvenous or subcutaneous defibrillator. Europace 2023; 25:euad270. [PMID: 37724686 PMCID: PMC10507661 DOI: 10.1093/europace/euad270] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/09/2023] [Indexed: 09/21/2023] Open
Abstract
AIMS The implantable cardioverter-defibrillator (ICD) is a life-saving therapy in patients with hypertrophic cardiomyopathy (HCM) at risk of sudden cardiac death. Implantable cardioverter-defibrillator complications are of concern. The subcutaneous ICD (S-ICD) does not use transvenous leads and is expected to reduce complications. However, it does not provide bradycardia and anti-tachycardia pacing (ATP). The aim of this study was to compare appropriate and inappropriate ICD interventions, complications, disease-related adverse events and mortality between HCM patients implanted with a S- or transvenous (TV)-ICD. METHODS AND RESULTS Consecutive HCM patients implanted with a S- (n = 216) or TV-ICD (n = 211) were enrolled. Propensity-adjusted cumulative Kaplan-Meier curves and multivariate Cox proportional hazard ratios were used to compare 5-year event-free survival and the risk of events. The S-ICD patients had lower 5-year risk of appropriate (HR: 0.32; 95%CI: 0.15-0.65; P = 0.002) and inappropriate (HR: 0.44; 95%CI: 0.20-0.95; P = 0.038) ICD interventions, driven by a high incidence of ATP therapy in the TV-ICD group. The S- and TV-ICD patients experienced similar 5-year rate of device-related complications, albeit the risk of major lead-related complications was lower in S-ICD patients (HR: 0.17; 95%CI: 0.038-0.79; P = 0.023). The TV- and S-ICD patients displayed similar risk of disease-related complications (HR: 0.64; 95%CI: 0.27-1.52; P = 0.309) and mortality (HR: 0.74; 95%CI: 0.29-1.87; P = 0.521). CONCLUSION Hypertrophic cardiomyopathy patients implanted with a S-ICD had lower 5-year risk of appropriate and inappropriate ICD therapies as well as of major lead-related complications as compared to those implanted with a TV-ICD. Long-term comparative follow-up studies will clarify whether the lower incidence of major lead-related complications will translate into a morbidity or survival benefit.
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Affiliation(s)
- Pietro Francia
- Cardiology, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, University Sapienza, Rome, Italy
| | - Matteo Ziacchi
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - Carmen Adduci
- Cardiology, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, University Sapienza, Rome, Italy
| | - Ernesto Ammendola
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, Monaldi Hospital, Naples, Italy
| | - Paolo Pieragnoli
- Careggi University Hospital, University of Florence, Florence, Italy
| | | | - Antonio Rapacciuolo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Valeria Rella
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS, Istituto Auxologico Italiano, San Luca Hospital, Milan, Italy
| | - Federico Migliore
- Department of Cardiac, Thoracic Vascular Sciences and Public Health University of Padova, Padova, Italy
| | - Stefano Viani
- Second Cardiology Division, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Maria Beatrice Musumeci
- Cardiology, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, University Sapienza, Rome, Italy
| | - Elena Biagini
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | | | - Rossella Baldini
- Cardiology, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, University Sapienza, Rome, Italy
| | - Giulio Falasconi
- Campus Clínic, University of Barcelona, Barcelona, Spain
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - Camillo Autore
- Cardiology, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, University Sapienza, Rome, Italy
| | - Mauro Biffi
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - Franco Cecchi
- Careggi University Hospital, University of Florence, Florence, Italy
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS, Istituto Auxologico Italiano, San Luca Hospital, Milan, Italy
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24
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Vázquez-Calvo S, Roca-Luque I, Althoff TF. Management of Ventricular Arrhythmias in Heart Failure. Curr Heart Fail Rep 2023; 20:237-253. [PMID: 37227669 DOI: 10.1007/s11897-023-00608-y] [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] [Accepted: 05/08/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE OF REVIEW Despite substantial progress in medical and device-based heart failure (HF) therapy, ventricular arrhythmias (VA) and sudden cardiac death (SCD) remain a major challenge. Here we review contemporary management of VA in the context of HF with one particular focus on recent advances in imaging and catheter ablation. RECENT FINDINGS Besides limited efficacy of antiarrhythmic drugs (AADs), their potentially life-threatening side effects are increasingly acknowledged. On the other hand, with tremendous advances in catheter technology, electroanatomical mapping, imaging, and understanding of arrhythmia mechanisms, catheter ablation has evolved into a safe, efficacious therapy. In fact, recent randomized trials support early catheter ablation, demonstrating superiority over AAD. Importantly, CMR imaging with gadolinium contrast has emerged as a central tool for the management of VA complicating HF: CMR is not only essential for an accurate diagnosis of the underlying entity and subsequent treatment decisions, but also improves risk stratification for SCD prevention and patient selection for ICD therapy. Finally, 3-dimensional characterization of arrhythmogenic substrate by CMR and imaging-guided ablation approaches substantially enhance procedural safety and efficacy. VA management in HF patients is highly complex and should be addressed in a multidisciplinary approach, preferably at specialized centers. While recent evidence supports early catheter ablation of VA, an impact on mortality remains to be demonstrated. Moreover, risk stratification for ICD therapy may have to be reconsidered, taking into account imaging, genetic testing, and other parameters beyond left ventricular function.
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Affiliation(s)
- Sara Vázquez-Calvo
- Arrhythmia Section, Cardiovascular Institute (ICCV), CLÍNIC Barcelona University Hospital, C/Villarroel N° 170, 08036, Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Ivo Roca-Luque
- Arrhythmia Section, Cardiovascular Institute (ICCV), CLÍNIC Barcelona University Hospital, C/Villarroel N° 170, 08036, Barcelona, Catalonia, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Till F Althoff
- Arrhythmia Section, Cardiovascular Institute (ICCV), CLÍNIC Barcelona University Hospital, C/Villarroel N° 170, 08036, Barcelona, Catalonia, Spain.
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.
