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Doldi F, Frommeyer G, Löher A, Ellermann C, Wolfes J, Güner F, Zerbst M, Engelke H, Korthals D, Reinke F, Eckardt L, Willy K. Validation of the PRAETORIAN score in a large subcutaneous implantable cardioverter-defibrillator collective: Usefulness in clinical routine. Heart Rhythm 2024:S1547-5271(24)00204-2. [PMID: 38382685 DOI: 10.1016/j.hrthm.2024.02.032] [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] [Revised: 01/20/2024] [Accepted: 02/12/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND To assess the risk of unsuccessful conversion of ventricular fibrillation during defibrillation testing (DFT) with the subcutaneous implantable cardioverter-defibrillator (S-ICD), the PRAETORIAN score has been proposed. OBJECTIVE The purpose of this study was to validate the PRAETORIAN score in a large S-ICD collective. METHODS A retrospective single-center analysis of S-ICD patients receiving intraoperative DFT was performed. DFT was performed using a stepwise protocol with 65-J standard polarity, change of polarity, increase to 80 J, and repositioning if necessary. If all DFTs failed, we switched to a transvenous ICD. RESULTS Overall, 398 patients were analyzed (268 male [67.3%]; mean age 42.4 ± 15.9 years; mean body mass index [BMI] 25.9 ± 4.8 kg/m2). Successful DFT with the first ICD shock was observed in 264 patients (66.3%). One hundred fourteen patients were defibrillated with the second (n = 104) or third (n = 10) DFT after changing shock polarity and/or shock energy. Overall, 20 patients needed at least 3 DFT (ie, 80 J and/or re-positioning). The majority (n = 88 [65.7%]) of DFT failures occurred before 2015 with the first-generation S-ICD. PRAETORIAN score was an independent predictor of DFT failure (odds ratio [OR] 1.007; 95% confidence interval [CI] 1.003-1.011 P ≤.001), while whereas BMI alone was not (P = .31). Presence of hypertrophic cardiomyopathy (HCM) (OR 2.6; 95% CI 1.3-4.4; P = .004) was predictive for at least 1 unsuccessful DFT in our multivariate regression analysis. CONCLUSION PRAETORIAN score proved to be a useful and valid predictive tool for successful DFT, whereas BMI only had a limited role. Patients with HCM were at increased risk for DFT failure or needed higher DFT energy.
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Affiliation(s)
- Florian Doldi
- Department for Cardiology II, Electrophysiology, University Hospital Münster, Münster, Germany.
| | - Gerrit Frommeyer
- Department for Cardiology II, Electrophysiology, University Hospital Münster, Münster, Germany
| | - Andreas Löher
- Department for Cardio-Thoracic Surgery, University Hospital Münster, Münster, Germany
| | - Christian Ellermann
- Department for Cardiology II, Electrophysiology, University Hospital Münster, Münster, Germany
| | - Julian Wolfes
- Department for Cardiology II, Electrophysiology, University Hospital Münster, Münster, Germany
| | - Fatih Güner
- Department for Cardiology II, Electrophysiology, University Hospital Münster, Münster, Germany
| | - Mathis Zerbst
- Department for Cardiology II, Electrophysiology, University Hospital Münster, Münster, Germany
| | - Hauke Engelke
- Department for Cardiology II, Electrophysiology, University Hospital Münster, Münster, Germany
| | - Dennis Korthals
- Department for Cardiology II, Electrophysiology, University Hospital Münster, Münster, Germany
| | - Florian Reinke
- Department for Cardiology II, Electrophysiology, University Hospital Münster, Münster, Germany
| | - Lars Eckardt
- Department for Cardiology II, Electrophysiology, University Hospital Münster, Münster, Germany
| | - Kevin Willy
- Department for Cardiology II, Electrophysiology, University Hospital Münster, Münster, Germany
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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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Mascheroni J, Stockburger M, Patwala A, Mont L, Rao A, Retzlaff H, Garweg C, Verbelen T, Gallagher AG. Effect of Metrics-Based Simulation Training to Proficiency on Procedure Quality and Errors Among Novice Cardiac Device Implanters: The IMPROF Randomized Trial. JAMA Netw Open 2023; 6:e2322750. [PMID: 37651144 PMCID: PMC10472192 DOI: 10.1001/jamanetworkopen.2023.22750] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/22/2023] [Indexed: 09/01/2023] Open
Abstract
Importance In cardiac device implant training, there is no common system to objectively assess trainees' ability to perform tasks at predetermined performance levels before in vivo practice; therefore, patients are potentially exposed to risks related to operators' early learning curve. Objective To assess the effect on implant performance quality of novel metrics-based simulation training to proficiency (proficiency-based progression [PBP]) vs traditional simulation-based training (SBT). Design, Setting, and Participants In this prospective randomized trial, conducted between March 8, 2022 and November 24, 2022, novice implanters were randomized (blinded) 1:1 to participate in an SBT curriculum (procedural knowledge e-learning and in-person simulation training) at an international skills training center, with proficiency demonstration requirements at each training stage for advancing (PBP approach) or without the requirements. Ultimately, trainees performed a cardiac resynchronization therapy (CRT) implant using virtual reality simulation. The procedure was video-recorded and subsequently scored using previously validated metrics by 2 independent assessors blinded to group. Physicians who had already implanted more than 20 pacemakers or defibrillators and fewer than 200 CRT systems as the first operator were eligible. Thirty-two implanters from 10 countries voluntarily enrolled in the training program and were randomized; 30 (15 per group) started and completed training. Data analysis was performed from November 27 to December 22, 2022. Intervention Training with PBP vs SBT. Main Outcome and Measures The primary outcome comprised 4 objectively assessed performance metrics derived from the video-recordings: number of procedural steps completed, errors, critical errors, and all errors combined. Results Baseline experience of the 30 participants (19 [63%] male; mean [SD] number of years in implant practice, 2.0 [1.8]; median [IQR] number of implanted pacemakers or defibrillators, 47.5 [30.0-115.0]; median [IQR] number of implanted CRT systems, 3.0 [1.25-10.0]) was similar between study groups. Compared with the SBT group, the PBP group completed 27% more procedural steps (median [IQR], 31 [30-32] vs 24 [22-27]; P < .001) and made 73% fewer errors (median [IQR], 2 [1-3] vs 7 [5-8]; P < .001), 84% fewer critical errors (median [IQR], 1 [0-1] vs 3 [3-5]; P < .001), and 77% fewer all errors combined (errors plus critical errors) (median [IQR], 3 [1-3] vs 11 [8-12]; P < .001); 14 of the 15 PBP trainees (93%) demonstrated the predefined target performance level vs 0 of the 15 SBT trainees. Conclusions and Relevance In this randomized trial, the PBP approach to novice implanter training generated superior objectively assessed performance vs SBT. If implemented broadly and systematically, PBP training may ensure safe and effective performance standards before trainees proceed to (supervised) in vivo practice. Future studies are needed to verify implications on procedure-related patient complications. Trial Registration ClinicalTrials.gov Identifier: NCT05952908.
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Affiliation(s)
- Jorio Mascheroni
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Cardiac Rhythm Management Training and Education, Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Martin Stockburger
- Department of Cardiology and Internal Medicine, Havelland Kliniken, Nauen, Germany
- Department of Cardiology and Angiology, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Ashish Patwala
- Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom
| | - Lluís Mont
- Department of Cardiology, Hospital Clinic, Universitat de Barcelona, Barcelona, Catalonia, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain
- Centro de Investigación Biomédica en Red Cardiovascular, Madrid, Spain
| | - Archana Rao
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | | | - Christophe Garweg
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Cardiology, UZ Leuven, Leuven, Belgium
| | - Tom Verbelen
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Cardiac Surgery, UZ Leuven, Leuven, Belgium
| | - Anthony G. Gallagher
- Orsi Academy, Melle, Belgium
- Faculty of Medicine, KU Leuven, Leuven, Belgium
- School of Medicine, Faculty of Life and Health Sciences, Ulster University, Londonderry, United Kingdom
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Guarracini F, Preda A, Bonvicini E, Coser A, Martin M, Quintarelli S, Gigli L, Baroni M, Vargiu S, Varrenti M, Forleo GB, Mazzone P, Bonmassari R, Marini M, Droghetti A. Subcutaneous Implantable Cardioverter Defibrillator: A Contemporary Overview. Life (Basel) 2023; 13:1652. [PMID: 37629509 PMCID: PMC10455445 DOI: 10.3390/life13081652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023] Open
Abstract
The difference between subcutaneous implantable cardioverter defibrillators (S-ICDs) and transvenous ICDs (TV-ICDs) concerns a whole extra thoracic implantation, including a defibrillator coil and pulse generator, without endovascular components. The improved safety profile has allowed the S-ICD to be rapidly taken up, especially among younger patients. Reports of its role in different cardiac diseases at high risk of SCD such as hypertrophic and arrhythmic cardiomyopathies, as well as channelopathies, is increasing. S-ICDs show comparable efficacy, reliability, and safety outcomes compared to TV-ICD. However, some technical issues (i.e., the inability to perform anti-bradycardia pacing) strongly limit the employment of S-ICDs. Therefore, it still remains only an alternative to the traditional ICD thus far. This review aims to provide a contemporary overview of the role of S-ICDs compared to TV-ICDs in clinical practice, including technical aspects regarding device manufacture and implantation techniques. Newer outlooks and future perspectives of S-ICDs are also brought up to date.
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Affiliation(s)
- Fabrizio Guarracini
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Alberto Preda
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Eleonora Bonvicini
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Alessio Coser
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Marta Martin
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Silvia Quintarelli
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Lorenzo Gigli
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Matteo Baroni
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Sara Vargiu
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Marisa Varrenti
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Giovanni Battista Forleo
- Department of Thoracic Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Turin, Italy;
| | - Patrizio Mazzone
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Roberto Bonmassari
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Massimiliano Marini
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Andrea Droghetti
- Cardiology Unit, Luigi Sacco University Hospital, 20157 Milan, Italy;
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de Veld JA, Pepplinkhuizen S, van der Stuijt W, Quast AFBE, Olde Nordkamp LRA, Kooiman KM, Wilde AAM, Smeding L, Knops RE. Successful defibrillation testing in patients undergoing elective subcutaneous implantable cardioverter-defibrillator generator replacement. Europace 2023; 25:euad184. [PMID: 37379530 PMCID: PMC10325005 DOI: 10.1093/europace/euad184] [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: 05/05/2023] [Accepted: 06/22/2023] [Indexed: 06/30/2023] Open
Abstract
AIMS After implantation of a subcutaneous implantable cardioverter-defibrillator (S-ICD), a defibrillation test (DFT) is performed to ensure that the device can effectively detect and terminate the induced ventricular arrhythmia. Data on DFT efficacy at generator replacement are scarce with a limited number of patients and conflicting results. This study evaluates conversion efficacy during DFT at elective S-ICD generator replacement in a large cohort from our tertiary centre. METHODS AND RESULTS Retrospective data of patients who underwent an S-ICD generator replacement for battery depletion with subsequent DFT between February 2015 and June 2022 were collected. Defibrillation test data were collected from both implant and replacement procedures. PRAETORIAN scores at implant were calculated. Defibrillation test was defined unsuccessful when two conversions at 65 J failed. A total of 121 patients were included. The defibrillation test was successful in 95% after the first and 98% after two consecutive tests. This was comparable with success rates at implant, despite a significant rise in shock impedance (73 ± 23 vs. 83 ± 24 Ω, P < 0.001). Both patients with an unsuccessful DFT at 65 J successfully converted with 80 J. CONCLUSION This study shows a high DFT conversion rate at elective S-ICD generator replacement, which is comparable to conversion rates at implant, despite a rise in shock impedance. Evaluating device position before generator replacement may be recommended to optimize defibrillation success at generator replacement.
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Affiliation(s)
- Jolien A de Veld
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Location AMC, Room C0-333, Meibergdreef 9, PO Box 22700, Amsterdam 1105AZ, The Netherlands
| | - Shari Pepplinkhuizen
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Location AMC, Room C0-333, Meibergdreef 9, PO Box 22700, Amsterdam 1105AZ, The Netherlands
| | - Willeke van der Stuijt
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Location AMC, Room C0-333, Meibergdreef 9, PO Box 22700, Amsterdam 1105AZ, The Netherlands
| | - Anne-Floor B E Quast
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Location AMC, Room C0-333, Meibergdreef 9, PO Box 22700, Amsterdam 1105AZ, The Netherlands
| | - Louise R A Olde Nordkamp
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Location AMC, Room C0-333, Meibergdreef 9, PO Box 22700, Amsterdam 1105AZ, The Netherlands
| | - Kirsten M Kooiman
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Location AMC, Room C0-333, Meibergdreef 9, PO Box 22700, Amsterdam 1105AZ, The Netherlands
| | - Arthur A M Wilde
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Location AMC, Room C0-333, Meibergdreef 9, PO Box 22700, Amsterdam 1105AZ, The Netherlands
| | - Lonneke Smeding
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Location AMC, Room C0-333, Meibergdreef 9, PO Box 22700, Amsterdam 1105AZ, The Netherlands
| | - Reinoud E Knops
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Location AMC, Room C0-333, Meibergdreef 9, PO Box 22700, Amsterdam 1105AZ, 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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7
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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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8
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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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9
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Friedman P, Murgatroyd F, Boersma LVA, Manlucu J, O'Donnell D, Knight BP, Clémenty N, Leclercq C, Amin A, Merkely BP, Birgersdotter-Green UM, Chan JYS, Biffi M, Knops RE, Engel G, Muñoz Carvajal I, Epstein LM, Sagi V, Johansen JB, Sterliński M, Steinwender C, Hounshell T, Abben R, Thompson AE, Wiggenhorn C, Willey S, Crozier I. Efficacy and Safety of an Extravascular Implantable Cardioverter-Defibrillator. N Engl J Med 2022; 387:1292-1302. [PMID: 36036522 DOI: 10.1056/nejmoa2206485] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The extravascular implantable cardioverter-defibrillator (ICD) has a single lead implanted substernally to enable pause-prevention pacing, antitachycardia pacing, and defibrillation energy similar to that of transvenous ICDs. The safety and efficacy of extravascular ICDs are not yet known. METHODS We conducted a prospective, single-group, nonrandomized, premarket global clinical study involving patients with a class I or IIa indication for an ICD, all of whom received an extravascular ICD system. The primary efficacy end point was successful defibrillation at implantation. The efficacy objective would be met if the lower boundary of the one-sided 97.5% confidence interval for the percentage of patients with successful defibrillation was greater than 88%. The primary safety end point was freedom from major system- or procedure-related complications at 6 months. The safety objective would be met if the lower boundary of the one-sided 97.5% confidence interval for the percentage of patients free from such complications was greater than 79%. RESULTS A total of 356 patients were enrolled, 316 of whom had an implantation attempt. Among the 302 patients in whom ventricular arrhythmia could be induced and who completed the defibrillation testing protocol, the percentage of patients with successful defibrillation was 98.7% (lower boundary of the one-sided 97.5% confidence interval [CI], 96.6%; P<0.001 for the comparison with the performance goal of 88%); 299 of 316 patients (94.6%) were discharged with a working ICD system. The Kaplan-Meier estimate of the percentage of patients free from major system- or procedure-related complications at 6 months was 92.6% (lower boundary of the one-sided 97.5% CI, 89.0%; P<0.001 for the comparison with the performance goal of 79%). No major intraprocedural complications were reported. At 6 months, 25 major complications were observed, in 23 of 316 patients (7.3%). The success rate of antitachycardia pacing, as assessed with generalized estimating equations, was 50.8% (95% CI, 23.3 to 77.8). A total of 29 patients received 118 inappropriate shocks for 81 arrhythmic episodes. Eight systems were explanted without extravascular ICD replacement over the 10.6-month mean follow-up period. CONCLUSIONS In this prospective global study, we found that extravascular ICDs were implanted safely and were able to detect and terminate induced ventricular arrhythmias at the time of implantation. (Funded by Medtronic; ClinicalTrials.gov number, NCT04060680.).
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Affiliation(s)
- Paul Friedman
- From Mayo Clinic, Rochester (P.F.), and Medtronic, Mounds View (A.E.T., C.W., S.W.) - both in Minnesota; King's College Hospital, London (F.M.); the Cardiology Department, St. Antonius Hospital, Nieuwegein (L.V.A.B.), and Amsterdam University Medical Centers, Amsterdam (L.V.A.B., R.E.K.) - both in the Netherlands; London Health Sciences Centre, London, ON, Canada (J.M.); Austin Hospital, Heidelberg, VIC, Australia (D.O.); Northwestern University, Evanston, IL (B.P.K.); Centre Hospitalier Régional Universitaire de Tours-Hôpital Trousseau, Tours (N.C.), and Centre Hospitalier Universitaire de Rennes-Hôpital Pontchaillou, Rennes (C.L.) - both in France; Riverside Methodist Hospital, Columbus, OH (A.A.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.P.M.); the University of California, San Diego, La Jolla (U.M.B.-G.), and Sequoia Hospital, Redwood City (G.E.) - both in California; Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (J.Y.S.C.); the Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (M.B.); Hospital Universitario Reina Sofía, Cordoba, Spain (I.M.C.); Northwell Health, Manhasset, NY (L.M.E.); Baptist Health, Jacksonville, FL (V.S.); Odense Universitetshospital, Odense, Denmark (J.B.J.); Klinika Zaburzeń Rytmu Serca/Narodowy Instytut Kardiologii-Stefana Kardynała Wyszyńskiego, Warsaw, Poland (M.S.); Kepler University Hospital, Linz, Austria (C.S.); the Iowa Heart Center, West Des Moines (T.H.); the Cardiovascular Institute of the South, Houma, LA (R.A.); and Christchurch Hospital, Christchurch, New Zealand (I.C.)
| | - Francis Murgatroyd
- From Mayo Clinic, Rochester (P.F.), and Medtronic, Mounds View (A.E.T., C.W., S.W.) - both in Minnesota; King's College Hospital, London (F.M.); the Cardiology Department, St. Antonius Hospital, Nieuwegein (L.V.A.B.), and Amsterdam University Medical Centers, Amsterdam (L.V.A.B., R.E.K.) - both in the Netherlands; London Health Sciences Centre, London, ON, Canada (J.M.); Austin Hospital, Heidelberg, VIC, Australia (D.O.); Northwestern University, Evanston, IL (B.P.K.); Centre Hospitalier Régional Universitaire de Tours-Hôpital Trousseau, Tours (N.C.), and Centre Hospitalier Universitaire de Rennes-Hôpital Pontchaillou, Rennes (C.L.) - both in France; Riverside Methodist Hospital, Columbus, OH (A.A.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.P.M.); the University of California, San Diego, La Jolla (U.M.B.-G.), and Sequoia Hospital, Redwood City (G.E.) - both in California; Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (J.Y.S.C.); the Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (M.B.); Hospital Universitario Reina Sofía, Cordoba, Spain (I.M.C.); Northwell Health, Manhasset, NY (L.M.E.); Baptist Health, Jacksonville, FL (V.S.); Odense Universitetshospital, Odense, Denmark (J.B.J.); Klinika Zaburzeń Rytmu Serca/Narodowy Instytut Kardiologii-Stefana Kardynała Wyszyńskiego, Warsaw, Poland (M.S.); Kepler University Hospital, Linz, Austria (C.S.); the Iowa Heart Center, West Des Moines (T.H.); the Cardiovascular Institute of the South, Houma, LA (R.A.); and Christchurch Hospital, Christchurch, New Zealand (I.C.)
| | - Lucas V A Boersma
- From Mayo Clinic, Rochester (P.F.), and Medtronic, Mounds View (A.E.T., C.W., S.W.) - both in Minnesota; King's College Hospital, London (F.M.); the Cardiology Department, St. Antonius Hospital, Nieuwegein (L.V.A.B.), and Amsterdam University Medical Centers, Amsterdam (L.V.A.B., R.E.K.) - both in the Netherlands; London Health Sciences Centre, London, ON, Canada (J.M.); Austin Hospital, Heidelberg, VIC, Australia (D.O.); Northwestern University, Evanston, IL (B.P.K.); Centre Hospitalier Régional Universitaire de Tours-Hôpital Trousseau, Tours (N.C.), and Centre Hospitalier Universitaire de Rennes-Hôpital Pontchaillou, Rennes (C.L.) - both in France; Riverside Methodist Hospital, Columbus, OH (A.A.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.P.M.); the University of California, San Diego, La Jolla (U.M.B.-G.), and Sequoia Hospital, Redwood City (G.E.) - both in California; Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (J.Y.S.C.); the Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (M.B.); Hospital Universitario Reina Sofía, Cordoba, Spain (I.M.C.); Northwell Health, Manhasset, NY (L.M.E.); Baptist Health, Jacksonville, FL (V.S.); Odense Universitetshospital, Odense, Denmark (J.B.J.); Klinika Zaburzeń Rytmu Serca/Narodowy Instytut Kardiologii-Stefana Kardynała Wyszyńskiego, Warsaw, Poland (M.S.); Kepler University Hospital, Linz, Austria (C.S.); the Iowa Heart Center, West Des Moines (T.H.); the Cardiovascular Institute of the South, Houma, LA (R.A.); and Christchurch Hospital, Christchurch, New Zealand (I.C.)
| | - Jaimie Manlucu
- From Mayo Clinic, Rochester (P.F.), and Medtronic, Mounds View (A.E.T., C.W., S.W.) - both in Minnesota; King's College Hospital, London (F.M.); the Cardiology Department, St. Antonius Hospital, Nieuwegein (L.V.A.B.), and Amsterdam University Medical Centers, Amsterdam (L.V.A.B., R.E.K.) - both in the Netherlands; London Health Sciences Centre, London, ON, Canada (J.M.); Austin Hospital, Heidelberg, VIC, Australia (D.O.); Northwestern University, Evanston, IL (B.P.K.); Centre Hospitalier Régional Universitaire de Tours-Hôpital Trousseau, Tours (N.C.), and Centre Hospitalier Universitaire de Rennes-Hôpital Pontchaillou, Rennes (C.L.) - both in France; Riverside Methodist Hospital, Columbus, OH (A.A.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.P.M.); the University of California, San Diego, La Jolla (U.M.B.-G.), and Sequoia Hospital, Redwood City (G.E.) - both in California; Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (J.Y.S.C.); the Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (M.B.); Hospital Universitario Reina Sofía, Cordoba, Spain (I.M.C.); Northwell Health, Manhasset, NY (L.M.E.); Baptist Health, Jacksonville, FL (V.S.); Odense Universitetshospital, Odense, Denmark (J.B.J.); Klinika Zaburzeń Rytmu Serca/Narodowy Instytut Kardiologii-Stefana Kardynała Wyszyńskiego, Warsaw, Poland (M.S.); Kepler University Hospital, Linz, Austria (C.S.); the Iowa Heart Center, West Des Moines (T.H.); the Cardiovascular Institute of the South, Houma, LA (R.A.); and Christchurch Hospital, Christchurch, New Zealand (I.C.)
| | - David O'Donnell
- From Mayo Clinic, Rochester (P.F.), and Medtronic, Mounds View (A.E.T., C.W., S.W.) - both in Minnesota; King's College Hospital, London (F.M.); the Cardiology Department, St. Antonius Hospital, Nieuwegein (L.V.A.B.), and Amsterdam University Medical Centers, Amsterdam (L.V.A.B., R.E.K.) - both in the Netherlands; London Health Sciences Centre, London, ON, Canada (J.M.); Austin Hospital, Heidelberg, VIC, Australia (D.O.); Northwestern University, Evanston, IL (B.P.K.); Centre Hospitalier Régional Universitaire de Tours-Hôpital Trousseau, Tours (N.C.), and Centre Hospitalier Universitaire de Rennes-Hôpital Pontchaillou, Rennes (C.L.) - both in France; Riverside Methodist Hospital, Columbus, OH (A.A.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.P.M.); the University of California, San Diego, La Jolla (U.M.B.-G.), and Sequoia Hospital, Redwood City (G.E.) - both in California; Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (J.Y.S.C.); the Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (M.B.); Hospital Universitario Reina Sofía, Cordoba, Spain (I.M.C.); Northwell Health, Manhasset, NY (L.M.E.); Baptist Health, Jacksonville, FL (V.S.); Odense Universitetshospital, Odense, Denmark (J.B.J.); Klinika Zaburzeń Rytmu Serca/Narodowy Instytut Kardiologii-Stefana Kardynała Wyszyńskiego, Warsaw, Poland (M.S.); Kepler University Hospital, Linz, Austria (C.S.); the Iowa Heart Center, West Des Moines (T.H.); the Cardiovascular Institute of the South, Houma, LA (R.A.); and Christchurch Hospital, Christchurch, New Zealand (I.C.)
| | - Bradley P Knight
- From Mayo Clinic, Rochester (P.F.), and Medtronic, Mounds View (A.E.T., C.W., S.W.) - both in Minnesota; King's College Hospital, London (F.M.); the Cardiology Department, St. Antonius Hospital, Nieuwegein (L.V.A.B.), and Amsterdam University Medical Centers, Amsterdam (L.V.A.B., R.E.K.) - both in the Netherlands; London Health Sciences Centre, London, ON, Canada (J.M.); Austin Hospital, Heidelberg, VIC, Australia (D.O.); Northwestern University, Evanston, IL (B.P.K.); Centre Hospitalier Régional Universitaire de Tours-Hôpital Trousseau, Tours (N.C.), and Centre Hospitalier Universitaire de Rennes-Hôpital Pontchaillou, Rennes (C.L.) - both in France; Riverside Methodist Hospital, Columbus, OH (A.A.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.P.M.); the University of California, San Diego, La Jolla (U.M.B.-G.), and Sequoia Hospital, Redwood City (G.E.) - both in California; Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (J.Y.S.C.); the Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (M.B.); Hospital Universitario Reina Sofía, Cordoba, Spain (I.M.C.); Northwell Health, Manhasset, NY (L.M.E.); Baptist Health, Jacksonville, FL (V.S.); Odense Universitetshospital, Odense, Denmark (J.B.J.); Klinika Zaburzeń Rytmu Serca/Narodowy Instytut Kardiologii-Stefana Kardynała Wyszyńskiego, Warsaw, Poland (M.S.); Kepler University Hospital, Linz, Austria (C.S.); the Iowa Heart Center, West Des Moines (T.H.); the Cardiovascular Institute of the South, Houma, LA (R.A.); and Christchurch Hospital, Christchurch, New Zealand (I.C.)
| | - Nicolas Clémenty
- From Mayo Clinic, Rochester (P.F.), and Medtronic, Mounds View (A.E.T., C.W., S.W.) - both in Minnesota; King's College Hospital, London (F.M.); the Cardiology Department, St. Antonius Hospital, Nieuwegein (L.V.A.B.), and Amsterdam University Medical Centers, Amsterdam (L.V.A.B., R.E.K.) - both in the Netherlands; London Health Sciences Centre, London, ON, Canada (J.M.); Austin Hospital, Heidelberg, VIC, Australia (D.O.); Northwestern University, Evanston, IL (B.P.K.); Centre Hospitalier Régional Universitaire de Tours-Hôpital Trousseau, Tours (N.C.), and Centre Hospitalier Universitaire de Rennes-Hôpital Pontchaillou, Rennes (C.L.) - both in France; Riverside Methodist Hospital, Columbus, OH (A.A.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.P.M.); the University of California, San Diego, La Jolla (U.M.B.-G.), and Sequoia Hospital, Redwood City (G.E.) - both in California; Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (J.Y.S.C.); the Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (M.B.); Hospital Universitario Reina Sofía, Cordoba, Spain (I.M.C.); Northwell Health, Manhasset, NY (L.M.E.); Baptist Health, Jacksonville, FL (V.S.); Odense Universitetshospital, Odense, Denmark (J.B.J.); Klinika Zaburzeń Rytmu Serca/Narodowy Instytut Kardiologii-Stefana Kardynała Wyszyńskiego, Warsaw, Poland (M.S.); Kepler University Hospital, Linz, Austria (C.S.); the Iowa Heart Center, West Des Moines (T.H.); the Cardiovascular Institute of the South, Houma, LA (R.A.); and Christchurch Hospital, Christchurch, New Zealand (I.C.)
| | - Christophe Leclercq
- From Mayo Clinic, Rochester (P.F.), and Medtronic, Mounds View (A.E.T., C.W., S.W.) - both in Minnesota; King's College Hospital, London (F.M.); the Cardiology Department, St. Antonius Hospital, Nieuwegein (L.V.A.B.), and Amsterdam University Medical Centers, Amsterdam (L.V.A.B., R.E.K.) - both in the Netherlands; London Health Sciences Centre, London, ON, Canada (J.M.); Austin Hospital, Heidelberg, VIC, Australia (D.O.); Northwestern University, Evanston, IL (B.P.K.); Centre Hospitalier Régional Universitaire de Tours-Hôpital Trousseau, Tours (N.C.), and Centre Hospitalier Universitaire de Rennes-Hôpital Pontchaillou, Rennes (C.L.) - both in France; Riverside Methodist Hospital, Columbus, OH (A.A.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.P.M.); the University of California, San Diego, La Jolla (U.M.B.-G.), and Sequoia Hospital, Redwood City (G.E.) - both in California; Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (J.Y.S.C.); the Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (M.B.); Hospital Universitario Reina Sofía, Cordoba, Spain (I.M.C.); Northwell Health, Manhasset, NY (L.M.E.); Baptist Health, Jacksonville, FL (V.S.); Odense Universitetshospital, Odense, Denmark (J.B.J.); Klinika Zaburzeń Rytmu Serca/Narodowy Instytut Kardiologii-Stefana Kardynała Wyszyńskiego, Warsaw, Poland (M.S.); Kepler University Hospital, Linz, Austria (C.S.); the Iowa Heart Center, West Des Moines (T.H.); the Cardiovascular Institute of the South, Houma, LA (R.A.); and Christchurch Hospital, Christchurch, New Zealand (I.C.)
| | - Anish Amin
- From Mayo Clinic, Rochester (P.F.), and Medtronic, Mounds View (A.E.T., C.W., S.W.) - both in Minnesota; King's College Hospital, London (F.M.); the Cardiology Department, St. Antonius Hospital, Nieuwegein (L.V.A.B.), and Amsterdam University Medical Centers, Amsterdam (L.V.A.B., R.E.K.) - both in the Netherlands; London Health Sciences Centre, London, ON, Canada (J.M.); Austin Hospital, Heidelberg, VIC, Australia (D.O.); Northwestern University, Evanston, IL (B.P.K.); Centre Hospitalier Régional Universitaire de Tours-Hôpital Trousseau, Tours (N.C.), and Centre Hospitalier Universitaire de Rennes-Hôpital Pontchaillou, Rennes (C.L.) - both in France; Riverside Methodist Hospital, Columbus, OH (A.A.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.P.M.); the University of California, San Diego, La Jolla (U.M.B.-G.), and Sequoia Hospital, Redwood City (G.E.) - both in California; Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (J.Y.S.C.); the Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (M.B.); Hospital Universitario Reina Sofía, Cordoba, Spain (I.M.C.); Northwell Health, Manhasset, NY (L.M.E.); Baptist Health, Jacksonville, FL (V.S.); Odense Universitetshospital, Odense, Denmark (J.B.J.); Klinika Zaburzeń Rytmu Serca/Narodowy Instytut Kardiologii-Stefana Kardynała Wyszyńskiego, Warsaw, Poland (M.S.); Kepler University Hospital, Linz, Austria (C.S.); the Iowa Heart Center, West Des Moines (T.H.); the Cardiovascular Institute of the South, Houma, LA (R.A.); and Christchurch Hospital, Christchurch, New Zealand (I.C.)
| | - Béla P Merkely
- From Mayo Clinic, Rochester (P.F.), and Medtronic, Mounds View (A.E.T., C.W., S.W.) - both in Minnesota; King's College Hospital, London (F.M.); the Cardiology Department, St. Antonius Hospital, Nieuwegein (L.V.A.B.), and Amsterdam University Medical Centers, Amsterdam (L.V.A.B., R.E.K.) - both in the Netherlands; London Health Sciences Centre, London, ON, Canada (J.M.); Austin Hospital, Heidelberg, VIC, Australia (D.O.); Northwestern University, Evanston, IL (B.P.K.); Centre Hospitalier Régional Universitaire de Tours-Hôpital Trousseau, Tours (N.C.), and Centre Hospitalier Universitaire de Rennes-Hôpital Pontchaillou, Rennes (C.L.) - both in France; Riverside Methodist Hospital, Columbus, OH (A.A.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.P.M.); the University of California, San Diego, La Jolla (U.M.B.-G.), and Sequoia Hospital, Redwood City (G.E.) - both in California; Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (J.Y.S.C.); the Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (M.B.); Hospital Universitario Reina Sofía, Cordoba, Spain (I.M.C.); Northwell Health, Manhasset, NY (L.M.E.); Baptist Health, Jacksonville, FL (V.S.); Odense Universitetshospital, Odense, Denmark (J.B.J.); Klinika Zaburzeń Rytmu Serca/Narodowy Instytut Kardiologii-Stefana Kardynała Wyszyńskiego, Warsaw, Poland (M.S.); Kepler University Hospital, Linz, Austria (C.S.); the Iowa Heart Center, West Des Moines (T.H.); the Cardiovascular Institute of the South, Houma, LA (R.A.); and Christchurch Hospital, Christchurch, New Zealand (I.C.)
| | - Ulrika M Birgersdotter-Green
- From Mayo Clinic, Rochester (P.F.), and Medtronic, Mounds View (A.E.T., C.W., S.W.) - both in Minnesota; King's College Hospital, London (F.M.); the Cardiology Department, St. Antonius Hospital, Nieuwegein (L.V.A.B.), and Amsterdam University Medical Centers, Amsterdam (L.V.A.B., R.E.K.) - both in the Netherlands; London Health Sciences Centre, London, ON, Canada (J.M.); Austin Hospital, Heidelberg, VIC, Australia (D.O.); Northwestern University, Evanston, IL (B.P.K.); Centre Hospitalier Régional Universitaire de Tours-Hôpital Trousseau, Tours (N.C.), and Centre Hospitalier Universitaire de Rennes-Hôpital Pontchaillou, Rennes (C.L.) - both in France; Riverside Methodist Hospital, Columbus, OH (A.A.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.P.M.); the University of California, San Diego, La Jolla (U.M.B.-G.), and Sequoia Hospital, Redwood City (G.E.) - both in California; Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (J.Y.S.C.); the Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (M.B.); Hospital Universitario Reina Sofía, Cordoba, Spain (I.M.C.); Northwell Health, Manhasset, NY (L.M.E.); Baptist Health, Jacksonville, FL (V.S.); Odense Universitetshospital, Odense, Denmark (J.B.J.); Klinika Zaburzeń Rytmu Serca/Narodowy Instytut Kardiologii-Stefana Kardynała Wyszyńskiego, Warsaw, Poland (M.S.); Kepler University Hospital, Linz, Austria (C.S.); the Iowa Heart Center, West Des Moines (T.H.); the Cardiovascular Institute of the South, Houma, LA (R.A.); and Christchurch Hospital, Christchurch, New Zealand (I.C.)