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25
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Gold MR, El-Chami MF, Burke MC, Upadhyay GA, Niebauer MJ, Prutkin JM, Herre JM, Kutalek S, Dinerman JL, Knight BP, Leigh J, Lucas L, Carter N, Brisben AJ, Aasbo JD, Weiss R. Postapproval Study of a Subcutaneous Implantable Cardioverter-Defibrillator System. J Am Coll Cardiol 2023; 82:383-397. [PMID: 37495274 DOI: 10.1016/j.jacc.2023.05.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/17/2023] [Accepted: 05/09/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND The subcutaneous implantable cardioverter-defibrillator (S-ICD) was developed to avoid complications related to transvenous implantable cardioverter-defibrillator (TV-ICD) leads. Device safety and efficacy were demonstrated previously with atypical clinical patients or limited follow-up. OBJECTIVES The S-ICD PAS (Subcutaneous Implantable Cardioverter-Defibrillator System Post Approval Study) is a real-world, multicenter, registry of U.S. centers that was designed to assess long-term S-ICD safety and efficacy in a diverse group of patients and implantation centers. METHODS Patients were enrolled in 86 U.S. centers with standard S-ICD indications and were observed for up to 5 years. Efficacy endpoints were first and final shock efficacy. Safety endpoints were complications directly related to the S-ICD system or implantation procedure. Endpoints were assessed using prespecified performance goals. RESULTS A total of 1,643 patients were prospectively enrolled, with a median follow-up of 4.2 years. All prespecified safety and efficacy endpoint goals were met. Shock efficacy rates for discrete episodes of ventricular tachycardia or ventricular fibrillation were 98.4%, and they did not differ significantly across follow-up years (P = 0.68). S-ICD-related and electrode-related complication-free rates were 93.4% and 99.3%, respectively. Only 1.6% of patients had their devices replaced by a TV-ICD for a pacing need. Cumulative all-cause mortality was 21.7%. CONCLUSIONS In the largest prospective study of the S-ICD to date, all study endpoints were met, despite a cohort with more comorbidities than in most previous trials. Complication rates were low and shock efficacy was high. These results demonstrate the 5-year S-ICD safety and efficacy for a large, diverse cohort of S-ICD recipients. (Subcutaneous Implantable Cardioverter-Defibrillator [S-ICD] System Post Approval Study [PAS]; NCT01736618).
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Affiliation(s)
- Michael R Gold
- Medical University of South Carolina, Charleston, South Carolina, USA.
| | | | | | - Gaurav A Upadhyay
- Center for Arrhythmia Care, Heart and Vascular Center, The University of Chicago Medicine, Chicago, Illinois, USA
| | | | | | - John M Herre
- Sentara Cardiovascular Research Institute, Norfolk, Virginia, USA
| | | | | | - Bradley P Knight
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jill Leigh
- Boston Scientific, Saint Paul, Minnesota, USA
| | | | | | | | - Johan D Aasbo
- Department of Cardiac Electrophysiology, Lexington Cardiology/Baptist Health Medical Group, Lexington, Kentucky, USA
| | - Raul Weiss
- Mount Sinai Medical Center, Miami Beach, Florida, USA
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26
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Lloyd MS, Brisben AJ, Reddy VY, Blomström-Lundqvist C, Boersma LV, Bongiorni MG, Burke MC, Cantillon DJ, Doshi R, Friedman PA, Gras D, Kutalek SP, Neuzil P, Roberts PR, Wright DJ, Appl U, West J, Carter N, Stein KM, Mont L, Knops RE. Design and rationale of the MODULAR ATP global clinical trial: A novel intercommunicative leadless pacing system and the subcutaneous implantable cardioverter-defibrillator. Heart Rhythm O2 2023; 4:448-456. [PMID: 37520021 PMCID: PMC10373150 DOI: 10.1016/j.hroo.2023.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
Background The subcutaneous implantable cardioverter-defibrillator (S-ICD) has demonstrated safety and efficacy for the treatment of malignant ventricular arrhythmias. However, a limitation of the S-ICD lies in the inability to either pace-terminate ventricular tachycardia or provide prolonged bradycardia pacing support. Objective The rationale and design of a prospective, single-arm, multinational trial of an intercommunicative leadless pacing system integrated with the S-ICD will be presented. Methods A technical description of the modular cardiac rhythm management (mCRM) system (EMPOWER leadless pacemaker and EMBLEM S-ICD) and the implantation procedure is provided. MODULAR ATP (Effectiveness of the EMPOWER™ Modular Pacing System and EMBLEM™ Subcutaneous ICD to Communicate Antitachycardia Pacing) is a multicenter, international trial enrolling up to 300 patients at risk of sudden cardiac death at up to 60 centers trial design. The safety endpoint of freedom from major complications related to the mCRM system or implantation procedure at 6 months and 2 years are significantly higher than 86% and 81%, respectively, and all-cause survival is significantly >85% at 2 years. Results Efficacy endpoints are that at 6 months mCRM communication success is significantly higher than 88% and the percentage of subjects with low and stable thresholds is significantly higher than 80%. Substudies to evaluate rate-responsive features and performance of the pacing module are also described. Conclusion The MODULAR ATP global clinical trial will prospectively test the safety and efficacy of the first intercommunicating leadless pacing system with the S-ICD. This trial will allow for robust validation of device-device communication, pacing performance, rate responsiveness, and system safety.
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Affiliation(s)
| | | | - Vivek Y. Reddy
- Icahn School of Medicine, Mount Sinai, New York, New York
| | - Carina Blomström-Lundqvist
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department of Medical Sciences, Cardiology - Arrhythmia, Uppsala University, Uppsala, Sweden
| | - Lucas V.A. Boersma
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | | | | | | | - Rahul Doshi
- Heart and Vascular Health, HonorHealth Research Institute, Scottsdale, Arizona
- College of Medicine, University of Arizona, Phoenix, Arizona
| | - Paul A. Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Daniel Gras
- Departement de Cardiologie, Hôpital Privé du Confluent, Nantes, France
| | - Steven P. Kutalek
- Department of Cardiology, Saint Mary Medical Center, Langhorne, Pennsylvania
- Cardiac Electrophysiology, Drexel University, Philadelphia, Pennsylvania
| | - Petr Neuzil
- Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Paul R. Roberts
- Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - David J. Wright
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Ursula Appl
- Boston Scientific Corporation, St. Paul, Minnesota
| | - Julie West
- Boston Scientific Corporation, St. Paul, Minnesota
| | | | | | - Lluis Mont
- Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Institut de Recerca Biomèdica, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
| | - Reinoud E. Knops
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
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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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Monkhouse C, Wharmby A, Carter Z, Hunter R, Dhinoja M, Chow A, Creta A, Honarbakhsh S, Ahsan S, Orini M, Lambiase PD. Exploiting SMART pass filter deactivation detection to minimize inappropriate subcutaneous implantable cardioverter defibrillator therapies: a real-world single-centre experience and management guide. Europace 2023; 25:euad040. [PMID: 37001913 PMCID: PMC10227655 DOI: 10.1093/europace/euad040] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/23/2023] [Indexed: 08/24/2023] Open
Abstract
AIMS The SMART Pass™ (SP) algorithm is a high-pass filter that aims to reduce inappropriate therapy (IT) in subcutaneous internal cardiac defibrillator (S-ICD), but SP can deactivate due to low amplitude sensed R waves or asystole. The association between IT and SP deactivation and management strategies were evaluated, hypothesizing SP deactivation increases the risk of IT and device re-programming, or lead/generator re-positioning could reduce this risk. METHODS AND RESULTS Retrospective single-centre audit of Emblem™ S-ICD devices implanted 2016 to 2020 utilizing health records and remote monitoring data. Cox regression models evaluated associations between SP deactivation and IT. A total of 348 patients (27 ± 16.6 months follow-up) were studied: 73% primary prevention. Thirty-eight patients (11.8%) received 83 shocks with 27 patients (7.8%) receiving a total of 44 IT. Causes of IT were oversensing (98%) and aberrantly conducted atrial fibrillation (2%). SP deactivation occurred in 32 of 348 patients (9%) and was significantly associated with increased risk of IT (hazard ratio 5.36, 95% CI 2.37-12.13). SP deactivation was due to low amplitude R waves (94%), associated with a higher defibrillation threshold at implant and presence of arrhythmogenic right ventricular cardiomyopathy. No further IT occurred 16 ± 15.5 months after corrective interventions, with changing the sensing vector being successful in 59% of cases. CONCLUSION To reduce the risk of IT, the cause of the SP deactivation should be investigated, and appropriate reprogramming, device, or lead modifications made. Utilizing the alert for SP deactivation and electrograms could pro-actively prevent IT.