| | - Joseph Y S Chan
- From Mayo Clinic, Rochester (P.F.), and Medtronic, Mounds View (A.E.T., C.W., S.W.) - both in Minnesota; King's College Hospital, London (F.M.); the Cardiology Department, St. Antonius Hospital, Nieuwegein (L.V.A.B.), and Amsterdam University Medical Centers, Amsterdam (L.V.A.B., R.E.K.) - both in the Netherlands; London Health Sciences Centre, London, ON, Canada (J.M.); Austin Hospital, Heidelberg, VIC, Australia (D.O.); Northwestern University, Evanston, IL (B.P.K.); Centre Hospitalier Régional Universitaire de Tours-Hôpital Trousseau, Tours (N.C.), and Centre Hospitalier Universitaire de Rennes-Hôpital Pontchaillou, Rennes (C.L.) - both in France; Riverside Methodist Hospital, Columbus, OH (A.A.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.P.M.); the University of California, San Diego, La Jolla (U.M.B.-G.), and Sequoia Hospital, Redwood City (G.E.) - both in California; Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (J.Y.S.C.); the Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (M.B.); Hospital Universitario Reina Sofía, Cordoba, Spain (I.M.C.); Northwell Health, Manhasset, NY (L.M.E.); Baptist Health, Jacksonville, FL (V.S.); Odense Universitetshospital, Odense, Denmark (J.B.J.); Klinika Zaburzeń Rytmu Serca/Narodowy Instytut Kardiologii-Stefana Kardynała Wyszyńskiego, Warsaw, Poland (M.S.); Kepler University Hospital, Linz, Austria (C.S.); the Iowa Heart Center, West Des Moines (T.H.); the Cardiovascular Institute of the South, Houma, LA (R.A.); and Christchurch Hospital, Christchurch, New Zealand (I.C.)
| | - Mauro Biffi
- From Mayo Clinic, Rochester (P.F.), and Medtronic, Mounds View (A.E.T., C.W., S.W.) - both in Minnesota; King's College Hospital, London (F.M.); the Cardiology Department, St. Antonius Hospital, Nieuwegein (L.V.A.B.), and Amsterdam University Medical Centers, Amsterdam (L.V.A.B., R.E.K.) - both in the Netherlands; London Health Sciences Centre, London, ON, Canada (J.M.); Austin Hospital, Heidelberg, VIC, Australia (D.O.); Northwestern University, Evanston, IL (B.P.K.); Centre Hospitalier Régional Universitaire de Tours-Hôpital Trousseau, Tours (N.C.), and Centre Hospitalier Universitaire de Rennes-Hôpital Pontchaillou, Rennes (C.L.) - both in France; Riverside Methodist Hospital, Columbus, OH (A.A.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.P.M.); the University of California, San Diego, La Jolla (U.M.B.-G.), and Sequoia Hospital, Redwood City (G.E.) - both in California; Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (J.Y.S.C.); the Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (M.B.); Hospital Universitario Reina Sofía, Cordoba, Spain (I.M.C.); Northwell Health, Manhasset, NY (L.M.E.); Baptist Health, Jacksonville, FL (V.S.); Odense Universitetshospital, Odense, Denmark (J.B.J.); Klinika Zaburzeń Rytmu Serca/Narodowy Instytut Kardiologii-Stefana Kardynała Wyszyńskiego, Warsaw, Poland (M.S.); Kepler University Hospital, Linz, Austria (C.S.); the Iowa Heart Center, West Des Moines (T.H.); the Cardiovascular Institute of the South, Houma, LA (R.A.); and Christchurch Hospital, Christchurch, New Zealand (I.C.)
| | - Reinoud E Knops
- From Mayo Clinic, Rochester (P.F.), and Medtronic, Mounds View (A.E.T., C.W., S.W.) - both in Minnesota; King's College Hospital, London (F.M.); the Cardiology Department, St. Antonius Hospital, Nieuwegein (L.V.A.B.), and Amsterdam University Medical Centers, Amsterdam (L.V.A.B., R.E.K.) - both in the Netherlands; London Health Sciences Centre, London, ON, Canada (J.M.); Austin Hospital, Heidelberg, VIC, Australia (D.O.); Northwestern University, Evanston, IL (B.P.K.); Centre Hospitalier Régional Universitaire de Tours-Hôpital Trousseau, Tours (N.C.), and Centre Hospitalier Universitaire de Rennes-Hôpital Pontchaillou, Rennes (C.L.) - both in France; Riverside Methodist Hospital, Columbus, OH (A.A.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.P.M.); the University of California, San Diego, La Jolla (U.M.B.-G.), and Sequoia Hospital, Redwood City (G.E.) - both in California; Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (J.Y.S.C.); the Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (M.B.); Hospital Universitario Reina Sofía, Cordoba, Spain (I.M.C.); Northwell Health, Manhasset, NY (L.M.E.); Baptist Health, Jacksonville, FL (V.S.); Odense Universitetshospital, Odense, Denmark (J.B.J.); Klinika Zaburzeń Rytmu Serca/Narodowy Instytut Kardiologii-Stefana Kardynała Wyszyńskiego, Warsaw, Poland (M.S.); Kepler University Hospital, Linz, Austria (C.S.); the Iowa Heart Center, West Des Moines (T.H.); the Cardiovascular Institute of the South, Houma, LA (R.A.); and Christchurch Hospital, Christchurch, New Zealand (I.C.)
| | - Greg Engel
- From Mayo Clinic, Rochester (P.F.), and Medtronic, Mounds View (A.E.T., C.W., S.W.) - both in Minnesota; King's College Hospital, London (F.M.); the Cardiology Department, St. Antonius Hospital, Nieuwegein (L.V.A.B.), and Amsterdam University Medical Centers, Amsterdam (L.V.A.B., R.E.K.) - both in the Netherlands; London Health Sciences Centre, London, ON, Canada (J.M.); Austin Hospital, Heidelberg, VIC, Australia (D.O.); Northwestern University, Evanston, IL (B.P.K.); Centre Hospitalier Régional Universitaire de Tours-Hôpital Trousseau, Tours (N.C.), and Centre Hospitalier Universitaire de Rennes-Hôpital Pontchaillou, Rennes (C.L.) - both in France; Riverside Methodist Hospital, Columbus, OH (A.A.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.P.M.); the University of California, San Diego, La Jolla (U.M.B.-G.), and Sequoia Hospital, Redwood City (G.E.) - both in California; Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (J.Y.S.C.); the Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (M.B.); Hospital Universitario Reina Sofía, Cordoba, Spain (I.M.C.); Northwell Health, Manhasset, NY (L.M.E.); Baptist Health, Jacksonville, FL (V.S.); Odense Universitetshospital, Odense, Denmark (J.B.J.); Klinika Zaburzeń Rytmu Serca/Narodowy Instytut Kardiologii-Stefana Kardynała Wyszyńskiego, Warsaw, Poland (M.S.); Kepler University Hospital, Linz, Austria (C.S.); the Iowa Heart Center, West Des Moines (T.H.); the Cardiovascular Institute of the South, Houma, LA (R.A.); and Christchurch Hospital, Christchurch, New Zealand (I.C.)
| | - Ignacio Muñoz Carvajal
- From Mayo Clinic, Rochester (P.F.), and Medtronic, Mounds View (A.E.T., C.W., S.W.) - both in Minnesota; King's College Hospital, London (F.M.); the Cardiology Department, St. Antonius Hospital, Nieuwegein (L.V.A.B.), and Amsterdam University Medical Centers, Amsterdam (L.V.A.B., R.E.K.) - both in the Netherlands; London Health Sciences Centre, London, ON, Canada (J.M.); Austin Hospital, Heidelberg, VIC, Australia (D.O.); Northwestern University, Evanston, IL (B.P.K.); Centre Hospitalier Régional Universitaire de Tours-Hôpital Trousseau, Tours (N.C.), and Centre Hospitalier Universitaire de Rennes-Hôpital Pontchaillou, Rennes (C.L.) - both in France; Riverside Methodist Hospital, Columbus, OH (A.A.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.P.M.); the University of California, San Diego, La Jolla (U.M.B.-G.), and Sequoia Hospital, Redwood City (G.E.) - both in California; Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (J.Y.S.C.); the Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (M.B.); Hospital Universitario Reina Sofía, Cordoba, Spain (I.M.C.); Northwell Health, Manhasset, NY (L.M.E.); Baptist Health, Jacksonville, FL (V.S.); Odense Universitetshospital, Odense, Denmark (J.B.J.); Klinika Zaburzeń Rytmu Serca/Narodowy Instytut Kardiologii-Stefana Kardynała Wyszyńskiego, Warsaw, Poland (M.S.); Kepler University Hospital, Linz, Austria (C.S.); the Iowa Heart Center, West Des Moines (T.H.); the Cardiovascular Institute of the South, Houma, LA (R.A.); and Christchurch Hospital, Christchurch, New Zealand (I.C.)
| | - Laurence M Epstein
- From Mayo Clinic, Rochester (P.F.), and Medtronic, Mounds View (A.E.T., C.W., S.W.) - both in Minnesota; King's College Hospital, London (F.M.); the Cardiology Department, St. Antonius Hospital, Nieuwegein (L.V.A.B.), and Amsterdam University Medical Centers, Amsterdam (L.V.A.B., R.E.K.) - both in the Netherlands; London Health Sciences Centre, London, ON, Canada (J.M.); Austin Hospital, Heidelberg, VIC, Australia (D.O.); Northwestern University, Evanston, IL (B.P.K.); Centre Hospitalier Régional Universitaire de Tours-Hôpital Trousseau, Tours (N.C.), and Centre Hospitalier Universitaire de Rennes-Hôpital Pontchaillou, Rennes (C.L.) - both in France; Riverside Methodist Hospital, Columbus, OH (A.A.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.P.M.); the University of California, San Diego, La Jolla (U.M.B.-G.), and Sequoia Hospital, Redwood City (G.E.) - both in California; Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (J.Y.S.C.); the Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (M.B.); Hospital Universitario Reina Sofía, Cordoba, Spain (I.M.C.); Northwell Health, Manhasset, NY (L.M.E.); Baptist Health, Jacksonville, FL (V.S.); Odense Universitetshospital, Odense, Denmark (J.B.J.); Klinika Zaburzeń Rytmu Serca/Narodowy Instytut Kardiologii-Stefana Kardynała Wyszyńskiego, Warsaw, Poland (M.S.); Kepler University Hospital, Linz, Austria (C.S.); the Iowa Heart Center, West Des Moines (T.H.); the Cardiovascular Institute of the South, Houma, LA (R.A.); and Christchurch Hospital, Christchurch, New Zealand (I.C.)
| | - Venkata Sagi
- From Mayo Clinic, Rochester (P.F.), and Medtronic, Mounds View (A.E.T., C.W., S.W.) - both in Minnesota; King's College Hospital, London (F.M.); the Cardiology Department, St. Antonius Hospital, Nieuwegein (L.V.A.B.), and Amsterdam University Medical Centers, Amsterdam (L.V.A.B., R.E.K.) - both in the Netherlands; London Health Sciences Centre, London, ON, Canada (J.M.); Austin Hospital, Heidelberg, VIC, Australia (D.O.); Northwestern University, Evanston, IL (B.P.K.); Centre Hospitalier Régional Universitaire de Tours-Hôpital Trousseau, Tours (N.C.), and Centre Hospitalier Universitaire de Rennes-Hôpital Pontchaillou, Rennes (C.L.) - both in France; Riverside Methodist Hospital, Columbus, OH (A.A.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.P.M.); the University of California, San Diego, La Jolla (U.M.B.-G.), and Sequoia Hospital, Redwood City (G.E.) - both in California; Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (J.Y.S.C.); the Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (M.B.); Hospital Universitario Reina Sofía, Cordoba, Spain (I.M.C.); Northwell Health, Manhasset, NY (L.M.E.); Baptist Health, Jacksonville, FL (V.S.); Odense Universitetshospital, Odense, Denmark (J.B.J.); Klinika Zaburzeń Rytmu Serca/Narodowy Instytut Kardiologii-Stefana Kardynała Wyszyńskiego, Warsaw, Poland (M.S.); Kepler University Hospital, Linz, Austria (C.S.); the Iowa Heart Center, West Des Moines (T.H.); the Cardiovascular Institute of the South, Houma, LA (R.A.); and Christchurch Hospital, Christchurch, New Zealand (I.C.)
| | - Jens B Johansen
- From Mayo Clinic, Rochester (P.F.), and Medtronic, Mounds View (A.E.T., C.W., S.W.) - both in Minnesota; King's College Hospital, London (F.M.); the Cardiology Department, St. Antonius Hospital, Nieuwegein (L.V.A.B.), and Amsterdam University Medical Centers, Amsterdam (L.V.A.B., R.E.K.) - both in the Netherlands; London Health Sciences Centre, London, ON, Canada (J.M.); Austin Hospital, Heidelberg, VIC, Australia (D.O.); Northwestern University, Evanston, IL (B.P.K.); Centre Hospitalier Régional Universitaire de Tours-Hôpital Trousseau, Tours (N.C.), and Centre Hospitalier Universitaire de Rennes-Hôpital Pontchaillou, Rennes (C.L.) - both in France; Riverside Methodist Hospital, Columbus, OH (A.A.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.P.M.); the University of California, San Diego, La Jolla (U.M.B.-G.), and Sequoia Hospital, Redwood City (G.E.) - both in California; Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (J.Y.S.C.); the Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (M.B.); Hospital Universitario Reina Sofía, Cordoba, Spain (I.M.C.); Northwell Health, Manhasset, NY (L.M.E.); Baptist Health, Jacksonville, FL (V.S.); Odense Universitetshospital, Odense, Denmark (J.B.J.); Klinika Zaburzeń Rytmu Serca/Narodowy Instytut Kardiologii-Stefana Kardynała Wyszyńskiego, Warsaw, Poland (M.S.); Kepler University Hospital, Linz, Austria (C.S.); the Iowa Heart Center, West Des Moines (T.H.); the Cardiovascular Institute of the South, Houma, LA (R.A.); and Christchurch Hospital, Christchurch, New Zealand (I.C.)
| | - Maciej Sterliński
- From Mayo Clinic, Rochester (P.F.), and Medtronic, Mounds View (A.E.T., C.W., S.W.) - both in Minnesota; King's College Hospital, London (F.M.); the Cardiology Department, St. Antonius Hospital, Nieuwegein (L.V.A.B.), and Amsterdam University Medical Centers, Amsterdam (L.V.A.B., R.E.K.) - both in the Netherlands; London Health Sciences Centre, London, ON, Canada (J.M.); Austin Hospital, Heidelberg, VIC, Australia (D.O.); Northwestern University, Evanston, IL (B.P.K.); Centre Hospitalier Régional Universitaire de Tours-Hôpital Trousseau, Tours (N.C.), and Centre Hospitalier Universitaire de Rennes-Hôpital Pontchaillou, Rennes (C.L.) - both in France; Riverside Methodist Hospital, Columbus, OH (A.A.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.P.M.); the University of California, San Diego, La Jolla (U.M.B.-G.), and Sequoia Hospital, Redwood City (G.E.) - both in California; Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (J.Y.S.C.); the Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (M.B.); Hospital Universitario Reina Sofía, Cordoba, Spain (I.M.C.); Northwell Health, Manhasset, NY (L.M.E.); Baptist Health, Jacksonville, FL (V.S.); Odense Universitetshospital, Odense, Denmark (J.B.J.); Klinika Zaburzeń Rytmu Serca/Narodowy Instytut Kardiologii-Stefana Kardynała Wyszyńskiego, Warsaw, Poland (M.S.); Kepler University Hospital, Linz, Austria (C.S.); the Iowa Heart Center, West Des Moines (T.H.); the Cardiovascular Institute of the South, Houma, LA (R.A.); and Christchurch Hospital, Christchurch, New Zealand (I.C.)
| | - Clemens Steinwender
- From Mayo Clinic, Rochester (P.F.), and Medtronic, Mounds View (A.E.T., C.W., S.W.) - both in Minnesota; King's College Hospital, London (F.M.); the Cardiology Department, St. Antonius Hospital, Nieuwegein (L.V.A.B.), and Amsterdam University Medical Centers, Amsterdam (L.V.A.B., R.E.K.) - both in the Netherlands; London Health Sciences Centre, London, ON, Canada (J.M.); Austin Hospital, Heidelberg, VIC, Australia (D.O.); Northwestern University, Evanston, IL (B.P.K.); Centre Hospitalier Régional Universitaire de Tours-Hôpital Trousseau, Tours (N.C.), and Centre Hospitalier Universitaire de Rennes-Hôpital Pontchaillou, Rennes (C.L.) - both in France; Riverside Methodist Hospital, Columbus, OH (A.A.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.P.M.); the University of California, San Diego, La Jolla (U.M.B.-G.), and Sequoia Hospital, Redwood City (G.E.) - both in California; Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (J.Y.S.C.); the Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (M.B.); Hospital Universitario Reina Sofía, Cordoba, Spain (I.M.C.); Northwell Health, Manhasset, NY (L.M.E.); Baptist Health, Jacksonville, FL (V.S.); Odense Universitetshospital, Odense, Denmark (J.B.J.); Klinika Zaburzeń Rytmu Serca/Narodowy Instytut Kardiologii-Stefana Kardynała Wyszyńskiego, Warsaw, Poland (M.S.); Kepler University Hospital, Linz, Austria (C.S.); the Iowa Heart Center, West Des Moines (T.H.); the Cardiovascular Institute of the South, Houma, LA (R.A.); and Christchurch Hospital, Christchurch, New Zealand (I.C.)
| | - Troy Hounshell
- From Mayo Clinic, Rochester (P.F.), and Medtronic, Mounds View (A.E.T., C.W., S.W.) - both in Minnesota; King's College Hospital, London (F.M.); the Cardiology Department, St. Antonius Hospital, Nieuwegein (L.V.A.B.), and Amsterdam University Medical Centers, Amsterdam (L.V.A.B., R.E.K.) - both in the Netherlands; London Health Sciences Centre, London, ON, Canada (J.M.); Austin Hospital, Heidelberg, VIC, Australia (D.O.); Northwestern University, Evanston, IL (B.P.K.); Centre Hospitalier Régional Universitaire de Tours-Hôpital Trousseau, Tours (N.C.), and Centre Hospitalier Universitaire de Rennes-Hôpital Pontchaillou, Rennes (C.L.) - both in France; Riverside Methodist Hospital, Columbus, OH (A.A.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.P.M.); the University of California, San Diego, La Jolla (U.M.B.-G.), and Sequoia Hospital, Redwood City (G.E.) - both in California; Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (J.Y.S.C.); the Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (M.B.); Hospital Universitario Reina Sofía, Cordoba, Spain (I.M.C.); Northwell Health, Manhasset, NY (L.M.E.); Baptist Health, Jacksonville, FL (V.S.); Odense Universitetshospital, Odense, Denmark (J.B.J.); Klinika Zaburzeń Rytmu Serca/Narodowy Instytut Kardiologii-Stefana Kardynała Wyszyńskiego, Warsaw, Poland (M.S.); Kepler University Hospital, Linz, Austria (C.S.); the Iowa Heart Center, West Des Moines (T.H.); the Cardiovascular Institute of the South, Houma, LA (R.A.); and Christchurch Hospital, Christchurch, New Zealand (I.C.)