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Affiliation(s)
| | - Amy Wharmby
- Barts Heart Centre, West Smithfield, EC1A 7BE, London, UK
| | - Zoe Carter
- Barts Heart Centre, West Smithfield, EC1A 7BE, London, UK
| | - Ross Hunter
- Barts Heart Centre, West Smithfield, EC1A 7BE, London, UK
| | - Mehul Dhinoja
- Barts Heart Centre, West Smithfield, EC1A 7BE, London, UK
| | - Anthony Chow
- Barts Heart Centre, West Smithfield, EC1A 7BE, London, UK
| | - Antonio Creta
- Barts Heart Centre, West Smithfield, EC1A 7BE, London, UK
| | | | - Syed Ahsan
- Barts Heart Centre, West Smithfield, EC1A 7BE, London, UK
| | - Michele Orini
- Barts Heart Centre, West Smithfield, EC1A 7BE, London, UK
- Institute of Cardiovascular Science, University College London (UCL), 62 Huntley Street, London EC1A 7BE, UK
| | - Pier D Lambiase
- Barts Heart Centre, West Smithfield, EC1A 7BE, London, UK
- Institute of Cardiovascular Science, University College London (UCL), 62 Huntley Street, London EC1A 7BE, UK
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Rordorf R, Viani S, Biffi M, Pieragnoli P, Migliore F, D’Onofrio A, Nigro G, Francia P, Ferrari P, Dello Russo A, Bisignani A, Ottaviano L, Palmisano P, Caravati F, Pisanò E, Pani A, Botto GL, Lovecchio M, Valsecchi S, Vicentini A. Reduction in inappropriate therapies through device programming in subcutaneous implantable defibrillator patients: data from clinical practice. Europace 2023; 25:euac234. [PMID: 36932709 PMCID: PMC10227499 DOI: 10.1093/europace/euac234] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/11/2022] [Indexed: 03/19/2023] Open
Abstract
AIMS In subcutaneous implantable cardioverter defibrillator (S-ICD) recipients, the UNTOUCHED study demonstrated a very low inappropriate shock rate on programming a conditional zone between 200 and 250 bpm and a shock zone for arrhythmias >250 bpm. The extent to which this programming approach is adopted in clinical practice is still unknown, as is its impact on the rates of inappropriate and appropriate therapies. METHODS AND RESULTS We assessed ICD programming on implantation and during follow-up in a cohort of 1468 consecutive S-ICD recipients in 56 Italian centres. We also measured the occurrence of inappropriate and appropriate shocks during follow-up. On implantation, the median programmed conditional zone cut-off was set to 200 bpm (IQR: 200-220) and the shock zone cut-off was 230 bpm (IQR: 210-250). During follow-up, the conditional zone cut-off rate was not significantly changed, while the shock zone cut-off was changed in 622 (42%) patients and the median value increased to 250 bpm (IQR: 230-250) (P < 0.001). UNTOUCHED-like programming of detection cut-offs was adopted in 426 (29%) patients immediately after device implantation, and in 714 (49%, P < 0.001) at the last follow-up. UNTOUCHED-like programming was independently associated with fewer inappropriate shocks (hazard ratio 0.50, 95%CI 0.25-0.98, P = 0.044), and had no impact on appropriate and ineffective shocks. CONCLUSIONS In recent years, S-ICD implanting centres have increasingly programmed high arrhythmia detection cut-off rates, at the time of implantation in the case of new S-ICD recipients, and during follow-up in the case of pre-existing implants. This has contributed significantly to reducing the incidence of inappropriate shocks in clinical practice. Rordorf: Programming of the S-ICD. CLINICAL TRIAL REGISTRATION URL: http://clinicaltrials.gov/Identifier: NCT02275637.
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Affiliation(s)
- Roberto Rordorf
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, IRCCS Fondazione Policlinico S. Matteo, Viale Camillo Golgi, 19, 27100 Pavia, Italy
| | - Stefano Viani
- Cardiology Unit, Azienda Ospedaliera Universitaria Pisana, via Paradisa, 2, 56123 Pisa, Italy
| | - Mauro Biffi
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, Policlinico S.Orsola-Malpighi, Via Giuseppe Massarenti, 9 40138 Bologna, Italy
| | - Paolo Pieragnoli
- Department of Cardiology, University of Florence, Largo Giovanni Alessandro Brambilla, 3, 50134 Firenze, Italy
| | - Federico Migliore
- Department of Cardiac, Thoracic Vascular Sciences and Public Health University of Padova, Via Nicolò Giustiniani, 2, 35128 Padova, Italy
| | - Antonio D’Onofrio
- ‘Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie’, Monaldi Hospital, Via Leonardo Bianchi, 80131 Napoli, Italy
| | - Gerardo Nigro
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, Piazza Luigi Miraglia, 2, 80138 Napoli, Italy
| | - Pietro Francia
- Cardiology, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, University Sapienza, Via di Grottarossa, 1035/1039, 00189 Roma, Italy
| | - Paola Ferrari
- Cardiac Electrophysiology and Pacing Unit, Papa Giovanni XXIII Hospital, Piazza OMS, 1, 24127 Bergamo, Italy
| | - Antonio Dello Russo
- Department of Biomedical Sciences and Public Health, Cardiology and Arrhythmology Clinic, Università Politecnica delle Marche, Via Conca, 71, 60126 Ancona, Italy
| | - Antonio Bisignani
- Division of Cardiology, Castrovillari Hospital, Via Padre Pio da Pietralcina, 87012, Castrovillari (CS), Italy
- Institute of Cardiology, Catholic University of the Sacred Heart, Largo Agostino gemelli, 8, 00168 Roma, Italy
| | - Luca Ottaviano
- Arrhythmia and Electrophysiology unit, Cardiothoracic Department Clinical Institute S. Ambrogio, Via Privata Val Vigezzo, 5, 20149 Milano, Italy
| | - Pietro Palmisano
- Cardiology Unit, ‘Card. G. Panico’ Hospital, Via San Pio X, 4, 73039 Tricase (LE), Italy
| | - Fabrizio Caravati
- Ospedale di Circolo e Fondazione Macchi, Via Luigi Borri, 57, 21200 Varese, Italy
| | - Ennio Pisanò
- Department of Cardiology, ‘Vito Fazzi’ Hospital, Piazza Filippo Muratore, 1, 73100 Lecce, Italy
| | - Antonio Pani
- Cardiology Division, ‘A. Manzoni’ Hospital, Via Eremo, 9/11, 23900 Lecco, Italy
| | - Giovanni Luca Botto
- Department of Clinical cardiology and Electrophysiology ASST Rhodense, Rho and Garbagnate M.se, Corso Europa, 250, 200117 Rho (MI), Italy
| | - Mariolina Lovecchio
- Rhythm Management Division, Boston Scientific, Viale Enrico Forlanini, 23, 20134 Milano, Italy
| | - Sergio Valsecchi
- Rhythm Management Division, Boston Scientific, Viale Enrico Forlanini, 23, 20134 Milano, Italy
| | - Alessandro Vicentini
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, IRCCS Fondazione Policlinico S. Matteo, Viale Camillo Golgi, 19, 27100 Pavia, Italy
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Saumarez R, Silberbauer J, Scannell J, Pytkowski M, Behr ER, Betts T, Della Bella P, Peters NS. Should lethal arrhythmias in hypertrophic cardiomyopathy be predicted using non-electrophysiological methods? Europace 2023; 25:euad045. [PMID: 36942430 PMCID: PMC10227650 DOI: 10.1093/europace/euad045] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/20/2023] [Indexed: 03/23/2023] Open
Abstract
While sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM) is due to arrhythmias, the guidelines for prediction of SCD are based solely on non-electrophysiological methods. This study aims to stimulate thinking about whether the interests of patients with HCM are better served by using current, 'risk factor', methods of prediction or by further development of electrophysiological methods to determine arrhythmic risk. Five published predictive studies of SCD in HCM, which contain sufficient data to permit analysis, were analysed to compute receiver operating characteristics together with their confidence bounds to compare their formal prediction either by bootstrapping or Monte Carlo analysis. Four are based on clinical risk factors, one with additional MRI analysis, and were regarded as exemplars of the risk factor approach. The other used an electrophysiological method and directly compared this method to risk factors in the same patients. Prediction methods that use conventional clinical risk factors and MRI have low predictive capacities that will only detect 50-60% of patients at risk with a 15-30% false positive rate [area under the curve (AUC) = ∼0.7], while the electrophysiological method detects 90% of events with a 20% false positive rate (AUC = ∼0.89). Given improved understanding of complex arrhythmogenesis, arrhythmic SCD is likely to be more accurately predictable using electrophysiologically based approaches as opposed to current guidelines and should drive further development of electrophysiologically based methods.
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Affiliation(s)
| | - John Silberbauer
- Department Cardiology, Royal Sussex Hospital, Eastern Road, Brighton BN2 5BE, UK
| | - Jack Scannell
- The Bayes Centre, University of Edinburgh, Edinburgh EH8 9BT, UK
| | - Mariusz Pytkowski
- Department of Cardiology, Narodowy Instytut Kardiologii, ul Alpejska 42, 04-628 Warsaw, Poland
| | | | - Timothy Betts
- Department of Cardiology, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Paulo Della Bella
- Department of Cardiology, San Raffaele Hospital, IT 20133, Milan, Italy
| | - Nicholas S Peters
- Department of Cardiology, Hammersmith Hospital, Imperial College, London W12 0HS, UK
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31
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ElRefai M, Abouelasaad M, Wiles BM, Dunn AJ, Coniglio S, Zemkoho AB, Morgan J, Roberts PR. Correlation analysis of deep learning methods in S-ICD screening. Ann Noninvasive Electrocardiol 2023:e13056. [PMID: 36920649 DOI: 10.1111/anec.13056] [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: 12/11/2022] [Revised: 01/12/2023] [Accepted: 02/26/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Machine learning methods are used in the classification of various cardiovascular diseases through ECG data analysis. The concept of varying subcutaneous implantable cardiac defibrillator (S-ICD) eligibility, owing to the dynamicity of ECG signals, has been introduced before. There are practical limitations to acquiring longer durations of ECG signals for S-ICD screening. This study explored the potential use of deep learning methods in S-ICD screening. METHODS This was a retrospective study. A deep learning tool was used to provide descriptive analysis of the T:R ratios over 24 h recordings of S-ICD vectors. Spearman's rank correlation test was used to compare the results statistically to those of a "gold standard" S-ICD simulator. RESULTS A total of 14 patients (mean age: 63.7 ± 5.2 years, 71.4% male) were recruited and 28 vectors were analyzed. Mean T:R, standard deviation of T:R, and favorable ratio time (FVR)-a new concept introduced in this study-for all vectors combined were 0.21 ± 0.11, 0.08 ± 0.04, and 79 ± 30%, respectively. There were statistically significant strong correlations between the outcomes of our novel tool and the S-ICD simulator (p < .001). CONCLUSION Deep learning methods could provide a practical software solution to analyze data acquired for longer durations than current S-ICD screening practices. This could help select patients better suited for S-ICD therapy as well as guide vector selection in S-ICD eligible patients. Further work is needed before this could be translated into clinical practice.