| | - Richard Abben
- From Mayo Clinic, Rochester (P.F.), and Medtronic, Mounds View (A.E.T., C.W., S.W.) - both in Minnesota; King's College Hospital, London (F.M.); the Cardiology Department, St. Antonius Hospital, Nieuwegein (L.V.A.B.), and Amsterdam University Medical Centers, Amsterdam (L.V.A.B., R.E.K.) - both in the Netherlands; London Health Sciences Centre, London, ON, Canada (J.M.); Austin Hospital, Heidelberg, VIC, Australia (D.O.); Northwestern University, Evanston, IL (B.P.K.); Centre Hospitalier Régional Universitaire de Tours-Hôpital Trousseau, Tours (N.C.), and Centre Hospitalier Universitaire de Rennes-Hôpital Pontchaillou, Rennes (C.L.) - both in France; Riverside Methodist Hospital, Columbus, OH (A.A.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.P.M.); the University of California, San Diego, La Jolla (U.M.B.-G.), and Sequoia Hospital, Redwood City (G.E.) - both in California; Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (J.Y.S.C.); the Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (M.B.); Hospital Universitario Reina Sofía, Cordoba, Spain (I.M.C.); Northwell Health, Manhasset, NY (L.M.E.); Baptist Health, Jacksonville, FL (V.S.); Odense Universitetshospital, Odense, Denmark (J.B.J.); Klinika Zaburzeń Rytmu Serca/Narodowy Instytut Kardiologii-Stefana Kardynała Wyszyńskiego, Warsaw, Poland (M.S.); Kepler University Hospital, Linz, Austria (C.S.); the Iowa Heart Center, West Des Moines (T.H.); the Cardiovascular Institute of the South, Houma, LA (R.A.); and Christchurch Hospital, Christchurch, New Zealand (I.C.)
| | - Amy E Thompson
- From Mayo Clinic, Rochester (P.F.), and Medtronic, Mounds View (A.E.T., C.W., S.W.) - both in Minnesota; King's College Hospital, London (F.M.); the Cardiology Department, St. Antonius Hospital, Nieuwegein (L.V.A.B.), and Amsterdam University Medical Centers, Amsterdam (L.V.A.B., R.E.K.) - both in the Netherlands; London Health Sciences Centre, London, ON, Canada (J.M.); Austin Hospital, Heidelberg, VIC, Australia (D.O.); Northwestern University, Evanston, IL (B.P.K.); Centre Hospitalier Régional Universitaire de Tours-Hôpital Trousseau, Tours (N.C.), and Centre Hospitalier Universitaire de Rennes-Hôpital Pontchaillou, Rennes (C.L.) - both in France; Riverside Methodist Hospital, Columbus, OH (A.A.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.P.M.); the University of California, San Diego, La Jolla (U.M.B.-G.), and Sequoia Hospital, Redwood City (G.E.) - both in California; Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (J.Y.S.C.); the Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (M.B.); Hospital Universitario Reina Sofía, Cordoba, Spain (I.M.C.); Northwell Health, Manhasset, NY (L.M.E.); Baptist Health, Jacksonville, FL (V.S.); Odense Universitetshospital, Odense, Denmark (J.B.J.); Klinika Zaburzeń Rytmu Serca/Narodowy Instytut Kardiologii-Stefana Kardynała Wyszyńskiego, Warsaw, Poland (M.S.); Kepler University Hospital, Linz, Austria (C.S.); the Iowa Heart Center, West Des Moines (T.H.); the Cardiovascular Institute of the South, Houma, LA (R.A.); and Christchurch Hospital, Christchurch, New Zealand (I.C.)
| | - Christopher Wiggenhorn
- From Mayo Clinic, Rochester (P.F.), and Medtronic, Mounds View (A.E.T., C.W., S.W.) - both in Minnesota; King's College Hospital, London (F.M.); the Cardiology Department, St. Antonius Hospital, Nieuwegein (L.V.A.B.), and Amsterdam University Medical Centers, Amsterdam (L.V.A.B., R.E.K.) - both in the Netherlands; London Health Sciences Centre, London, ON, Canada (J.M.); Austin Hospital, Heidelberg, VIC, Australia (D.O.); Northwestern University, Evanston, IL (B.P.K.); Centre Hospitalier Régional Universitaire de Tours-Hôpital Trousseau, Tours (N.C.), and Centre Hospitalier Universitaire de Rennes-Hôpital Pontchaillou, Rennes (C.L.) - both in France; Riverside Methodist Hospital, Columbus, OH (A.A.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.P.M.); the University of California, San Diego, La Jolla (U.M.B.-G.), and Sequoia Hospital, Redwood City (G.E.) - both in California; Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (J.Y.S.C.); the Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (M.B.); Hospital Universitario Reina Sofía, Cordoba, Spain (I.M.C.); Northwell Health, Manhasset, NY (L.M.E.); Baptist Health, Jacksonville, FL (V.S.); Odense Universitetshospital, Odense, Denmark (J.B.J.); Klinika Zaburzeń Rytmu Serca/Narodowy Instytut Kardiologii-Stefana Kardynała Wyszyńskiego, Warsaw, Poland (M.S.); Kepler University Hospital, Linz, Austria (C.S.); the Iowa Heart Center, West Des Moines (T.H.); the Cardiovascular Institute of the South, Houma, LA (R.A.); and Christchurch Hospital, Christchurch, New Zealand (I.C.)
| | - Sarah Willey
- From Mayo Clinic, Rochester (P.F.), and Medtronic, Mounds View (A.E.T., C.W., S.W.) - both in Minnesota; King's College Hospital, London (F.M.); the Cardiology Department, St. Antonius Hospital, Nieuwegein (L.V.A.B.), and Amsterdam University Medical Centers, Amsterdam (L.V.A.B., R.E.K.) - both in the Netherlands; London Health Sciences Centre, London, ON, Canada (J.M.); Austin Hospital, Heidelberg, VIC, Australia (D.O.); Northwestern University, Evanston, IL (B.P.K.); Centre Hospitalier Régional Universitaire de Tours-Hôpital Trousseau, Tours (N.C.), and Centre Hospitalier Universitaire de Rennes-Hôpital Pontchaillou, Rennes (C.L.) - both in France; Riverside Methodist Hospital, Columbus, OH (A.A.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.P.M.); the University of California, San Diego, La Jolla (U.M.B.-G.), and Sequoia Hospital, Redwood City (G.E.) - both in California; Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (J.Y.S.C.); the Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (M.B.); Hospital Universitario Reina Sofía, Cordoba, Spain (I.M.C.); Northwell Health, Manhasset, NY (L.M.E.); Baptist Health, Jacksonville, FL (V.S.); Odense Universitetshospital, Odense, Denmark (J.B.J.); Klinika Zaburzeń Rytmu Serca/Narodowy Instytut Kardiologii-Stefana Kardynała Wyszyńskiego, Warsaw, Poland (M.S.); Kepler University Hospital, Linz, Austria (C.S.); the Iowa Heart Center, West Des Moines (T.H.); the Cardiovascular Institute of the South, Houma, LA (R.A.); and Christchurch Hospital, Christchurch, New Zealand (I.C.)
| | - Ian Crozier
- From Mayo Clinic, Rochester (P.F.), and Medtronic, Mounds View (A.E.T., C.W., S.W.) - both in Minnesota; King's College Hospital, London (F.M.); the Cardiology Department, St. Antonius Hospital, Nieuwegein (L.V.A.B.), and Amsterdam University Medical Centers, Amsterdam (L.V.A.B., R.E.K.) - both in the Netherlands; London Health Sciences Centre, London, ON, Canada (J.M.); Austin Hospital, Heidelberg, VIC, Australia (D.O.); Northwestern University, Evanston, IL (B.P.K.); Centre Hospitalier Régional Universitaire de Tours-Hôpital Trousseau, Tours (N.C.), and Centre Hospitalier Universitaire de Rennes-Hôpital Pontchaillou, Rennes (C.L.) - both in France; Riverside Methodist Hospital, Columbus, OH (A.A.); Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.P.M.); the University of California, San Diego, La Jolla (U.M.B.-G.), and Sequoia Hospital, Redwood City (G.E.) - both in California; Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China (J.Y.S.C.); the Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (M.B.); Hospital Universitario Reina Sofía, Cordoba, Spain (I.M.C.); Northwell Health, Manhasset, NY (L.M.E.); Baptist Health, Jacksonville, FL (V.S.); Odense Universitetshospital, Odense, Denmark (J.B.J.); Klinika Zaburzeń Rytmu Serca/Narodowy Instytut Kardiologii-Stefana Kardynała Wyszyńskiego, Warsaw, Poland (M.S.); Kepler University Hospital, Linz, Austria (C.S.); the Iowa Heart Center, West Des Moines (T.H.); the Cardiovascular Institute of the South, Houma, LA (R.A.); and Christchurch Hospital, Christchurch, New Zealand (I.C.)
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10
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Vereshchagina AV, Uskach TM, Sapelnikov OV, Amanatova VA, Grishin IR, Kulikov AA, Kostin VS, Akchurin RS. Safety and Tolerability of Implanted Subcutaneous Cardioverter-Defibrillator Systems. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2022. [DOI: 10.20996/1819-6446-2022-08-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim. To study the safety and tolerability of the subcutaneous implantable cardioverter defibrillator (S-ICD) after implantation.Material and methods. The results of 33 patients with implanted S-ICD 6 months follow-up. The criteria for inclusion in the observational study were: age over 18 years, indications for primary or secondary prevention of sudden cardiac death. The exclusion criteria were indications for implantation of transvenous ICD (patients with sustained monomorphic ventricular tachycardia, the need for anti-bradycardia or resynchronization therapy), as well as patients with a QRS complex of more than 130 msec. All patients underwent a standard preoperative examination (routine blood tests, chest X-ray, transthoracic echocardiography), quality-of-life questionnaires and transesophageal echocardiography. At follow-up, patients were examined after 6 months after implantation, the device was interrogated and a quality-of-life questionnaire was completed. All episodes of shock therapy and complications were documented.Results. Male patients predominated (84%), with a mean age of 57 [43;62] years. Left ventricular ejection fraction was 30% [26;34]. The mean QRS duration was 100 [94;108] msec. According to the of 24-hour Holter ECG monitoring, episodes of unstable VT were recorded in 42.4% of patients. The most common indications for S-ICD implantation were dilated (33%) and ischemic cardiomyopathy (42%). Primary prevention was indicated in 97% of patients. At the end of the implantation of the S-ICD, the patients underwent a defibrillation test and device configuration. In 63.6% of cases, during automatic tuning, the device selected the primary perception vector. In 27.2% of patients, optimal recognition of the subcutaneous signal was observed in the secondary vector, and in 9.2% of patients, the alternative vector was favorable. All patients underwent two-zone programming. The conditional shock zone was programmed at an average rate of 192 beats/min (range 180-210 beats/min) and the shock zone was programmed at an average rate of 222 beats/min (range 220-240 beats/min). Perioperative complications occurred in two patients. During the follow-up period, no shocks were recorded in 27 patients. Adequate shocks for 6 months were recorded in two patients. During 6 months of observation, one lethal outcome was noted due to complications of viral pneumonia. During the observation period, there were no rehospitalizations for cardiovascular diseases.Conclusion. The use of S-ICD, even in patients with structural myocardial disease who do not require antibradycardia pacing, is effective in preventing SCD. The number of inadequate discharges and the number of complications in clinical practice is comparable to the data of multicenter studies. S-ICD implantation was not accompanied by a decrease in quality of life. Careful selection of candidates, along with state-of-the-art device programming, is an important parameter for the selection and success of S-ICD application.
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Affiliation(s)
- A. V. Vereshchagina
- National Medical Research Center of Cardiology named after academician E.I. Chazov
| | - T. M. Uskach
- National Medical Research Center of Cardiology named after academician E.I. Chazov; Russian Medical Academy of Continuous Professional Education
| | - O. V. Sapelnikov
- National Medical Research Center of Cardiology named after academician E.I. Chazov
| | - V. A. Amanatova
- National Medical Research Center of Cardiology named after academician E.I. Chazov
| | - I. R. Grishin
- National Medical Research Center of Cardiology named after academician E.I. Chazov
| | - A. A. Kulikov
- National Medical Research Center of Cardiology named after academician E.I. Chazov
| | - V. S. Kostin
- National Medical Research Center of Cardiology named after academician E.I. Chazov
| | - R. S. Akchurin
- National Medical Research Center of Cardiology named after academician E.I. Chazov
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11
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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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12
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Corrado D, Link MS, Schwartz PJ. Implantable defibrillators in primary prevention of genetic arrhythmias. A shocking choice? Eur Heart J 2022; 43:3029-3040. [PMID: 35725934 PMCID: PMC9443985 DOI: 10.1093/eurheartj/ehac298] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/10/2022] [Accepted: 05/24/2022] [Indexed: 12/15/2022] Open
Abstract
Many previously unexplained life-threatening ventricular arrhythmias and sudden cardiac deaths (SCDs) in young individuals are now recognized to be genetic in nature and are ascribed to a growing number of distinct inherited arrhythmogenic diseases. These include hypertrophic cardiomyopathy, arrhythmogenic cardiomyopathy, long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia (VT), and short QT syndrome. Because of their lower frequency compared to coronary disease, risk factors for SCD are not very precise in patients with inherited arrhythmogenic diseases. As randomized studies are generally non-feasible and may even be ethically unjustifiable, especially in the presence of effective therapies, the risk assessment of malignant arrhythmic events such as SCD, cardiac arrest due to ventricular fibrillation (VF), appropriate implantable cardioverter defibrillator (ICD) interventions, or ICD therapy on fast VT/VF to guide ICD implantation is based on observational data and expert consensus. In this document, we review risk factors for SCD and indications for ICD implantation and additional therapies. What emerges is that, allowing for some important differences between cardiomyopathies and channelopathies, there is a growing and disquieting trend to create, and then use, semi-automated systems (risk scores, risk calculators, and, to some extent, even guidelines) which then dictate therapeutic choices. Their common denominator is a tendency to favour ICD implantation, sometime with reason, sometime without it. This contrasts with the time-honoured approach of selecting, among the available therapies, the best option (ICDs included) based on the clinical judgement for the specific patient and after having assessed the protection provided by optimal medical treatment.
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Affiliation(s)
- Domenico Corrado
- Inherited Arrhythmogenic Cardiomyopathies and Sports Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy
| | - Mark S Link
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, USA
| | - Peter J Schwartz
- Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, Milan, Italy
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13
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Weiss R, Mark GE, El-Chami MF, Biffi M, Probst V, Lambiase PD, Miller MA, McClernon T, Hansen LK, Knight BP, Baddour LM. Process Mapping Strategies to Prevent Subcutaneous Implantable Cardioverter-Defibrillator Infections. J Cardiovasc Electrophysiol 2022; 33:1628-1635. [PMID: 35662315 PMCID: PMC9544305 DOI: 10.1111/jce.15566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 05/02/2022] [Accepted: 05/26/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Infection remains a major complication of cardiac implantable electronic devices (CIEDs) and can lead to significant morbidity and mortality. Implantable devices that avoid transvenous leads, such as the subcutaneous implantable cardioverter-defibrillator (S-ICD), can reduce the risk of serious infection-related complications, such as bloodstream infection and infective endocarditis. While the 2017 AHA/ACC/HRS guidelines include recommendations for S-ICD use for patients at high risk of infection, currently, there are no clinical trial data that address best practices for the prevention of S-ICD infections. Therefore, an expert panel was convened to develop consensus on these topics. METHODS An expert process mapping methodology was used to achieve consensus on the appropriate steps to minimize or prevent S-ICD infections. Two face-to-face meetings of high-volume S-ICD implanters and an infectious diseases specialist, with expertise on cardiovascular implantable electronic device infections, were conducted to develop consensus on useful strategies pre-, peri-, and post-implant to reduce S-ICD infection risk. RESULTS Expert panel consensus of recommended steps for patient preparation, S-ICD implantation, and post-operative management were developed to provide guidance in individual patient management. CONCLUSION Achieving expert panel consensus by process mapping methodology for S-ICD infection prevention was attainable, and the results should be helpful to clinicians in adopting interventions to minimize risks of S-ICD infection. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Raul Weiss
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - George E Mark
- Department of Cardiology, Cooper University Hospital, Camden, NJ
| | - Mikhael F El-Chami
- Division of Cardiology, Section of Electrophysiology, Emory University Hospital, Atlanta, GA
| | - Mauro Biffi
- University of Bologna, and Azienda Ospedaliera di Bologna, Bologna, Italy
| | - Vincent Probst
- L'Institut du Thorax, Cardiologic Department and Reference Center for Hereditary Arrhythmic Diseases, Nantes, France
| | - Pier D Lambiase
- UCL Institute of Cardiovascular Science, and Barts Heart Center, London, UK
| | - Marc A Miller
- Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, NY, New York
| | | | | | - Bradley P Knight
- Medical Director of Cardiac Electrophysiology, Center for Heart Rhythm Disorders Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, IL
| | - Larry M Baddour
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.,Department of Cardiovascular Disease, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
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14
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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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15
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Migliore F, Viani S, Ziacchi M, Ottaviano L, Francia P, Bianchi V, De Bonis S, De Filippo P, Tola G, Vicentini A, Taravelli E, Calvi VI, Lovecchio M, Valsecchi S, Botto GL. The “Defibrillation Testing, Why Not?” survey. Testing of subcutaneous and transvenous defibrillators in the Italian clinical practice. IJC HEART & VASCULATURE 2022; 38:100952. [PMID: 35071727 PMCID: PMC8761693 DOI: 10.1016/j.ijcha.2022.100952] [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: 11/20/2021] [Accepted: 01/01/2022] [Indexed: 11/25/2022]
Abstract
Background Defibrillation testing (DT) can be omitted in patients undergoing transvenous implantable cardioverter–defibrillator (T-ICD) implantation, but it is still recommended for patients at risk for a high defibrillation threshold and for ICD generator changes. Moreover, DT is still recommended on implantation of subcutaneous ICD (S-ICD). The aim of the present survey was to analyze the current practice of DT during T-ICD and S-ICD implantations. Methods In March 2021, an ad hoc questionnaire on the current performance of DT and the standard practice adopted during testing was completed at 72 Italian centers implanting S-ICD and T-ICD. Results 48 (67%) operators reported never performing DT during de-novo T-ICD implantations, while no operators perform it systematically. The remaining respondents perform it for patients at risk for a high defibrillation threshold. DT is never performed at T-ICD generator change. At the time of de-novo S-ICD implantation, DT is never performed by 9 (13%) operators and performed systematically by 48 (66%). The remaining operators frequently omit DT in patients with more severe systolic dysfunction. DT is not performed at S-ICD generator change by 92% of operators. DT is conducted by delivering a first shock energy of 65 J by 60% of operators, while the remaining 40% test lower energy values. Conclusions In current clinical practice, most operators omit DT at T-ICD implantation, even when still recommended in the guidelines. DT is also frequently omitted at S-ICD implantation, and a wide variability exists among operators in the procedures followed during DT.