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Affiliation(s)
- Mohamed ElRefai
- Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Faculty of Medicine, University of Southampton, Southampton, UK
| | - Mohamed Abouelasaad
- Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Anthony J Dunn
- School of Mathematical Sciences, University of Southampton, UK
| | | | - Alain B Zemkoho
- School of Mathematical Sciences, University of Southampton, UK
| | - John Morgan
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Paul R Roberts
- Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Faculty of Medicine, University of Southampton, Southampton, UK
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32
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Subcutaneous ICDs implantation following removal of normally functioning non-infected transvenous ICDs in two young patients. J Cardiol Cases 2023. [DOI: 10.1016/j.jccase.2023.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2023] Open
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33
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Könemann H, Frommeyer G, Eckardt L. [ESC guideline 2022: management of ventricular arrhythmias in clinical practice]. Dtsch Med Wochenschr 2023; 148:325-330. [PMID: 36878232 DOI: 10.1055/a-1932-6711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
The recently published guideline of the European Society of Cardiology for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death updates the guideline from 2015. Overall, the current guideline is characterised by a great practical relevance: Illustrative algorithms, e.g., for diagnostic evaluation, and tables make the guideline a user-friendly reference book. In the diagnostic evaluation and risk stratification of sudden cardiac death, cardiac magnetic resonance imaging and genetic testing are significantly upgraded. In long-term management, the optimal treatment of the underlying disease is essential, and recommendations for heart failure therapy are adapted to current international guidelines. Catheter ablation is upgraded especially for patients with ischaemic cardiomyopathy and recurrent ventricular tachycardia, as well as in the management of symptomatic idiopathic ventricular arrhythmias. Criteria for primary prophylactic defibrillator therapy remain controversial. In the context of dilated cardiomyopathy, imaging, genetic testing, and clinical factors are given special weight in addition to left ventricular function. Additionally, revised diagnostic criteria for a large number of primary electrical diseases are provided.
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Affiliation(s)
- Hilke Könemann
- Rhythmologie, Klinik für Kardiologie II, Universitätsklinikum Münster, Münster
| | - Gerrit Frommeyer
- Rhythmologie, Klinik für Kardiologie II, Universitätsklinikum Münster, Münster
| | - Lars Eckardt
- Rhythmologie, Klinik für Kardiologie II, Universitätsklinikum Münster, Münster
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Migliore F, Pittorru R, Giacomin E, Dall'Aglio PB, Falzone PV, Bertaglia E, Iliceto S, Gregori D, De Lazzari M, Corrado D. Intermuscular two-incision technique for implantation of the subcutaneous implantable cardioverter defibrillator: a 3-year follow-up. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01478-z. [PMID: 36662384 DOI: 10.1007/s10840-023-01478-z] [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: 11/15/2022] [Accepted: 01/10/2023] [Indexed: 01/21/2023]
Abstract
PURPOSE The aim of the present study was to evaluate the outcome of patients underwent subcutaneous implantable cardioverter defibrillator (S-ICD) implantation with the intermuscular (IM) two-incision technique during 3-year follow-up. METHODS the study population consisted of 105 consecutive patients (79 male; median 50 [13-77] years) underwent S-ICD implantation with the IM two-incision technique. The composite primary end point of the study consisted of device-related complications and inappropriate shocks (IAS). Secondary end points included the individual components of the primary end point, death from any cause, appropriate therapy, major adverse cardiac events, hospitalization for heart failure, and heart transplantation. RESULTS According to the PRAETORIAN score, the risk of conversion failure was classified as low in 99 patients (94.3%), intermediate in 6 (5.7%).Ventricular fibrillation was successfully converted at ≤65 J in 97.4% of patients. During a median follow-up of 39 (16-53) months, 10 patients (9.5%) experienced device-related complications, and 9 (8.5%) patients reported IAS. Lead-associated complications were the most common (5 patients, 4.7%), including 2 cases of lead failure (1.9%). Pocket complications were reported in 2 patients (1.9%). Extra-cardiac oversensing (3.8%) represented the leading cause of IAS. No T-wave oversensing episodes were recorded. Twelve patients (11.4%) experienced appropriate shocks. Eight patients (7.6%) died during follow-up. IAS or device-related complications did not impact on mortality. CONCLUSIONS The overall device-related complications and IAS rates over 3 years of follow-up were 9.5% and 8.5%, respectively. According to our findings, the IM two-incision technique allows for optimal positioning of the device achieving a low PRAETORIAN score with a high conversion rate. IM two-incision technique allows low incidence of pocket complications, shifting the type of complications towards lead-related complications, which represent the most common complications. The IM two-incision technique would not seem to impact the occurrence of IAS. Management of complications are safe without impact on the outcome.
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Affiliation(s)
- Federico Migliore
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35121, Padova, Italy.
| | - Raimondo Pittorru
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35121, Padova, Italy
| | - Enrico Giacomin
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35121, Padova, Italy
| | - Pietro Bernardo Dall'Aglio
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35121, Padova, Italy
| | - Pasquale Valerio Falzone
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35121, Padova, Italy
| | - Emanuele Bertaglia
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35121, Padova, Italy
| | - Sabino Iliceto
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35121, Padova, Italy
| | - Dario Gregori
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35121, Padova, Italy
- Statistics, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Manuel De Lazzari
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35121, Padova, Italy
| | - Domenico Corrado
- Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35121, Padova, Italy
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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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Cabrera-Romero E, de Frutos F, Garcia-Pavia P. Septal thrombus formation after subcutaneous implantable cardioverter shock in a young female with dilated cardiomyopathy. Eur Heart J Case Rep 2022; 7:ytac457. [PMID: 36578819 PMCID: PMC9792269 DOI: 10.1093/ehjcr/ytac457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/02/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Eva Cabrera-Romero
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, CIBERCV, Manuel de Falla, 2, 28222 Madrid, Spain
| | - Fernando de Frutos
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, CIBERCV, Manuel de Falla, 2, 28222 Madrid, Spain
| | - Pablo Garcia-Pavia
- Corresponding author. Tel: +34 91 191 7297, Fax: +34 91 191 7718, , twitter: @dr_pavia
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Römers H, van Dijk V, Boersma L. Evolution of extravascular implantable cardioverter-defibrillator therapy for ventricular arrhythmias. Heart Rhythm O2 2022; 4:59-64. [PMID: 36713037 PMCID: PMC9877388 DOI: 10.1016/j.hroo.2022.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Implantable cardioverter-defibrillators have become an established therapy for the prevention of sudden cardiac death due to life-threatening ventricular arrhythmias in the last decades. In all those years, the use of transvenous leads has proven to be the most vulnerable part of the system. The development of the completely subcutaneous implantable cardioverter-defibrillator opened a new era of device therapy outside of the vascular system. The next step, enabling extravascular devices with the option of antitachycardia pacing, is just around the corner. This may become an important option for all patients without a bradycardia pacing indication that are in need for antitachycardia pacing because of monomorphic ventricular tachycardia.
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Affiliation(s)
- Hans Römers
- Department of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
- Address reprint requests and correspondence: Dr Hans Römers, Cardiology, St Antonius Hospital, University of Amsterdam, Koekoekslaan 1, Nieuwe-gein, Utrecht 3435CM, the Netherlands.
| | - Vincent van Dijk
- Department of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Lucas Boersma
- Department of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
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Haeberlin A, Burri H, Schaer B, Koepfli P, Grebmer C, Breitenstein A, Reichlin T, Noti F. Sense-B-noise: an enigmatic cause for inappropriate shocks in subcutaneous implantable cardioverter defibrillators. Europace 2022; 25:767-774. [PMID: 36353759 PMCID: PMC9935013 DOI: 10.1093/europace/euac202] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 09/30/2022] [Indexed: 11/11/2022] Open
Abstract
AIMS Subcutaneous implantable cardioverter defibrillators (S-ICDs) are well established. However, inappropriate shocks (IAS) remain a source of concern since S-ICDs offer very limited troubleshooting options. In our multicentre case series, we describe several patients who experienced IAS due to a previously unknown S-ICD system issue. METHODS AND RESULTS We observed six patients suffering from this novel IAS entity. The IAS occurred exclusively in primary or alternate S-ICD sensing vector configuration (therefore called 'Sense-B-noise'). IAS were caused by non-physiologic oversensing episodes characterized by intermittent signal saturation, diminished QRS amplitudes, and disappearance of the artefacts after the IAS. Noise/oversensing could not be provoked by manipulation, X-ray did not show evidence for lead/header issues and impedance measurements were within normal limits. The pooled experience of our centres implies that up to ∼5% of S-ICDs may be affected. The underlying root cause was discussed extensively with the manufacturer but remains unknown and is under further investigation. CONCLUSION Sense-B-noise is a novel cause for IAS due to non-physiologic signal oversensing, arising from a previously unknown S-ICD system issue. Sense-B-noise may be suspected if episodes of signal saturation in primary or alternate vector configuration are present, oversensing cannot be provoked, and X-ray and electrical measurements appear normal. The issue can be resolved by reprogramming the device to secondary sensing vector.
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Affiliation(s)
| | - Haran Burri
- University Hospital of Geneva, Cardiology Department, Geneva, Switzerland
| | - Beat Schaer
- Department of Cardiology, University Hospital, University of Basel, Basel, Switzerland
| | | | - Christian Grebmer
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | | | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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39
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Kattih B, Operhalski F, Boeckling F, Hecker F, Michael F, Vamos M, Hohnloser SH, Erath JW. Clinical outcomes of subcutaneous vs. transvenous implantable defibrillator therapy in a polymorbid patient cohort. Front Cardiovasc Med 2022; 9:1008311. [PMID: 36330004 PMCID: PMC9624387 DOI: 10.3389/fcvm.2022.1008311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background The subcutaneous implantable cardioverter-defibrillator (S-ICD) has been designed to overcome lead-related complications and device endocarditis. Lacking the ability for pacing or resynchronization therapy its usage is limited to selected patients at risk for sudden cardiac death (SCD). Objective The aim of this single-center study was to assess clinical outcomes of S-ICD and single-chamber transvenous (TV)-ICD in an all-comers population. Methods The study cohort comprised a total of 119 ICD patients who underwent either S-ICD (n = 35) or TV-ICD (n = 84) implantation at the University Hospital Frankfurt from 2009 to 2017. By applying an inverse probability-weighting (IPW) analysis based on the propensity score including the Charlson Comorbidity Index (CCI) to adjust for potential extracardiac comorbidities, we aimed for head-to-head comparison on the study composite endpoint: overall survival, hospitalization, and device-associated events (including appropriate and inappropriate shocks or system-related complications). Results The median age of the study population was 66.0 years, 22.7% of the patients were female. The underlying heart disease was ischemic cardiomyopathy (61.4%) with a median LVEF of 30%. Only 52.9% had received an ICD for primary prevention, most of the patients (67.3%) had advanced heart failure (NYHA class II–III) and 16.8% were in atrial fibrillation. CCI was 5 points in TV-ICD patients vs. 4 points for patients with S-ICD (p = 0.209) indicating increased morbidity. The composite endpoint occurred in 38 patients (31.9 %), revealing no significant difference between patients implanted with an S-ICD or TV-ICD (unweighted HR 1.50, 95 % confidence interval (CI) 0.78–2.90; p = 0.229, weighted HR 0.94, 95% CI, 0.61–1.50, p = 0.777). Furthermore, we observed no difference in any single clinical endpoint or device-associated outcome, neither in the unweighted cohort nor following inverse probability-weighting. Conclusion Clinical outcomes of the S-ICD and TV-ICD revealed no differences in the composite endpoint including survival, freedom of hospitalization and device-associated events, even after careful adjustment for potential confounders. Moreover, the CCI was evaluated in a S-ICD cohort demonstrating higher survival rates than predicted by the CCI in young, polymorbid (S-)ICD patients.