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16
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Sonoda Y, Fukuzawa K, Izawa Y, Sakai J, Hirata KI. Ultrasound-guided intermuscular pocket creation for a subcutaneous implantable cardioverter-defibrillator. HeartRhythm Case Rep 2022; 8:137-141. [PMID: 35242555 PMCID: PMC8858752 DOI: 10.1016/j.hrcr.2021.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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17
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Lambiase PD, Theuns DA, Murgatroyd F, Barr C, Eckardt L, Neuzil P, Scholten M, Hood M, Kuschyk J, Brisben AJ, Carter N, Stivland TM, Knops R, Boersma LVA. OUP accepted manuscript. Eur Heart J 2022; 43:2037-2050. [PMID: 35090007 PMCID: PMC9156377 DOI: 10.1093/eurheartj/ehab921] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 11/17/2022] Open
Abstract
Aims To report 5-year outcomes of EFFORTLESS registry patients with early generation subcutaneous implantable cardioverter-defibrillator (S-ICD) devices. Methods and results Kaplan–Meier, trend and multivariable analyses were performed for mortality and late (years 2–5) complications, appropriate shock (AS) and inappropriate shock (IAS) rates. Nine hundred and eighty-four of 994 enrolled patients with diverse diagnoses (28% female, 48 ± 17 years, body mass index 27 ± 6 kg/m2, ejection fraction 43 ± 18%) underwent S-ICD implantation. Median follow-up was 5.1 years (interquartile range 4.7–5.5 years). All-cause mortality was 9.3% (95% confidence interval 7.2–11.3%) at 5 years; 703 patients remained in follow-up on study completion, 171 withdrew including 87 (8.8%) with device explanted, and 65 (6.6%) lost to follow-up. Of the explants, only 20 (2.0%) patients needed a transvenous device for pacing indications. First and final shock efficacy for discrete ventricular arrhythmias was consistent at 90% and 98%, respectively, with storm episode final shock efficacy at 95.2%. Time to therapy remained unaltered. Overall 1- and 5-year complication rates were 8.9% and 15.2%, respectively. Early complications did not predict later complications. There were no structural lead failures. Inappropriate shock rates at 1 and 5 years were 8.7% and 16.9%, respectively. Self-terminating inappropriately sensed episodes predicted late IAS. Predictors of late AS included self-terminating appropriately sensed episodes and earlier AS. Conclusion In this diverse S-ICD registry population, spontaneous shock efficacy was consistently high over 5 years. Very few patients underwent S-ICD replacement with a transvenous device for pacing indications. Treated and self-terminating arrhythmic episodes predict future shock events, which should encourage more personalized device optimization.
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Affiliation(s)
- Pier D Lambiase
- Corresponding author. Tel: +44 203 679 4407, Fax: +44 207 573 8847,
| | - Dominic A Theuns
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Craig Barr
- Department of Cardiology, Russells Hall Hospital, Dudley, UK
| | - Lars Eckardt
- Department of Cardiology II, University Hospital, Muenster, Germany
| | - Petr Neuzil
- Department of Cardiology, Na Homolce Hospital, Prague, Czechia
| | - Marcoen Scholten
- Thorax Center, Medical Spectrum Twente, Enschede, The Netherlands
| | - Margaret Hood
- Department of Cardiology, Auckland City Hospital, Auckland, New Zealand
| | - Jȕrgen Kuschyk
- Cardiology, Angiology, Hemostaseology and Internal Intensive Care Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Amy J Brisben
- Rhythm Management Division, Boston Scientific, St Paul, MN, USA
| | - Nathan Carter
- Rhythm Management Division, Boston Scientific, St Paul, MN, USA
| | | | - Reinoud Knops
- Department of Cardiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Lucas V A Boersma
- Department of Cardiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Heart Center, St Antonius Hospital, Nieuwegein, The Netherlands
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18
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Elliott MK, Sidhu BS, Mehta VS, Gould J, Martic D, Rinaldi CA. The importance of leadless pacemaker positioning in relation to subcutaneous implantable cardioverter-defibrillator sensing in completely leadless cardiac resynchronization and defibrillation systems. HeartRhythm Case Rep 2021; 7:628-632. [PMID: 34552857 PMCID: PMC8441212 DOI: 10.1016/j.hrcr.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Mark K Elliott
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Baldeep Singh Sidhu
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Vishal S Mehta
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Justin Gould
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Dejana Martic
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.,Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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19
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Karimianpour A, John L, Gold MR. The Subcutaneous ICD: A Review of the UNTOUCHED and PRAETORIAN Trials. Arrhythm Electrophysiol Rev 2021; 10:108-112. [PMID: 34401183 PMCID: PMC8353550 DOI: 10.15420/aer.2020.47] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 02/17/2021] [Indexed: 11/05/2022] Open
Abstract
The ICD is an important part of the treatment and prevention of sudden cardiac death in many high-risk populations. Traditional transvenous ICDs (TV-ICDs) are associated with certain short- and long- term risks. The subcutaneous ICD (S-ICD) was developed in order to avoid these risks and complications. However, this system is associated with its own set of limitations and complications. First, patient selection is important, as S-ICDs do not provide pacing therapy currently. Second, pre-procedural screening is important to minimise T wave and myopotential oversensing. Finally, until recently, the S-ICD was primarily used in younger patients with fewer co-morbidities and less structural heart disease, limiting the general applicability of the device. S-ICDs achieve excellent rates of arrhythmia conversion and have demonstrated noninferiority to TV-ICDs in terms of complication rates in real-world studies. The objective of this review is to discuss the latest literature, including the UNTOUCHED and PRAETORIAN trials, and to address the risk of inappropriate shocks.
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Affiliation(s)
- Ahmadreza Karimianpour
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, US
| | - Leah John
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, US
| | - Michael R Gold
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, US
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20
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Long-term complications in patients implanted with subcutaneous implantable cardioverter-defibrillators: Real-world data from the extended ELISIR experience. Heart Rhythm 2021; 18:2050-2058. [PMID: 34271173 DOI: 10.1016/j.hrthm.2021.07.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/21/2021] [Accepted: 07/07/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Recently, the Food and Drug Administration issued a recall for the subcutaneous implantable cardioverter-defibrillator (S-ICD) because of the possibility of lead ruptures and accelerated battery depletion. OBJECTIVE The aim of this study was to evaluate device-related complications over time in a large real-world multicenter S-ICD cohort. METHODS Patients implanted with an S-ICD from January 2015 to June 2020 were enrolled from a 19-institution European registry (Experience from the Long-term Italian S-ICD registry [ELISIR]; ClinicalTrials.gov identifier NCT0473876). Device-related complication rates over follow-up were collected. Last follow-up of patients was performed after the Boston Scientific recall issue. RESULTS A total of 1254 patients (median age 52.0 [interquartile range 41.0-62.2] years; 973 (77.6%) men; 387 (30.9%) ischemic) was enrolled. Over a follow-up of 23.2 (12.8-37.8) months, complications were observed in 117 patients (9.3%) for a total of 127 device-related complications (23.6% managed conservatively and 76.4% required reintervention). Twenty-seven patients (2.2%) had unanticipated generator replacement after 3.6 (3.3-3.9) years, while 4 (0.3%) had lead rupture. Body mass index (hazard ratio [HR] 1.063 [95% confidence interval 1.028-1.100]; P < .001), chronic kidney disease (HR 1.960 [1.191-3.225]; P = .008), and oral anticoagulation (HR 1.437 [1.010-2.045]; P = .043) were associated with an increase in overall complications, whereas older age (HR 0.980 [0.967-0.994]; P = .007) and procedure performed in high-volume centers (HR 0.463 [0.300-0.715]; P = .001) were protective factors. CONCLUSION The overall complication rate over 23.2 months of follow-up in a multicenter S-ICD cohort was 9.3%. Early unanticipated device battery depletions occurred in 2.2% of patients, while lead fracture was observed in 0.3%, which is in line with the expected rates reported by Boston Scientific.
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21
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Haeberlin A, Kozhuharov N, Knecht S, Tanner H, Schaer B, Noti F, Osswald S, Servatius H, Baldinger S, Seiler J, Lam A, Mosher L, Sticherling C, Roten L, Kühne M, Reichlin T. Leadless pacemaker implantation quality: importance of the operator's experience. Europace 2021; 22:939-946. [PMID: 32361742 DOI: 10.1093/europace/euaa097] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 04/04/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS Leadless cardiac pacemaker (PM) implantation differs from conventional PM implantation. While the procedure has been considered safe, recent real-world data raised concerns about the learning curve of new operators and their implantation quality. The goal of this study was to investigate the influence of the first operator's experience on leadless PM implantation quality and procedural efficiency. METHODS AND RESULTS We performed a bicentric analysis of all Micra TPS™ implantations in two large tertiary referral hospitals. We assessed both leadless PM implantation quality based on the absence of complications (requiring intervention or prolonged hospitalization), good electrical performance (pacing threshold ≤ 1.5 V/0.24 ms, R-wave amplitude > 5 mV), and acceptable fluoroscopy duration (<10 min) as well as procedural efficiency in relation to the operator's experience. Univariate and multivariate logistic regression analyses were performed to identify predictors for implantation quality and procedural efficiency. Leadless PM implantation was successful in 106/111 cases (95.5%). Three patients (2.7%) experienced acute complications (one cardiac tamponade, one femoral bleeding, one posture-related PM exit block). Multivariate analysis showed that implantation quality of more experienced first operators was higher [odds ratio 1.09 (95% confidence interval 1.00-1.19), P = 0.05]. Procedural efficiency increased with operator experience as evidenced by an inverse correlation of procedure time, time to the first deployment, fluoroscopy time, and the number of procedures performed (all P < 0.05). CONCLUSION The operator's learning curve is a critical factor for leadless PM implantation quality and procedural efficiency.
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Affiliation(s)
- Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland.,Cardio-Thoracic Unit, Bordeaux University Hospital (CHU), Av. de Magellan, 33604 Pessac, France.,Sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland
| | - Nikola Kozhuharov
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland
| | - Beat Schaer
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland
| | - Stefan Osswald
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland
| | - Samuel Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland
| | - Anna Lam
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland
| | - Luke Mosher
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland
| | - Michael Kühne
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland
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22
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Mascheroni J, Mont L, Stockburger M, Patwala A, Retzlaff H, Gallagher AG. The imperative of consistency and proficiency in cardiac devices implant skills training. Open Heart 2021; 8:e001629. [PMID: 33972405 PMCID: PMC8112444 DOI: 10.1136/openhrt-2021-001629] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jorio Mascheroni
- College of Medicine and Health, University College Cork, Cork, Ireland
| | - Lluís Mont
- Department of Cardiology, Hospital Clinic, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
| | - Martin Stockburger
- Department of Cardiology and Internal Medicine, Havelland Kliniken, Nauen, Germany
- Department of Cardiology and Angiology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Ashish Patwala
- Department of Cardiology, University Hospital of North Midlands, Stoke-on-Trent, UK
| | | | - Anthony G Gallagher
- Orsi Academy, Melle, Belgium
- Faculty of Medicine, KU Leuven, Leuven, Belgium
- School of Medicine, Faculty of Life and Health Sciences, Ulster University, Londonderry, UK
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23
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Ricciardi D, Ziacchi M, Gasperetti A, Schiavone M, Picarelli F, Diemberger I, Bontempi L, Di Belardino N, Bisignani G, De Bonis S, Mitacchione G, Calabrese V, Lavalle C, Piro A, Pignalberi C, Santini L, Grigioni F, Tondo C, Biffi M, Forleo GB. Clinical impact of defibrillation testing in a real‐world S‐ICD population: Data from the ELISIR registry. J Cardiovasc Electrophysiol 2020; 32:468-476. [DOI: 10.1111/jce.14833] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/29/2020] [Accepted: 11/19/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Danilo Ricciardi
- Department of Cardiology Policlinico Universitario Campus Bio‐Medico Roma Italy
| | - Matteo Ziacchi
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine‐DIMES University of Bologna Bologna Italy
| | | | | | - Francesco Picarelli
- Department of Cardiology Policlinico Universitario Campus Bio‐Medico Roma Italy
- Department of Cardiology Ospedali Riuniti Anzio‐Nettuno Anzio Italy
| | - Igor Diemberger
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine‐DIMES University of Bologna Bologna Italy
| | - Luca Bontempi
- Department of Cardiology Spedali Civili Brescia Brescia Italy
| | | | - Giovanni Bisignani
- Department of Cardiology Ospedale “Ferrari”, Castrovillari Cosenza Italy
| | - Silvia De Bonis
- Department of Cardiology Ospedale “Ferrari”, Castrovillari Cosenza Italy
| | | | - Vito Calabrese
- Department of Cardiology Policlinico Universitario Campus Bio‐Medico Roma Italy
| | - Carlo Lavalle
- Department of Cardiovascular/Respiratory Diseases, Nephrology, Anesthesiology, and Geriatric Sciences Policlinico Umberto I Sapienza University of Rome Rome Italy
| | - Agostino Piro
- Department of Cardiovascular/Respiratory Diseases, Nephrology, Anesthesiology, and Geriatric Sciences Policlinico Umberto I Sapienza University of Rome Rome Italy
| | | | - Luca Santini
- Division of Cardiology Ospedale G.B. Grassi Ostia Italy
| | - Francesco Grigioni
- Department of Cardiology Policlinico Universitario Campus Bio‐Medico Roma Italy
| | - Claudio Tondo
- Heart Rhythm Center Centro Cardiologico Monzino, IRCCS Milan Italy
- Department of Clinical Sciences and Community Health University of Milan Milan Italy
| | - Mauro Biffi
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine‐DIMES University of Bologna Bologna Italy
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24
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Singh P, Afzal MR, Weiss R. Perioperative considerations during implantation of the subcutaneous defibrillator: State‐of‐the‐art review. Pacing Clin Electrophysiol 2020; 43:1451-1458. [DOI: 10.1111/pace.14072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 09/08/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Prabhpreet Singh
- Division of Cardiovascular Medicine Wexner Medical Center, The Ohio State University Medical Center Columbus Ohio
| | - Muhammad Rizwan Afzal
- Division of Cardiovascular Medicine Wexner Medical Center, The Ohio State University Medical Center Columbus Ohio
| | - Raul Weiss
- Division of Cardiovascular Medicine Wexner Medical Center, The Ohio State University Medical Center Columbus Ohio
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25
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Rordorf R, Casula M, Pezza L, Fortuni F, Sanzo A, Savastano S, Vicentini A. Subcutaneous versus transvenous implantable defibrillator: An updated meta-analysis. Heart Rhythm 2020; 18:382-391. [PMID: 33212250 DOI: 10.1016/j.hrthm.2020.11.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Implantable cardioverter-defibrillator (ICD) placement is a well-established therapy for prevention of sudden cardiac death. The subcutaneous implantable cardioverter-defibrillator (S-ICD) was specifically designed to overcome some of the complications related to the transvenous implantable cardioverter-defibrillator (TV-ICD), such as lead complications and systemic infections. Evidence on the comparison of S-ICD vs TV-ICD are limited. OBJECTIVE The purpose of this study was to conduct an updated meta-analysis comparing S-ICD vs TV-ICD. METHODS Electronic databases were searched for studies directly comparing clinical outcomes and complications between S-ICD and TV-ICD. The primary outcome was the composite of clinically relevant complications (lead, pocket, major procedural complications; device-related infections) and inappropriate shocks. Secondary outcomes included death and the individual components of the primary outcome. RESULTS Thirteen studies comprising 9073 patients were included in the analysis. Mean left ventricular ejection fraction was 40% ± 10%; 30% of patients were female; and 73% had an ICD implanted for primary prevention. There was no statistically significant difference in the risk of the primary outcome between S-ICD and TV-ICD (odds ratio [OR] 0.80; 95% confidence interval [CI] 0.53-1.19). Patients with S-ICD had lower risk of lead complications (OR 0.14; 95% CI 0.06-0.29; P <.00001) and major procedural complications (OR 0.18; 95% CI 0.06-0.57; P = .003) but higher risk of pocket complications (OR 2.18; 95% CI 1.30-3.66; P = .003) compared to those with TV-ICD. No significant differences were found for the other outcomes. CONCLUSION In patients with an indication for ICD without the need for pacing, TV-ICD and S-ICD are overall comparable in terms of the composite of clinically relevant device-related complications and inappropriate shock.