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Affiliation(s)
- Badder Kattih
- Division of Clinical Electrophysiology, Department of Cardiology, University Hospital Frankfurt, J. W. Goethe University, Frankfurt am Main, Germany
| | - Felix Operhalski
- Division of Clinical Electrophysiology, Department of Cardiology, University Hospital Frankfurt, J. W. Goethe University, Frankfurt am Main, Germany
| | - Felicitas Boeckling
- Division of Clinical Electrophysiology, Department of Cardiology, University Hospital Frankfurt, J. W. Goethe University, Frankfurt am Main, Germany
| | - Florian Hecker
- Department of Cardiac Surgery, University Hospital Frankfurt, J. W. Goethe University, Frankfurt am Main, Germany
| | - Felix Michael
- Division of Clinical Electrophysiology, Department of Cardiology, University Hospital Frankfurt, J. W. Goethe University, Frankfurt am Main, Germany
| | - Mate Vamos
- Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Stefan H. Hohnloser
- Division of Clinical Electrophysiology, Department of Cardiology, University Hospital Frankfurt, J. W. Goethe University, Frankfurt am Main, Germany
| | - Julia W. Erath
- Division of Clinical Electrophysiology, Department of Cardiology, University Hospital Frankfurt, J. W. Goethe University, Frankfurt am Main, Germany
- *Correspondence: Julia W. Erath
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40
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Knops RE, Pepplinkhuizen S, Delnoy PPHM, Boersma LVA, Kuschyk J, El-Chami MF, Bonnemeier H, Behr ER, Brouwer TF, Kaab S, Mittal S, Quast AFBE, van der Stuijt W, Smeding L, de Veld JA, Tijssen JGP, Bijsterveld NR, Richter S, Brouwer MA, de Groot JR, Kooiman KM, Lambiase PD, Neuzil P, Vernooy K, Alings M, Betts TR, Bracke FALE, Burke MC, de Jong JSSG, Wright DJ, Jansen WPJ, Whinnett ZI, Nordbeck P, Knaut M, Philbert BT, van Opstal JM, Chicos AB, Allaart CP, Borger van der Burg AE, Dizon JM, Miller MA, Nemirovsky D, Surber R, Upadhyay GA, Weiss R, de Weger A, Wilde AAM, Olde Nordkamp LRA. Device-related complications in subcutaneous versus transvenous ICD: a secondary analysis of the PRAETORIAN trial. Eur Heart J 2022; 43:4872-4883. [PMID: 36030464 PMCID: PMC9748587 DOI: 10.1093/eurheartj/ehac496] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The subcutaneous implantable cardioverter-defibrillator (S-ICD) is developed to overcome lead-related complications and systemic infections, inherent to transvenous ICD (TV-ICD) therapy. The PRAETORIAN trial demonstrated that the S-ICD is non-inferior to the TV-ICD with regard to the combined primary endpoint of inappropriate shocks and complications. This prespecified secondary analysis evaluates all complications in the PRAETORIAN trial. METHODS AND RESULTS The PRAETORIAN trial is an international, multicentre, randomized trial in which 849 patients with an indication for ICD therapy were randomized to receive an S- ICD (N = 426) or TV-ICD (N = 423) and followed for a median of 49 months. Endpoints were device-related complications, lead-related complications, systemic infections, and the need for invasive interventions. Thirty-six device-related complications occurred in 31 patients in the S-ICD group of which bleedings were the most frequent. In the TV-ICD group, 49 complications occurred in 44 patients of which lead dysfunction was most frequent (HR: 0.69; P = 0.11). In both groups, half of all complications were within 30 days after implantation. Lead-related complications and systemic infections occurred significantly less in the S-ICD group compared with the TV-ICD group (P < 0.001, P = 0.03, respectively). Significantly more complications required invasive interventions in the TV-ICD group compared with the S-ICD group (8.3% vs. 4.3%, HR: 0.59; P = 0.047). CONCLUSION This secondary analysis shows that lead-related complications and systemic infections are more prevalent in the TV-ICD group compared with the S-ICD group. In addition, complications in the TV-ICD group were more severe as they required significantly more invasive interventions. This data contributes to shared decision-making in clinical practice.
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Affiliation(s)
| | | | | | - Lucas V A Boersma
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart failure & Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands,Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Juergen Kuschyk
- First Department of Medicine, University Medical Center Mannheim, Mannheim, Germany,German Center for Cardiovascular Research Partner Site Heidelberg, Mannheim, Germany
| | - Mikhael F El-Chami
- Division of Cardiology Section of Electrophysiology, Emory University, Atlanta, GA, United States
| | - Hendrik Bonnemeier
- Klinik für Innere Medizin III, Schwerpunkt Kardiologie und Angiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Elijah R Behr
- St George’s University of London, London, United Kingdom,St George’s University hospitals NHS Foundation Trust, London, United Kingdom
| | - Tom F Brouwer
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart failure & Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Stefan Kaab
- Department of Medicine I, Ludwig-Maximillians University Hospital, München, Germany,German Center for Cardiovascular Research, Munich Heart Alliance, Munich, Germany,European Reference Network for rare, low prevalence and complex diseases of the heart: ERN GUARD-Heart
| | - Suneet Mittal
- The Valley Health System, Ridgewood, NJ, United States
| | - Anne-Floor B E Quast
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart failure & Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Willeke van der Stuijt
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart failure & Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Lonneke Smeding
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart failure & Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Jolien A de Veld
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart failure & Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Jan G P Tijssen
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart failure & Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | | | - Sergio Richter
- Department of Electrophysiology, Heart Center at University of Leipzig, Leipzig, Germany,Heart Surgery, Heart Center Dresden, Carl Gustav Carus Medical Faculty, Dresden University of Technology, Dresden, Germany
| | - Marc A Brouwer
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Joris R de Groot
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart failure & Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Kirsten M Kooiman
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart failure & Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Pier D Lambiase
- Office of the Director of Clinical Electrophysiology Research and Lead for Inherited Arrhythmia Specialist Services, University College London and Barts Heart Centre, London, United Kingdom
| | - Petr Neuzil
- Department of Cardiology, Homolka Hospital, Prague, Czech Republic
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Marco Alings
- Department of Cardiology, Amphia Hospital, Breda, the Netherlands,Werkgroep Cardiologische Centra Nederland, Utrecht, the Netherlands
| | - Timothy R Betts
- Oxford Biomedical Research Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Frank A L E Bracke
- Department of Electrophysiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | | | | | - David J Wright
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Ward P J Jansen
- Department of Cardiology, Tergooi MC, Blaricum, The Netherlands
| | - Zachary I Whinnett
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Peter Nordbeck
- University and University Hospital Würzburg, Würzburg, Germany
| | - Michael Knaut
- Heart Surgery, Heart Center Dresden, Carl Gustav Carus Medical Faculty, Dresden University of Technology, Dresden, Germany
| | - Berit T Philbert
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Alexandru B Chicos
- Division of Cardiology, Northwestern Memorial Hospital, Northwestern University, Chicago, IL, United States
| | - Cornelis P Allaart
- Department of Cardiology, and Amsterdam Cardiovascular Sciences (ACS), Amsterdam UMC, Location VUMC, Amsterdam, The Netherlands
| | | | - Jose M Dizon
- Department of Medicine—Cardiology, Columbia University Irving Medical Center, New York, NY, United States
| | - Marc A Miller
- Icahn School of Medicine at Mount Sinai, Mount Sinaï Hospital, New York, NY, United States
| | - Dmitry Nemirovsky
- Cardiac Electrophysiology Division, Department of Medicine, Englewood Hospital and Medical Center, Englewood, NJ, United States
| | - Ralf Surber
- Department of Internal Medicine I, Jena University Hospital, Jena, Germany
| | - Gaurav A Upadhyay
- Center for Arrhythmia Care, Heart and Vascular Institute, University of Chicago Pritzker School of Medicine, Chicago, IL, United States
| | - Raul Weiss
- Division of Cardiovascular Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Anouk de Weger
- Amsterdam UMC location University of Amsterdam, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences Heart failure & Arrhythmias, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
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41
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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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42
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Boersma LV, El-Chami M, Steinwender C, Lambiase P, Murgatroyd F, Mela T, Theuns DAMJ, Khelae SK, Kalil C, Zabala F, Stuehlinger M, Lenarczyk R, Clementy N, Tamirisa KP, Rinaldi CA, Knops R, Lau CP, Crozier I, Boveda S, Defaye P, Deharo JC, Botto GL, Vassilikos V, Oliveira MM, Tse HF, Figueroa J, Stambler BS, Guerra JM, Stiles M, Marques M. Practical considerations, indications, and future perspectives for leadless and extravascular cardiac implantable electronic devices: a position paper by EHRA/HRS/LAHRS/APHRS. Europace 2022; 24:1691-1708. [PMID: 35912932 DOI: 10.1093/europace/euac066] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Lucas V Boersma
- Cardiology Department, St Antonius Hospital, Nieuwegein, The Netherlands.,Cardiology Department, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Mikhael El-Chami
- Medicine/Cardiology Department, Emory University, Atlanta, GA, USA
| | - Clemens Steinwender
- Department of Cardiology and Internal Intensive Care, Kepler University Hospital Linz, Krankenhausstraße 9, Linz, Austria
| | - Pier Lambiase
- Department of Cardiology, UCL & Barts Heart Centre, Institute of Cardiovascular Science, UCL, Barts Heart Centre, London, UK
| | | | - Theofania Mela
- Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Dominic A M J Theuns
- Erasmus MC, Cardiology, Clinical Electrophysiology, CA Rotterdam, The Netherlands
| | | | - Carlos Kalil
- Cardiology Department, Hospital São Francisco da Santa Casa de Misericórdia, Porto Alegre, Brazil
| | - Federico Zabala
- Electrophysiology Unit, Hospital San Martin de La Plata, Buenos Aires, Argentina
| | - Markus Stuehlinger
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Radoslaw Lenarczyk
- Department of Cardiology, Congenital Heart Disease and Electrotherapy, Medical University of Silesia, Silesian Center for Heart Disease, Curie-Sklodowska Str 9, 41-800 Zabrze, Poland
| | - Nicolas Clementy
- Cardiology Department, Centre Hospitalier Régional Universitaire de Tours, France
| | - Kamala P Tamirisa
- Cardiac Electrophysiology, Cardiac MRI, Texas Cardiac Arrhythmia Institute, 11970 N, Central Expressway, Dallas, TX, USA
| | | | - Reinoud Knops
- Cardiology Department, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Chu-Pak Lau
- Department of Medicine, Queen Mary Hospital, Suite 1303, Central Building, 1 Pedder Street, Central, Hong Kong
| | - Ian Crozier
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, 31076 Toulouse, France.,Universitair Ziekenhuis Brussel-VUB, Heart Rhythm Management Centre, Brussels, Belgium, and INSERM U970, 75908 Paris Cedex 15 France
| | - Pascal Defaye
- CHU Grenoble Alpes, Unite de Rythmologie Service De Cardiologie, CS10135, 38043 Grenoble Cedex 09, France
| | - Jean Claude Deharo
- Aix-Marseille Université, Faculté de Médecine, F-13385 Marseille, France.,Cardiology Department, Hospital de Santa Cruz, Lisbon, Portugal
| | | | - Vassilios Vassilikos
- Medical School, Aristotle University of Thessaloniki, Greece & Hippokrateio General Hospital, Thessaloniki, Greece
| | - Mario Martins Oliveira
- Department of Cardiology, Hospital Santa Marta, Rua Santa Marta, 1167-024 Lisbon, Portugal
| | - Hung Fat Tse
- The Cardiology Division, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.,Hong Kong-Guangdong Stem Cell and Regenerative Medicine Research Centre, The University of Hong Kong and Guangzhou Institutes of Biomedicine and Health, Hong Kong SAR, China
| | - Jorge Figueroa
- Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
| | - Bruce S Stambler
- Unidad de Arritmias y Marcapasos, Sanatorio Allende, Obispo Oro 42, CP 5000, Córdoba, Argentina
| | - Jose M Guerra
- Piedmont Heart Institute, 275 Collier Road Northwest, Suite 500, Atlanta, GA 30309, USA
| | - Martin Stiles
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Universidad Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Manlio Marques
- Waikato Clinical School, University of Auckland, Auckland, New Zealand.,National Institute of Cardiology Ignacio Chávez, Mexico City, Mexico
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43
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van der Stuijt W, Smeding L, Olde Nordkamp LRA, Knops RE. Response by van der Stuijt et al to Letter Regarding Article, "Efficacy and Safety of Appropriate Shocks and Antitachycardia Pacing in Transvenous and Subcutaneous Implantable Defibrillators: Analysis of All Appropriate Therapy in the PRAETORIAN Trial". Circulation 2022; 146:e10-e11. [PMID: 35877837 DOI: 10.1161/circulationaha.122.060879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Willeke van der Stuijt
- Amsterdam UMC, location University of Amsterdam, Amsterdam Cardiovascular Sciences, Department of Clinical and Experimental Cardiology, The Netherlands
| | - Lonneke Smeding
- Amsterdam UMC, location University of Amsterdam, Amsterdam Cardiovascular Sciences, Department of Clinical and Experimental Cardiology, The Netherlands
| | - Louise R A Olde Nordkamp
- Amsterdam UMC, location University of Amsterdam, Amsterdam Cardiovascular Sciences, Department of Clinical and Experimental Cardiology, The Netherlands
| | - Reinoud E Knops
- Amsterdam UMC, location University of Amsterdam, Amsterdam Cardiovascular Sciences, Department of Clinical and Experimental Cardiology, The Netherlands
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Friedman DJ, Tully AS, Zeitler EP. Subcutaneous and Transvenous ICDs: an Update on Contemporary Questions and Controversies. Curr Cardiol Rep 2022; 24:947-958. [PMID: 35639275 DOI: 10.1007/s11886-022-01712-6] [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] [Accepted: 04/26/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW While the subcutaneous (S-) implantable cardioverter-defibrillator (ICDs) is an alternative to the transvenous (TV-) ICD in many patients, optimal use remains unclear. In this review, we summarize recent clinically relevant data on sensing algorithms, inappropriate shocks, defibrillation testing, and battery and electrode failures. RECENT FINDINGS Changes in sensing algorithms and S-ICD programming have significantly decreased inappropriate shock rates. Avoiding fat below the S-ICD coil and can is key for reducing the defibrillation threshold. While S-ICD battery and electrode failures have resulted in recalls, system components remain commercially available since failure rates are low and no other similar devices are available. The S-ICD is a good alternative to the TV-ICD for many patients, and particularly in light of recently developed device algorithms and improvements in implant technique. Future research will need to better understand: the impact of S-ICD electrode and battery failures and the potential for integrating leadless pacing into a modular S-ICD platform.
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Affiliation(s)
- Daniel J Friedman
- Electrophysiology Section, Duke University Hospital, 2301 Erwin Road, Durham, NC, 27710, USA.
| | - Albert S Tully
- The Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Emily P Zeitler
- The Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Division of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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45
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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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