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Affiliation(s)
- Roberto Rordorf
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy.
| | - Matteo Casula
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy; Department of Molecular Medicine, Unit of Cardiology, University of Pavia, Pavia, Italy
| | - Laura Pezza
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy; Department of Molecular Medicine, Unit of Cardiology, University of Pavia, Pavia, Italy
| | - Federico Fortuni
- Department of Molecular Medicine, Unit of Cardiology, University of Pavia, Pavia, Italy
| | - Antonio Sanzo
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy
| | - Simone Savastano
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy
| | - Alessandro Vicentini
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy
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Willy K, Reinke F, Rath B, Ellermann C, Wolfes J, Bögeholz N, Köbe J, Eckardt L, Frommeyer G. Pitfalls of the S-ICD therapy: experiences from a large tertiary centre. Clin Res Cardiol 2020; 110:861-867. [PMID: 33130912 PMCID: PMC8166696 DOI: 10.1007/s00392-020-01767-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/15/2020] [Indexed: 11/25/2022]
Abstract
Aim The subcutaneous ICD (S-ICD) has evolved to a potential first option for many patients who have to be protected from sudden cardiac death. Many trials have underlined a similar performance regarding its effectiveness in relation to transvenous ICDs and have shown the expected benefits concerning infective endocarditis and lead failure. However, there have also been problems due to the peculiarities of the device, such as oversensing and myopotentials. In this study, we present patients from a large tertiary centre suffering from complications with an S-ICD and propose possible solutions. Methods and results All S-ICD patients who experienced complications related to the device (n = 40) of our large-scale single-centre S-ICD registry (n = 351 patients) were included in this study. Baseline characteristics, complications occurring and solutions to these problems were documented over a mean follow-up of 50 months. In most cases (n = 23), patients suffered from oversensing (18 cases with T wave or P wave oversensing, 5 due to myopotentials). Re-programming successfully prevented further oversensing episode in 13/23 patients. In 9 patients, generator or lead-related complications, mostly due to infectious reasons (5/9), occurred. Further problems consisted of ineffective shocks in one patient and need for antibradycardia stimulation in 2 patients and indication for CRT in 2 other patients. In total, the S-ICD had to be extracted in 10 patients. 7 of them received a tv-ICD subsequently, 3 patients refused re-implantation of any ICD. One other patient kept the ICD but had antitachycardic therapy deactivated due to inappropriate shocks for myopotential oversensing. Conclusion The S-ICD is a valuable option for many patients for the prevention of sudden cardiac death. Nonetheless, certain problems are immanent to the S-ICD (limited re-programming options, size of the generator) and should be addressed in future generations of the S-ICD. Graphic abstract ![]()
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Affiliation(s)
- Kevin Willy
- Clinic for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Munster, Germany.
| | - Florian Reinke
- Clinic for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Munster, Germany
| | - Benjamin Rath
- Clinic for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Munster, Germany
| | - Christian Ellermann
- Clinic for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Munster, Germany
| | - Julian Wolfes
- Clinic for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Munster, Germany
| | - Nils Bögeholz
- Clinic for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Munster, Germany
| | - Julia Köbe
- Clinic for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Munster, Germany
| | - Lars Eckardt
- Clinic for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Munster, Germany
| | - Gerrit Frommeyer
- Clinic for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Munster, Germany
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Willy K, Reinke F, Bögeholz N, Köbe J, Eckardt L, Frommeyer G. The entirely subcutaneous ICDTM system in patients with congenital heart disease: experience from a large single-centre analysis. Europace 2020; 21:1537-1542. [PMID: 31302706 DOI: 10.1093/europace/euz190] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 06/19/2019] [Indexed: 01/27/2023] Open
Abstract
AIMS The subcutaneous implantable cardioverter-defibrillator (S-ICDTM) is an important advance in device therapy for the prevention of sudden cardiac death (SCD). Although current guidelines recommend S-ICDTM use, long-term data are still limited, especially in subgroups such as adult patients with congenital heart diseases. This cohort is of high interest because of the difficult anatomic conditions in these patients. METHODS AND RESULTS All S-ICDTM patients with an underlying congenital heart disease (CHD) resulting in an indication for ICD implantation (n = 20 patients) in our large-scaled single-centre S-ICDTM registry (n = 249 patients) were included in this study. Baseline characteristics, appropriate and inappropriate shocks, and complications were documented in a mean follow-up of 36 months. Primary prevention of SCD was the indication for implantation of an S-ICDTM in six patients (30%). Of all 20 patients with an overall mean age of 40.5 ± 11.5 years, 12 were male (60%). The mean left ventricular ejection fraction was 46.5 ± 11.3%. Nine episodes of ventricular tachycardia (two monomorphic and seven polymorphic) were adequately terminated in three patients (15%). In two patients, T-Wave-Oversensing resulting in an inappropriate shock was observed, which could be managed by changing the sensing vector or activation of the SMART PASSTM filter. There were no S-ICDTM system-related infections. In one patient, surgical revision was necessary due to a persistent haematoma. CONCLUSION The S-ICDTM seems to be a valuable option for the prevention of SCD in patients with various CHDs and complex anatomical anomalies. The S-ICDTM is safe and works effectively, also in these complex patients. Inadequate shock delivery was rare and could be managed by reprogramming.
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Affiliation(s)
- Kevin Willy
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, D Münster, Germany
| | - Florian Reinke
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, D Münster, Germany
| | - Nils Bögeholz
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, D Münster, Germany
| | - Julia Köbe
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, D Münster, Germany
| | - Lars Eckardt
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, D Münster, Germany
| | - Gerrit Frommeyer
- Department for Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer-Campus 1 Gebäude A1, D Münster, Germany
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Burke MC, Aasbo JD, El-Chami MF, Weiss R, Dinerman J, Hanon S, Kalahasty G, Bass E, Gold MR. 1-Year Prospective Evaluation of Clinical Outcomes and Shocks: The Subcutaneous ICD Post Approval Study. JACC Clin Electrophysiol 2020; 6:1537-1550. [PMID: 33213814 DOI: 10.1016/j.jacep.2020.05.036] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 05/24/2020] [Accepted: 05/26/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This study evaluated spontaneous arrhythmias and clinical outcomes in the S-ICD System PAS (Subcutaneous Implantable Cardioverter-Defibrillator Post Approval Study) cohort. BACKGROUND The U.S. S-ICD PAS trial patient population more closely resembles transvenous ICD cohorts than earlier studies, which included many patients with little structural heart disease and few comorbidities. Early outcomes and low peri-operative complication rates were demonstrated in the S-ICD PAS cohort, but there are no data detailing spontaneous arrhythmias and clinical outcomes. METHODS The S-ICD PAS prospective registry included 1,637 de novo patients from 86 U.S. centers. Descriptive statistics, Kaplan-Meier time to event, and multivariate logistic regression were performed using data out to 365 days. RESULTS Patients (68.5% men; mean ejection fraction of 32.0%; 42.9% ischemic; 13.4% on dialysis) underwent implantation for primary (76.6%) or secondary prevention indication. The complication-free rate was 92.5%. The appropriate shock (AS) rate was 5.3%. A total of 395 ventricular tachycardia (VT) or fibrillation (VF) episodes were appropriately sensed, with 131 (33.2%) self-terminating. First and final shock efficacy (up to 5 shocks) for the 127 discrete AS episodes were 91.3% and 100.0%, respectively. Discrete AS episodes included 67 monomorphic VT (MVT) and 60 polymorphic VT (PVT)/VF, with first shock efficacy of 95.2% and 86.7%, respectively. There were 19 storm events in 18 subjects, with 84.2% conversion success. Storm episodes were more likely PVT/VF (98 of 137). CONCLUSIONS In the first year after implantation, a predominantly primary prevention population with low ejection fraction demonstrated a high complication-free rate and spontaneous event shock efficacy for MVT and PVT/VF arrhythmias at rapid ventricular rates. (Subcutaneous Implantable Cardioverter-Defibrillator System Post Approval Study [S-ICD PAS; NCT01736618).
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Affiliation(s)
| | - Johan D Aasbo
- Department of Cardiac Electrophysiology, Baptist Health Lexington, Lexington, Kentucky, USA
| | - Mikhael F El-Chami
- Department of Medicine, Emory University Hospital, Atlanta, Georgia, USA
| | - Raul Weiss
- Department of Medicine, Ohio State University, Columbus, Ohio, USA
| | - Jay Dinerman
- Heart Center Research, LLC, Huntsville, Alabama, USA
| | - Sam Hanon
- Department of Medicine, Beth Israel Medical Center, New York, New York, USA
| | - Gauthem Kalahasty
- Department of Internal Medicine, Virginia Commonwealth University Health System, Richmond, Virginia, USA
| | - Eric Bass
- NAMSA (Biostatistics), Minneapolis, Minnesota, USA
| | - Michael R Gold
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
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van der Stuijt W, Baalman SWE, Brouwer TF, Quast AFBE, de Groot JR, Knops RE. Long-term follow-up of the two-incision implantation technique for the subcutaneous implantable cardioverter-defibrillator. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:1476-1480. [PMID: 32720398 PMCID: PMC7754287 DOI: 10.1111/pace.14022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/24/2020] [Accepted: 07/26/2020] [Indexed: 11/30/2022]
Abstract
Introduction The two‐incision implantation technique of the subcutaneous implantable cardioverter‐defibrillator (S‐ICD) was introduced as an alternative to the standard three‐incision approach by omitting the superior parasternal incision. Thereby, complications may be prevented. Short‐term follow‐up demonstrated the safety and efficacy of the two‐incision technique. However, long‐term results are lacking. Methods This retrospective study included patients implanted between February 2009 and June 2020. Patients were divided into a group of patients who were implanted with the standard three‐incision technique and a group who were implanted with the two‐incision technique. Outcomes were defibrillation impedance and efficacy and complications requiring intervention. Results A total of 268 patients were included (age 42.4 ± 16.6 years, 35.4% female, BMI 25.1 ± 4.5 kg/m2). Thirty‐one patients underwent S‐ICD implantation with the three‐incision technique and 237 patients with the two‐incision technique. First shock efficacy during defibrillation testing was 93% in the three‐incision group versus 94% in the two‐incision group (P = .69), and shock impedance was 85 versus 68 ohms (P = .04). First shock success was 75% versus 76% for spontaneous episodes (P = 1.00). Complication‐free survival at 5‐year follow‐up in the three‐incision group was estimated at 0.96 (95% CI 0.90‐1.00) versus 0.98 (95% CI 0.96‐1.00) in the two‐incision group (P = .20) and for inappropriate shocks at 5‐year 0.77 (95% CI 0.63‐0.94) versus 0.83 (95% CI 0.77‐0.89, P = .30), respectively. Conclusion Five‐year follow‐up in this S‐ICD cohort showed similar complication rates and effectiveness of two‐incision technique compared to the three‐incision technique. This technique offers physicians a less invasive and more simplified implantation procedure for the S‐ICD, with a better cosmetic result.
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Affiliation(s)
- Willeke van der Stuijt
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Sarah W E Baalman
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Tom F Brouwer
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Anne-Floor B E Quast
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Joris R de Groot
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Reinoud E Knops
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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30
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The role of entirely subcutaneous ICD™ systems in patients with dilated cardiomyopathy. J Cardiol 2020; 75:567-570. [DOI: 10.1016/j.jjcc.2019.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/26/2019] [Accepted: 10/15/2019] [Indexed: 02/04/2023]
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Baddour LM, Weiss R, Mark GE, El-Chami MF, Biffi M, Probst V, Lambiase PD, Miller MA, McClernon T, Hansen LK, Knight BP. Diagnosis and management of subcutaneous implantable cardioverter-defibrillator infections based on process mapping. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:958-965. [PMID: 32267974 PMCID: PMC7607386 DOI: 10.1111/pace.13902] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/16/2020] [Accepted: 03/02/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Infection is a well-recognized complication of cardiovascular implantable electronic device (CIED) implantation, including the more recently available subcutaneous implantable cardioverter-defibrillator (S-ICD). Although the AHA/ACC/HRS guidelines include recommendations for S-ICD use, currently there are no clinical trial data that address the diagnosis and management of S-ICD infections. Therefore, an expert panel was convened to develop consensus on these topics. METHODS A process mapping methodology was used to achieve a primary goal - the development of consensus on the diagnosis and management of S-ICD infections. Two face-to-face meetings of panel experts were conducted to recommend useful information to clinicians in individual patient management of S-ICD infections. RESULTS Panel consensus of a stepwise approach in the diagnosis and management was developed to provide guidance in individual patient management. CONCLUSION Achieving expert panel consensus by process mapping methodology in S-ICD infection diagnosis and management was attainable, and the results should be helpful in individual patient management.
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Affiliation(s)
- Larry M Baddour
- Division of Infectious Diseases, Department of Medicine, and Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Raul Weiss
- The Ohio State University Wexner Medical Center, Cardiology, DHLRI, Columbus, Ohio
| | - George E Mark
- Department of Cardiology, Cooper University Hospital, Camden, New Jersey
| | - Mikhael F El-Chami
- Division of Cardiology, Section of Electrophysiology, Emory University Hospital, Atlanta, Georgia
| | - Mauro Biffi
- Institute of Cardiology, S. Orsola Malpighi Hospital, Bologna, Italy
| | - Vincent Probst
- L'Institut du Thorax, CHU de Nantes, Cardiology, Nantes, France
| | - Pier D Lambiase
- UCL Institute of Cardiovascular Science, and Barts Heart Center, London, UK
| | - Marc A Miller
- Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York
| | | | | | - Bradley P Knight
- Center for Heart Rhythm Disorders Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, Illinois
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Ishida Y, Sasaki S, Toyama Y, Nishizaki K, Shoji Y, Kinjo T, Itoh T, Horiuchi D, Kimura M, Gold MR, Tomita H. A novel screening test for inappropriate shocks due to myopotentials from the subcutaneous implantable cardioverter–defibrillator. Heart Rhythm O2 2020; 1:27-34. [PMID: 34113857 PMCID: PMC8183885 DOI: 10.1016/j.hroo.2020.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background The subcutaneous implantable cardioverter-defibrillator (S-ICD) is effective in preventing sudden cardiac death. Compared with transvenous ICDs, S-ICDs have a lower rate of inappropriate shocks (IASs) for supraventricular arrhythmias, but such shocks for T-wave oversensing (TWO) and extracardiac myopotentials are more common. No screening tests to identify patients at risk for IAS due to myopotential interference (MPI) currently are available. Objective The purpose of this study was to assess the efficacy of a tube exercise test (TET) developed to detect MPI post S-ICD implantation. Methods TET includes 3 different maneuvers using an exercise tube. S-ICD electrograms were recorded to assess MPI while patients performed each of the maneuvers. Results TET was performed in 43 patients, and MPI was observed in 12 patients (28%). In 10 of the 12 TET-positive patients, the positive vector corresponded with a vector that did not show TWO on standard S-ICD preoperative screening. During median follow-up of 672 days (interquartile range 465–805 days), 3 patients (7%) experienced IAS due to MPI. Importantly, the vector at the time of IAS in all 3 patients passed standard preoperative screening for TWO but was positive with TET. Sensitivity and specificity of TET were 100% and 78%, respectively, and positive and negative predictive values were 25% and 100%, respectively. Conclusion Postimplant screening for MPI identified patients at increased risk for IAS. TET may be helpful for guiding optimal programming to prevent IAS.
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Affiliation(s)
- Yuji Ishida
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Shingo Sasaki
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuichi Toyama
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kimitaka Nishizaki
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yoshihiro Shoji
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takahiko Kinjo
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Taihei Itoh
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Daisuke Horiuchi
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Masaomi Kimura
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Michael R. Gold
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Hirofumi Tomita
- Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
- Address reprint requests and correspondence: Dr Hirofumi Tomita, Department of Cardiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan.
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Mohammed M, Arshi J, Ramza BM, Wimmer AP, Steinhaus DA, Giocondo MJ, Gupta SK, Yousuf OK. Outcomes using a single tapered dilator for Micra leadless pacemaker implant. Indian Pacing Electrophysiol J 2020; 20:105-111. [PMID: 32145397 PMCID: PMC7244861 DOI: 10.1016/j.ipej.2020.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 02/24/2020] [Accepted: 03/01/2020] [Indexed: 11/30/2022] Open
Abstract
Objectives Comparison of outcomes, device deployment time (DT), and total time (TT) using a single tapered Coons dilator versus sequential serial dilation for implantation of the Micra leadless pacemaker. Background Micra leadless pacemaker placement requires a 23 French Micra introducer sheath (MIS) for percutaneous delivery. We sought to evaluate outcomes with use of a single tapered Coons dilator (CD) versus sequential serial dilatation (SD) method to facilitate insertion of the Micra introducer sheath. Methods 35 patients were included in the SD arm and 49 in the CD arm. DT and TT were recorded in minutes and cost in dollars. Analysis was performed using independent t-test between two groups and one-way ANOVA to evaluate inter-operator variability in the CD arm. Results Both DT and TT were significantly lower for the CD arm (15.1 ± 5.1 vs 23.5 ± 9.3, p < 0.0005 and 29.9 ± 14 vs 39.3 ± 13.5 min, p = 0.000374; respectively). The cost was also significantly lower using a CD versus SD. There was no inter-operator variability in the CD arm between 6 operators (p = 0.177 for DT and p = 0.304 for TT). No complications occurred in the SD arm. There were 3 vascular access site complications in the CD arm, all of which occurred early in the operator’s experience. Conclusion Coons dilator is an efficient and cost-effective method for vascular dilatation to facilitate Micra leadless pacemaker insertion. Rate of complications is low and expected to improve with greater experience.
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Affiliation(s)
- Moghniuddin Mohammed
- Department of Medicine, Saint Luke's Hospital, Kansas City, MO, USA; Department of Biomedical and Health Informatics, University of Missouri Kansas City, MO, USA
| | - Juwairiya Arshi
- Department of Medicine, Saint Luke's Hospital, Kansas City, MO, USA
| | - Brian M Ramza
- Division of Cardiology, Saint Luke's MidAmerica Heart Institute, Kansas City, MO, USA; University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - Alan P Wimmer
- Division of Cardiology, Saint Luke's MidAmerica Heart Institute, Kansas City, MO, USA; University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - Daniel A Steinhaus
- Division of Cardiology, Saint Luke's MidAmerica Heart Institute, Kansas City, MO, USA; University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - Michael J Giocondo
- Division of Cardiology, Saint Luke's MidAmerica Heart Institute, Kansas City, MO, USA; University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - Sanjaya K Gupta
- Division of Cardiology, Saint Luke's MidAmerica Heart Institute, Kansas City, MO, USA; University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - Omair K Yousuf
- Division of Cardiology, Saint Luke's MidAmerica Heart Institute, Kansas City, MO, USA; University of Missouri Kansas City School of Medicine, Kansas City, MO, USA.
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Kaya E, Siebermair J, Vonderlin N, Hadjamu N, Azizy O, Rassaf T, Wakili R. Impact of diabetes as a risk factor in patients undergoing subcutaneous implantable cardioverter defibrillator implantation: A single-centre study. Diab Vasc Dis Res 2020; 17:1479164120911560. [PMID: 32292066 PMCID: PMC7510351 DOI: 10.1177/1479164120911560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Patients with diabetes mellitus are known to carry an increased risk for surgical site infections and perioperative complications. The subcutaneous implantable cardioverter defibrillator is an established treatment option in patients at risk for sudden cardiac death especially with an increased risk for infection over time. METHODS AND RESULTS Forty-eight patients (mean age = 55.0 ± 21.3 years, 31.3% patients with diabetes mellitus, 75% male) who underwent consecutive subcutaneous implantable cardioverter defibrillator surgery between February 2016 and May 2019 were retrospectively analysed. Overall adverse events including relevant bleeding complications, any surgical wound problems and infections requiring reoperation or device malfunction were evaluated as primary combined safety endpoint. Patients with diabetes mellitus tended to be older with a higher body mass index compared to non-diabetes mellitus. Procedure duration and postsurgery hospital days were not different in diabetes mellitus versus non-diabetes mellitus patients. Analysis of the primary combined endpoint showed no significant difference but a trend towards higher event rates in the diabetes mellitus group (diabetes mellitus vs non-diabetes mellitus: 20% vs 12.1%, p = 0.119). CONCLUSION Diabetes mellitus is a frequent and relevant variable in patients undergoing subcutaneous implantable cardioverter defibrillator implantation represented by 31.3% in this consecutive cohort. Our results suggest that diabetes mellitus is not associated with a prolonged hospital stay or increased rate of periprocedural adverse events.
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Affiliation(s)
| | | | | | | | | | | | - Reza Wakili
- Reza Wakili, Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, University of Duisburg–Essen, Essen, Hufelandstrasse 55, 45147 Essen, Germany.
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Rudic B, Tülümen E, Fastenrath F, Röger S, Goranova D, Akin I, Borggrefe M, Kuschyk J. Incidence, mechanisms, and clinical impact of inappropriate shocks in patients with a subcutaneous defibrillator. Europace 2020; 22:761-768. [DOI: 10.1093/europace/euaa026] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 01/23/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aims
Inappropriate shocks (IAS) remain a challenge for patients and physicians after implantation of the subcutaneous implantable cardioverter-defibrillator (S-ICD). The aims were to assess and characterize different patterns of IAS.
Methods and results
Two hundred and thirty-nine patients were implanted with an S-ICD between 2010 and 2018 for primary and secondary prevention. Follow-up data of at least 6 months were analysed. During a mean follow-up of 34.9 ± 16.0 months, a total of 73 shocks occurred in 38 patients (6%). Forty-three (59%) shocks were considered appropriate due to ventricular tachycardia/ventricular fibrillation, while 30 (41%) were inappropriate and occurred in 19 patients (8%). Myopotentials/noise was the most frequent cause of inappropriate shocks (n = 8), followed by T-wave oversensing (n = 6) and undersensing of the QRS, resulting in adaptation of the automatic gain control and inappropriate shock (n = 5). Seventy-four percent of all IAS occurred on the primary vector, while no IAS occurred on the alternate vector. In seven of eight patients (88%), IAS related to myopotentials have occurred on the primary sensing vector. Multivariate analysis identified taller patients, primary sensing vector and first-generation S-ICD device as predictors for IAS. SMART pass effectively reduced the occurrence of IAS in the second-generation S-ICD system.
Conclusion
Inappropriate therapies are less frequently observed on the alternate vector. The primary vector seems to be unfavourable with regard to oversensing caused by myopotentials. Inappropriate shocks were associated with an increased rate of rehospitalization but not mortality. These observations have implications for the prevention of inappropriate S-ICD shocks.
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Affiliation(s)
- Boris Rudic
- 1st Department of Medicine - Cardiology, University Medical Centre Mannheim, D-68167 Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Erol Tülümen
- 1st Department of Medicine - Cardiology, University Medical Centre Mannheim, D-68167 Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Fabian Fastenrath
- 1st Department of Medicine - Cardiology, University Medical Centre Mannheim, D-68167 Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Susanne Röger
- 1st Department of Medicine - Cardiology, University Medical Centre Mannheim, D-68167 Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Diana Goranova
- 1st Department of Medicine - Cardiology, University Medical Centre Mannheim, D-68167 Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- 1st Department of Medicine - Cardiology, University Medical Centre Mannheim, D-68167 Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Martin Borggrefe
- 1st Department of Medicine - Cardiology, University Medical Centre Mannheim, D-68167 Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Jürgen Kuschyk
- 1st Department of Medicine - Cardiology, University Medical Centre Mannheim, D-68167 Mannheim, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
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Okabe T, Miller A, Koppert T, Cavalcanti R, Alcivar-Franco D, Osei J, Kahaly O, Afzal MR, Tyler J, Kalbfleisch SJ, Weiss R, Houmsse M, Augostini RS, Daoud EG, Andritsos MJ, Bhandary S, Dimitrova G, Fiorini K, Elsayed-Awad H, Flores A, Gorelik L, Iyer MH, Saklayen S, Stein E, Turner K, Perez W, Hummel JD, Essandoh MK. Feasibility and safety of same day subcutaneous defibrillator implantation and send home (DASH) strategy. J Interv Card Electrophysiol 2019; 57:311-318. [PMID: 31813098 DOI: 10.1007/s10840-019-00673-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/19/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To assess the feasibility and safety of same-day discharge after S-ICD implantation by implementing a specific analgesia protocol and phone follow-up. METHODS Consecutive patients presenting for outpatient S-ICD implantation were enrolled between 1/1/2018 and 4/30/2019. An analgesia protocol included pre-operative acetaminophen and oxycodone, intraoperative local bupivacaine, and limited use of oxycodone-acetaminophen at discharge. The primary outcome was successful same-day discharge. Numerical Pain Rating Scale (NPRS) on postoperative day (POD) 1, 3, 14, and 30 and any unplanned health care visits during the 1-month follow-up period were assessed. RESULTS Out of 53 potentially eligible S-ICD patients, 49 patients (92.5%) were enrolled and successfully discharged on the same day. Mean age of these 49 patients was 47 ± 14 years. There were no acute procedural complications. Severe pain (NPRS ≥ 8) on POD 0, 1, and 3 was present in 14.3%, 14.3%, and 8.2% of patients, respectively. The total in-hospital stay was 534 ± 80 min. Four unplanned visits (8%) due to cardiac or device-related issues occurred during 1-month follow-up, including 2 patients with heart failure exacerbation, one patient with an incisional infection, and one patient with inappropriate shocks. CONCLUSIONS With the appropriate institutional protocol including specific analgesics and phone follow-up, same-day discharge after outpatient S-ICD implantation is feasible and appears safe for most patients.. Device-related pain can be severe in the first 3 days post-implantation and can be successfully treated with limited supply of narcotic medications.
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Affiliation(s)
- Toshimasa Okabe
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Adrianne Miller
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Tanner Koppert
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Rafael Cavalcanti
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Diego Alcivar-Franco
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jemina Osei
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Omar Kahaly
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Muhammad R Afzal
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jaret Tyler
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Steven J Kalbfleisch
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Raul Weiss
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Mahmoud Houmsse
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ralph S Augostini
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Emile G Daoud
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Michael J Andritsos
- Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Sujatha Bhandary
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Galina Dimitrova
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kasey Fiorini
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Hamdy Elsayed-Awad
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Antolin Flores
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Leonid Gorelik
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Manoj H Iyer
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Samiya Saklayen
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Erica Stein
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Katja Turner
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - William Perez
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - John D Hummel
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Michael K Essandoh
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Ziacchi M, Bisignani G, Palmisano P, Scalone A, Martignani C, Elvira Mocavero P, Caravati F, Della Cioppa N, Mazzuero A, Pecora D, Vicentini A, Landolina ME, Debonis S, Scimia P, Lovecchio M, Valsecchi S, Diemberger I, Droghetti A. Serratus anterior plane block in subcutaneous implantable cardioverter defibrillator implantation: A case‐control analysis. J Cardiovasc Electrophysiol 2019; 31:144-149. [DOI: 10.1111/jce.14293] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/15/2019] [Accepted: 11/25/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Matteo Ziacchi
- Institute of CardiologyUniversity of Bologna, Policlinico S.Orsola‐MalpighiBologna Italy
| | | | | | | | - Cristian Martignani
- Institute of CardiologyUniversity of Bologna, Policlinico S.Orsola‐MalpighiBologna Italy
| | - Paola Elvira Mocavero
- “Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie”, Monaldi HospitalNaples Italy
| | - Fabrizio Caravati
- Division of Cardiology“Circolo e Fondazione Macchi” HospitalVarese Italy
| | - Nadia Della Cioppa
- Division of CardiologySecond University of Naples, Monaldi HospitalNaples Italy
| | | | | | | | | | | | - Paolo Scimia
- Department of Anesthesia and Intensive Care UnitASST CremonaCremona Italy
| | | | | | - Igor Diemberger
- Institute of CardiologyUniversity of Bologna, Policlinico S.Orsola‐MalpighiBologna Italy
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Outcome differences and device performance of the subcutaneous ICD in patients with and without structural heart disease. Clin Res Cardiol 2019; 109:755-760. [PMID: 31667624 DOI: 10.1007/s00392-019-01564-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The performance of the subcutaneous ICD (S-ICD™) has been described in different kinds of heart disease and has been proven to be an important advance in prevention of sudden cardiac death (SCD). While positive experiences with the S-ICD™ initially came from collectives of patients without structural heart diseases, positive results have also been collected from cohorts with structural heart disease. MATERIALS AND METHODS All S-ICD™ patients with either ischemic cardiomyopathy (ICM), dilated cardiomyopathy (DCM) or hypertrophic cardiomyopathy (HCM) as the main indication for ICD implantation (n = 144 patients) or electrical heart disease/idiopathic ventricular fibrillation (n = 83 patients) in our large-scaled single-center S-ICD™ registry were included in this study. Baseline characteristics, appropriate and inappropriate shocks, and complications were documented in a mean follow-up of 18 ± 15 months. RESULTS Baseline characteristics were significantly different between the two groups in most categories. In contrast, there was no difference concerning neither appropriate nor inappropriate shock delivery between the two groups. Also other outcome parameters such as need for surgical revisions and all-cause mortality did not differ. There was a significant difference between the first- and second-generation S-ICDs™ in inadequate shocks mainly driven by patients with HCM. CONCLUSION In our study, S-ICD™ performance was similar in patients with and without structural heart disease. Decision pro- or contra-S-ICD™ should be made rather on the basis of expected shock rate and probability of the need for future anti-tachycardia or anti-bradycardia pacing than in dependence of the underlying heart disease.
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39
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The subcutaneous implantable cardioverter-defibrillator in review. Am Heart J 2019; 217:131-139. [PMID: 31654943 DOI: 10.1016/j.ahj.2019.08.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 08/13/2019] [Indexed: 01/14/2023]
Abstract
The subcutaneous implantable cardioverter defibrillator (S-ICD) is a completely extrathoracic device that has recently been FDA approved for the prevention of sudden cardiac death in select populations. Although the transvenous implantable cardioverter defibrillator (TV-ICD) has a proven mortality benefit in multiple patient populations, there are significant risks both with implantation and years after its placement. The S-ICD may help prevent some of these complications. Currently, the S-ICD is typically implanted in patients with prior device infection or at an increased risk for an infection, younger patients with difficult venous access related to either hemodialysis or difficult cardiac anatomy, patients who live active lifestyles, and those who may outlive the TV-ICD leads. There is an absolute contraindication for S-ICD implantations for patients who need pacing either for ventricular tachycardia or bradycardia because this device cannot perform these functions. To date, there are no randomized controlled trial (RCT) data evaluating the safety and efficacy of this relatively new device. Observational studies of both the S-ICD alone and in comparison with the TV-ICD have showed promising results, including a decrease in lead-related and periprocedural complications as well as a high level of effectiveness at terminating ventricular arrhythmias. These analyses over time may have contributed to the evolution and comfortability with the S-ICD system, as physicians are more often referring for and/or implanting this device for patients with appropriate indications. Furthermore, inappropriate shock rates with the S-ICD have decreased over time especially with dual zone programming. This review summarizes the results of a multitude of observational studies with respect to patient selection for the S-ICD, complication rates, appropriate and inappropriate shock rates, and programming. This review also tackles current ongoing randomized trials. Although the results of ongoing trials will be helpful, there is still a continued need to evaluate the efficacy of the S-ICD in broader patient populations including patients with several comorbidities and older patients so that more patients can be considered for this potentially lifesaving device.
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40
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Boersma LV, El-Chami MF, Bongiorni MG, Burke MC, Knops RE, Aasbo JD, Lambiase PD, Deharo JC, Russo AM, Dinerman J, Shaik N, Barr CS, Carter N, Appl U, Brisben AJ, Stein KM, Gold MR. Understanding Outcomes with the EMBLEM S-ICD in Primary Prevention Patients with Low EF Study (UNTOUCHED): Clinical characteristics and perioperative results. Heart Rhythm 2019; 16:1636-1644. [DOI: 10.1016/j.hrthm.2019.04.048] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Indexed: 10/26/2022]
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41
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Performance of the entirely subcutaneous ICD in borderline indications. Clin Res Cardiol 2019; 109:694-699. [DOI: 10.1007/s00392-019-01558-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 09/24/2019] [Indexed: 01/16/2023]
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42
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Quast AB, Baalman SW, Van der Stuijt W, Wilde AA, Knops RE. Minimal defibrillation thresholds and the correlation with implant position in subcutaneous implantable‐defibrillator patients. J Cardiovasc Electrophysiol 2019; 30:2441-2447. [DOI: 10.1111/jce.14171] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/20/2019] [Accepted: 09/06/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Anne‐Floor B.E. Quast
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | - Sarah W.E. Baalman
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | - Willeke Van der Stuijt
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | - Arthur A.M. Wilde
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | - Reinoud E. Knops
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
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43
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León Salas B, Trujillo-Martín MM, García García J, Ramallo Fariña Y, García Quintana A, Quirós López R, Serrano-Aguilar P. Subcutaneous implantable cardioverter-defibrillator in primary and secondary prevention of sudden cardiac death: A meta-analysis. Pacing Clin Electrophysiol 2019; 42:1253-1268. [PMID: 31396970 DOI: 10.1111/pace.13774] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/18/2019] [Accepted: 08/04/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Subcutaneous implantable cardioverter-defibrillator (S-ICD) is gaining in popularity for primary and secondary prevention of sudden cardiac death. The objective was to evaluate the safety and clinical effectiveness of the S-ICD for prevention of sudden cardiac death compared to transvenous cardioverter-defibrillator (TV-ICD). METHODS A systematic review with meta-analyses was performed. The electronic databases MEDLINE, EMBASE, SCI, and Cochrane Central Register of Controlled Trials were consulted in March 2018 with no restrictions on publication date. Predefined criteria were used to determine inclusion of studies and to assess their methodologic quality. RESULTS Ten longitudinal-observational studies with comparison group presenting moderate methodologic flaws were included (N = 7820). The combination of results indicates that health-related quality of life is not significantly different between S-ICD and TV-ICD groups (Physical health: MD = 2.90; 95% CI = -3.88, 9.68/Mental health: MD = 0.13; 95% CI = -2.11, 2.37). Mortality occurred in 4.4% of S-ICD patients and 5.9% of TV-ICD patients died (OR = 0.79; 95% CI = 0.50, 1.24). The incidence of infections (OR = 1.79; 95% CI = 0.93, 3.43) and inappropriate shocks (OR = 1.28, 95% CI = 0.91, 1.78) is not significantly different between both groups. The S-ICD reduces complications related to electrodes/leads (OR = 0.13, 95% CI = 0.05, 0.29) and has lower electrodes/leads movement compared with TV-ICD (OR = 0.26; 95% CI 0.10, 0.67). In contrast, pneumothorax is more likely in TV-ICD than S-ICD (OR = 0.17; 95% CI = 0.03, 0.97). CONCLUSIONS S-ICD reduces electrodes/leads movement, electrodes/leads related complications, and pneumothorax. Our study did not demonstrate a statistically significant difference in mortality, health-related quality of life, and infection rate between S-ICD and TV-ICD.
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Affiliation(s)
- Beatriz León Salas
- Canary Islands Foundation of Health Research (FUNCANIS), Santa Cruz de Tenerife, Spain.,Spanish Network of Health Technology Assessment (RedETS), Spain
| | - María M Trujillo-Martín
- Canary Islands Foundation of Health Research (FUNCANIS), Santa Cruz de Tenerife, Spain.,Spanish Network of Health Technology Assessment (RedETS), Spain.,Health Services and Chronic Diseases Research Network (REDISSEC), Spain.,Center for Biomedical Research of the Canary Islands (CIBICAN), Santa Cruz de Tenerife, Spain
| | - Javier García García
- Quality and Patient Safety Unit, Nuestra Señora de Candelaria University Hospital, Santa Cruz de Tenerife, Spain
| | - Yolanda Ramallo Fariña
- Canary Islands Foundation of Health Research (FUNCANIS), Santa Cruz de Tenerife, Spain.,Spanish Network of Health Technology Assessment (RedETS), Spain.,Health Services and Chronic Diseases Research Network (REDISSEC), Spain.,Center for Biomedical Research of the Canary Islands (CIBICAN), Santa Cruz de Tenerife, Spain
| | - Antonio García Quintana
- Cardiology Unit, Dr. Negrin University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Raúl Quirós López
- Health Services and Chronic Diseases Research Network (REDISSEC), Spain.,Internal Medicine Service, Costa del Sol Hospital, Marbella, Spain
| | - Pedro Serrano-Aguilar
- Spanish Network of Health Technology Assessment (RedETS), Spain.,Health Services and Chronic Diseases Research Network (REDISSEC), Spain.,Center for Biomedical Research of the Canary Islands (CIBICAN), Santa Cruz de Tenerife, Spain.,Evaluation Service of the Canary Islands Health Service (SESCS), Canary Islands Health Service, Santa Cruz de Tenerife, Spain
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Mascheroni J, Mont L, Stockburger M, Patwala A, Retzlaff H, Gallagher AG, Alonso C, Binner L, Bongiorni MG, Diaz Infante E, Gadler F, Gras D, Margitfalvi P, Moreno J, Paratsii O, Rao A, Schäfer H, van Kraaij D. International expert consensus on a scientific approach to training novice cardiac resynchronization therapy implanters using performance quality metrics. Int J Cardiol 2019; 289:63-69. [DOI: 10.1016/j.ijcard.2019.04.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/12/2019] [Accepted: 04/10/2019] [Indexed: 01/22/2023]
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45
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Willy K, Bettin M, Reinke F, Bögeholz N, Ellermann C, Rath B, Leitz P, Köbe J, Eckardt L, Frommeyer G. Feasibility of entirely subcutaneous ICD™ systems in patients with coronary artery disease. Clin Res Cardiol 2019; 108:1234-1239. [PMID: 30903274 DOI: 10.1007/s00392-019-01455-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 03/13/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND The subcutaneous ICD (S-ICD™) is an important advance in device therapy for the prevention of sudden cardiac death (SCD). Although current guidelines recommend S-ICD™ use, long-term data are still limited, especially in subgroups. Among several cardiac diseases that prone to SCD, coronary artery disease (CAD) carries several peculiarities that may hamper S-ICD™ therapy in this cohort. CAD can lead to an ischemic cardiomyopathy (ICM) with a reduced left-ventricular ejection fraction (LVEF) and bundle branch blocks, which can be difficult for ICD sensing and discrimination of arrhythmia. CAD is mainly driven by risk factors such as diabetes mellitus, which put these patients at an elevated risk for infectious complications of cardiac devices. Furthermore, in ICM myocardial scars are frequent and are a potential substrate for ventricular tachycardia, which may be accessible for antitachycardia pacing. At the moment, it remains unclear if there is a value of S-ICD™ therapy in this subgroup. Therefore, this study analysed patients with CAD. MATERIALS AND METHODS All S-ICD™ patients with CAD as the main indication for ICD implantation (n = 45 patients) in our large-scaled single-center S-ICD™ registry (n = 249 patients) were included in this study. Baseline characteristics, appropriate and inappropriate shocks, and complications were documented in a mean follow-up of 22.5 ± 8.3 months. RESULTS Primary prevention of SCD was the indication for implantation of an S-ICD™ in 28 patients (62%). Of all 45 patients with an overall mean age of 58.1 ± 11.4 years, 40 were male (88%). The mean LVEF was 37.7 ± 12.6%. Three episodes of ventricular arrhythmia (one monomorphic, one polymorphic, one ventricular fibrillation) were adequately terminated in three patients (7%). In only one patient, oversensing resulting in an inappropriate shock was observed, which could be managed by changing the sensing vector. 15 of the examined 45 patients previously had a transvenous ICD, which was explanted due to system-related infections. In only two patients, S-ICD™ was changed to transvenous ICD because of the need of antibradycardia stimulation. There were no S-ICD™ system-related infections. CONCLUSION The S-ICD™ seems to be a valuable option for the prevention of SCD in CAD patients. Patients with systemic infections of a transvenous ICD and, therefore, a need for an alternative might benefit from the absence of intracardiac leads as the S-ICD™ is safe and works flawlessly in these patients. Inadequate shock delivery was very rare, while every episode of ventricular arrhythmia was terminated by the first shock.
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Affiliation(s)
- Kevin Willy
- Clinic for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Markus Bettin
- Clinic for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Florian Reinke
- Clinic for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Nils Bögeholz
- Clinic for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Christian Ellermann
- Clinic for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Benjamin Rath
- Clinic for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Patrick Leitz
- Clinic for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Julia Köbe
- Clinic for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Lars Eckardt
- Clinic for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany
| | - Gerrit Frommeyer
- Clinic for Cardiology II: Electrophysiology, University Hospital Münster, Münster, Germany.
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Bögeholz N, Willy K, Niehues P, Rath B, Dechering DG, Frommeyer G, Kochhäuser S, Löher A, Köbe J, Reinke F, Eckardt L. Spotlight on S-ICD™ therapy: 10 years of clinical experience and innovation. Europace 2019; 21:1001-1012. [DOI: 10.1093/europace/euz029] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 02/09/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Subcutaneous ICD (S-ICD™) therapy has been established in initial clinical trials and current international guideline recommendations for patients without demand for pacing, cardiac resynchronization, or antitachycardia pacing. The promising experience in ‘ideal’ S-ICD™ candidates increasingly encourages physicians to provide the benefits of S-ICD™ therapy to patients in clinical constellations beyond ‘classical’ indications of S-ICD™ therapy, which has led to a broadening of S-ICD™ indications in many centres. However, the decision for S-ICD™ implantation is still not covered by controlled randomized trials but rather relies on patient series or observational studies. Thus, this review intends to give a contemporary update on available empirical evidence data and technical advancements of S-ICD™ technology and sheds a spotlight on S-ICD™ therapy in recently discovered fields of indication beyond ideal preconditions. We discuss the eligibility for S-ICD™ therapy in Brugada syndrome as an example for an adverse and dynamic electrocardiographic pattern that challenges the S-ICD™ sensing and detection algorithms. Besides, the S-ICD™ performance and defibrillation efficacy in conditions of adverse structural remodelling as exemplified for hypertrophic cardiomyopathy is discussed. In addition, we review recent data on potential device interactions between S-ICD™ systems and other implantable cardio-active systems (e.g. pacemakers) including specific recommendations, how these could be prevented. Finally, we evaluate limitations of S-ICD™ therapy in adverse patient constitutions, like distinct obesity, and present contemporary strategies to assure proper S-ICD™ performance in these patients. Overall, the S-ICD™ performance is promising even for many patients, who may not be ‘classical’ candidates for this technology.
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Affiliation(s)
- Nils Bögeholz
- Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany
| | - Kevin Willy
- Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany
| | - Philipp Niehues
- Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany
| | - Benjamin Rath
- Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany
| | - Dirk G Dechering
- Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany
| | - Gerrit Frommeyer
- Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany
| | - Simon Kochhäuser
- Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany
| | - Andreas Löher
- Department of Cardiothoracic Surgery, University Hospital of Muenster, Muenster, Germany
| | - Julia Köbe
- Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany
| | - Florian Reinke
- Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany
| | - Lars Eckardt
- Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany
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Migliore F, Mattesi G, De Franceschi P, Allocca G, Crosato M, Calzolari V, Fantinel M, Ortis B, Facchin D, Daleffe E, Fabris T, Marras E, De Lazzari M, Zanon F, Marcantoni L, Siciliano M, Corrado D, Iliceto S, Bertaglia E, Zecchin M. Multicentre experience with the second-generation subcutaneous implantable cardioverter defibrillator and the intermuscular two-incision implantation technique. J Cardiovasc Electrophysiol 2019; 30:854-864. [PMID: 30827041 PMCID: PMC6850019 DOI: 10.1111/jce.13894] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 02/14/2019] [Accepted: 02/25/2019] [Indexed: 11/27/2022]
Abstract
Introduction The recently developed second‐generation subcutaneous implantable cardioverter defibrillator (S‐ICD) and the intermuscular two‐incision implantation technique demonstrate potential favorable features that reduce inappropriate shocks and complications. However, data concerning large patient populations are lacking. The aim of this multicentre prospective study was to evaluate the safety and outcome of second‐generation S‐ICD using the intermuscular two‐incision technique in a large population study. Methods and Results The study population included 101 consecutive patients (75% male; mean age, 45 ± 13 years) who received second‐generation S‐ICD (EMBLEM; Boston Scientific, Marlborough, MA) implantation using the intermuscular two‐incision technique as an alternative to the standard implantation technique. Twenty nine (29%) patients were implanted for secondary prevention. Twenty four (24%) patients had a previously implanted transvenous ICD. All patients were implanted without any procedure‐related complications. Defibrillation testing was performed in 80 (79%) patients, and ventricular tachycardia was successfully converted at less than or equal to 65 J in 98.75% (79/80) of patients without pulse generator adjustments. During a median follow‐up of 21 ± 10 months, no complications requiring surgical revision or local or systemic device‐related infections were observed. Ten patients (9.9%) received appropriate and successful shocks for ventricular arrhythmias. Three (2.9%) patients experienced inappropriate shocks due to oversensing the cardiac signal (n = 1), noncardiac signal (n = 1), and a combination of both cardiac and noncardiac signals (n = 1), with one patient requiring device explantation. No patients required device explantation due to antitachycardia pacing indications. Conclusions According to our multicentre study, second‐generation S‐ICD implanted with the intermuscular two‐incision technique is an available safe combination and appears to be associated with a low risk of complications, such as inappropriate shocks.
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Affiliation(s)
- Federico Migliore
- Department of Cardiac, Thoracic And Vascular Sciences, University of Padova, Padova, Italy
| | - Giulia Mattesi
- Department of Cardiac, Thoracic And Vascular Sciences, University of Padova, Padova, Italy
| | - Pietro De Franceschi
- Department of Cardiac, Thoracic And Vascular Sciences, University of Padova, Padova, Italy
| | - Giuseppe Allocca
- Department of Cardiology, Hospital of Conegliano, Treviso, Italy
| | - Martino Crosato
- Department of Cardiology, Ca´ Foncello, Civil Hospital, Treviso, Italy
| | | | - Mauro Fantinel
- Department of Cardiology, Civil Hospital, Feltre, Belluno, Italy
| | - Benedetta Ortis
- Cardiovascular Department, University of Trieste, Trieste, Italy
| | - Domenico Facchin
- Cardiology Division, Azienda Sanitaria Universitaria Integrata di Udine and IRCAB Foundation, P.le Santa Maria della Misericordia, Udine, Italy
| | - Elisabetta Daleffe
- Cardiology Division, Azienda Sanitaria Universitaria Integrata di Udine and IRCAB Foundation, P.le Santa Maria della Misericordia, Udine, Italy
| | - Tommaso Fabris
- Department of Cardiac, Thoracic And Vascular Sciences, University of Padova, Padova, Italy
| | - Elena Marras
- Department of Cardiology, Dell´Angelo Hospital, Mestre, Italy
| | - Manuel De Lazzari
- Department of Cardiac, Thoracic And Vascular Sciences, University of Padova, Padova, Italy
| | - Francesco Zanon
- Cardiology Department, Arrhythmia And Electrophysiology Unit, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | - Lina Marcantoni
- Cardiology Department, Arrhythmia And Electrophysiology Unit, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | | | - Domenico Corrado
- Department of Cardiac, Thoracic And Vascular Sciences, University of Padova, Padova, Italy
| | - Sabino Iliceto
- Department of Cardiac, Thoracic And Vascular Sciences, University of Padova, Padova, Italy
| | - Emanuele Bertaglia
- Department of Cardiac, Thoracic And Vascular Sciences, University of Padova, Padova, Italy
| | - Massimo Zecchin
- Cardiovascular Department, University of Trieste, Trieste, Italy
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48
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Quast AFBE, Baalman SWE, Brouwer TF, Smeding L, Wilde AAM, Burke MC, Knops RE. A novel tool to evaluate the implant position and predict defibrillation success of the subcutaneous implantable cardioverter-defibrillator: The PRAETORIAN score. Heart Rhythm 2019; 16:403-410. [PMID: 30292861 DOI: 10.1016/j.hrthm.2018.09.029] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Suboptimal positioning of the subcutaneous implantable cardioverter-defibrillator (S-ICD) increases the defibrillation threshold and risk of conversion failure. OBJECTIVE Our objective is to develop a tool to evaluate the implant position and predict defibrillation success of the S-ICD: the PRAETORIAN score. METHODS The PRAETORIAN score is based on clinical and computer modeling knowledge of determinants affecting the defibrillation threshold: subcoil fat, subgenerator fat, and anterior positioning of the S-ICD generator. The score evaluates these determinants on the postoperative anterior-posterior and lateral chest radiographs and has 3 categories: 30-<90 points representing a low risk, 90-<150 points representing an intermediate risk, and ≥150 points representing a high risk of conversion failure. The score was developed using 2 separate S-ICD data sets for derivation and validation. The performance metrics are the positive and negative predictive values. RESULTS The development data set consisted of 181 patients with S-ICD, and the validation cohort consisted of 321 patients from the S-ICD Investigational Device Exemption trial. The distribution of scores was 93%-98% low risk (<90 points), 2%-5% intermediate risk (90-<150 points), and 1% high risk (≥150 points). The positive predictive value for an intermediate or high PRAETORIAN score for a failed conversion test was 51%, while a low PRAETORIAN score predicted a successful conversion in 99.8% of patients. CONCLUSION The PRAETORIAN score allows the identification of patients with high defibrillation thresholds by using the routine chest radiograph and provides feedback to implanters on S-ICD positioning. The PRAETORIAN-DFT trial will prospectively validate the score by randomizing to standard conversion testing vs using the score without conversion testing.
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Affiliation(s)
- Anne-Floor B E Quast
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Sarah W E Baalman
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Tom F Brouwer
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Lonneke Smeding
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Arthur A M Wilde
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Martin C Burke
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; CorVita Science Foundation, Chicago, Illinois
| | - Reinoud E Knops
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Al-Ghamdi B. Subcutaneous Implantable Cardioverter Defibrillators: An Overview of Implantation Techniques and Clinical Outcomes. Curr Cardiol Rev 2019; 15:38-48. [PMID: 30014805 PMCID: PMC6367695 DOI: 10.2174/1573403x14666180716164740] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 07/09/2018] [Accepted: 07/10/2018] [Indexed: 11/22/2022] Open
Abstract
Sudden Cardiac Death (SCD) is a significant health problem worldwide. Multiple randomized controlled trials have shown that Implantable Cardioverter Defibrillators (ICDs) are effective life-saving management option for individuals at risk of SCD in both primary and secondary prevention. Although the conventional transvenous ICDs (TV-ICDs) are safe and effective, there are potential complications associated with its use, including localized pocket or wound infection or systematic infection, a vascular access related complication such as pneumothorax, and venous thrombosis, and lead related complications such as dislodgement, malfunction, and perforation. Furthermore, transvenous leads placement may not be feasible in certain patients like those with venous anomaly or occlusion, or with the presence of intracardiac shunts. Transvenous leads extraction, when needed, is associated with considerable morbidity & mortality and requires significant skills and costs. Totally subcutaneous ICD (S-ICD) is designed to afford the same life-saving benefit of the conventional TV-ICDs while avoiding the shortcomings of the TV-leads and to simplify the implant techniques and hence expand the use of ICDs in clinical practice. It becomes commercially available after receiving CE mark in 2009, and its use increased significantly after its FDA approval in 2012. This review aims to give an overview of the S-ICD system components, implantation procedure, clinical indications, safety, efficacy, and future directions.
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Affiliation(s)
- Bandar Al-Ghamdi
- Heart Center, College of Medicine, King Faisal Specialist Hospital & Research Centre, Zahrawi St, Al Maather, Riyadh 12713, Saudi Arabia.,Alfaisal University, College of Medicine, King Faisal Specialist Hospital & Research Centre, Zahrawi St, Al Maather, Riyadh 12713, Saudi Arabia
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50
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Rationale and design of the randomized prospective ATLAS study: Avoid Transvenous Leads in Appropriate Subjects. Am Heart J 2019; 207:1-9. [PMID: 30399474 DOI: 10.1016/j.ahj.2018.09.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 09/15/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND The defibrillator lead is the weakest part of the transvenous (TV) implantable cardioverter defibrillation (ICD) system and a frequent cause of morbidity. Lead dislodgement, cardiac perforation, insertion-related trauma including pneumothorax and vascular injury, are common early complications of TV-ICD implantation. Venous occlusion, tricuspid valve dysfunction, lead fracture and lead insulation failure are additional, later complications. The introduction of a totally sub-cutaneous ICD (S-ICD) may reduce these lead-related issues, patient morbidity, hospitalizations and costs. However, such benefits compared to the TV-ICD have not been demonstrated in a randomized trial. DESIGN ATLAS (Avoid Transvenous Leads in Appropriate Subjects) is a multi-centered, randomized, open-label, parallel group trial. Patients younger than 60 years are eligible. If older than 60 years, patients are eligible if they have an inherited heart rhythm disease, or risk factors for ICD-related complication, such as hemodialysis, a history of ICD or pacemaker infection, heart valve replacement, or severe pulmonary disease. This study will determine if using an S-ICD compared to a TV-ICD reduces a primary composite outcome of perioperative complications including pulmonary or pericardial perforation, lead dislodgement or dysfunction, tricuspid regurgitation and ipsilateral venous thrombosis. Five hundred patients will be enrolled from 14 Canadian hospitals, and data collected to both early- (at 6 months) and mid-term complications (at 24 months) as well as mortality and ICD shock efficacy. SUMMARY The ATLAS randomized trial is comparing early- and mid-term vascular and lead-related complications among S-ICD versus TV-ICD recipients who are younger or at higher risk of ICD-related complications.
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