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Gold MR, El-Chami MF, Burke MC, Upadhyay GA, Niebauer MJ, Prutkin JM, Herre JM, Kutalek S, Dinerman JL, Knight BP, Leigh J, Lucas L, Carter N, Brisben AJ, Aasbo JD, Weiss R. Postapproval Study of a Subcutaneous Implantable Cardioverter-Defibrillator System. J Am Coll Cardiol 2023; 82:383-397. [PMID: 37495274 DOI: 10.1016/j.jacc.2023.05.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/17/2023] [Accepted: 05/09/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND The subcutaneous implantable cardioverter-defibrillator (S-ICD) was developed to avoid complications related to transvenous implantable cardioverter-defibrillator (TV-ICD) leads. Device safety and efficacy were demonstrated previously with atypical clinical patients or limited follow-up. OBJECTIVES The S-ICD PAS (Subcutaneous Implantable Cardioverter-Defibrillator System Post Approval Study) is a real-world, multicenter, registry of U.S. centers that was designed to assess long-term S-ICD safety and efficacy in a diverse group of patients and implantation centers. METHODS Patients were enrolled in 86 U.S. centers with standard S-ICD indications and were observed for up to 5 years. Efficacy endpoints were first and final shock efficacy. Safety endpoints were complications directly related to the S-ICD system or implantation procedure. Endpoints were assessed using prespecified performance goals. RESULTS A total of 1,643 patients were prospectively enrolled, with a median follow-up of 4.2 years. All prespecified safety and efficacy endpoint goals were met. Shock efficacy rates for discrete episodes of ventricular tachycardia or ventricular fibrillation were 98.4%, and they did not differ significantly across follow-up years (P = 0.68). S-ICD-related and electrode-related complication-free rates were 93.4% and 99.3%, respectively. Only 1.6% of patients had their devices replaced by a TV-ICD for a pacing need. Cumulative all-cause mortality was 21.7%. CONCLUSIONS In the largest prospective study of the S-ICD to date, all study endpoints were met, despite a cohort with more comorbidities than in most previous trials. Complication rates were low and shock efficacy was high. These results demonstrate the 5-year S-ICD safety and efficacy for a large, diverse cohort of S-ICD recipients. (Subcutaneous Implantable Cardioverter-Defibrillator [S-ICD] System Post Approval Study [PAS]; NCT01736618).
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Affiliation(s)
- Michael R Gold
- Medical University of South Carolina, Charleston, South Carolina, USA.
| | | | | | - Gaurav A Upadhyay
- Center for Arrhythmia Care, Heart and Vascular Center, The University of Chicago Medicine, Chicago, Illinois, USA
| | | | | | - John M Herre
- Sentara Cardiovascular Research Institute, Norfolk, Virginia, USA
| | | | | | - Bradley P Knight
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jill Leigh
- Boston Scientific, Saint Paul, Minnesota, USA
| | | | | | | | - Johan D Aasbo
- Department of Cardiac Electrophysiology, Lexington Cardiology/Baptist Health Medical Group, Lexington, Kentucky, USA
| | - Raul Weiss
- Mount Sinai Medical Center, Miami Beach, Florida, USA
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2
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Rordorf R. The ATLAS Randomised Clinical Trial: What do the Superiority Results
Mean for Subcutaneous ICD Therapy and Sudden Cardiac Death Prevention as a Whole? Arrhythm Electrophysiol Rev 2022; 11. [DOI: 10.15420/aer.2022.11.s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/08/2022] [Indexed: 11/04/2022] Open
Abstract
This review sets out the key evidence comparing subcutaneous ICDs (S-ICDs) and transvenous ICDs and uses it to empower clinical cardiologists and those who implant ICDs to make optimum patient selections for S-ICD use. The evidence demonstrates that clinical trials performed until recently have proven the performance of S-ICDs. However, the latest data now available from the ATLAS randomised controlled trial have added new insights to this body of evidence. ATLAS demonstrates the superiority of S-ICDs over transvenous ICDs regarding lead-related complications, findings that point to promising opportunities for patients who are at risk of sudden cardiac death.
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Affiliation(s)
- Roberto Rordorf
- Arrhythmias and Electrophysiology Unit, Policlinico San Matteo Foundation, Pavia, Italy
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3
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External versus internal cardioversion for atrial fibrillation: a meta-analysis of randomized controlled trials. J Interv Card Electrophysiol 2020; 61:445-451. [PMID: 32737850 DOI: 10.1007/s10840-020-00836-5] [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: 05/26/2020] [Accepted: 07/21/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patients with atrial fibrillation (AF) often require rhythm control strategy for amelioration of symptoms. It is unclear if there is any difference between external cardioversion (ECV) and internal cardioversion (ICV) for successful conversion of AF to normal sinus rhythm. METHODS We performed a meta-analysis of published randomized controlled trials (RCTs) evaluating success of cardioversion using ECV versus ICV. RESULTS In the pooled analysis of 5 RCTS, there was no difference in success of cardioversion using ECV versus ICV (OR 1.69, 95% CI 0.24-11.83, p = 0.6). In the subgroup analysis, there was no difference between ECV and direct electrode ICV (OR 0.41, 95% CI 0.09-1.83, p = 0.24). However, ECV was significantly better compared with ICV using ICD (OR 11.97, 95% CI 1.87-76.73, p = 0.009). CONCLUSIONS There was no difference between ECV versus ICV in effectiveness for termination of AF. Larger well-designed randomized controlled trials are needed to confirm our findings.
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Elayi CS, Parrott K, Etaee F, Shah J, Leung S, Guglin M, Elayi E, Jessinger M, Ogunbayo G, Catanzaro J, Morales G, Darrat Y. Randomized trial comparing the effectiveness of internal (through implantable cardioverter defibrillator) versus external cardioversion of atrial fibrillation. J Interv Card Electrophysiol 2020; 58:261-267. [PMID: 31927665 DOI: 10.1007/s10840-019-00689-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 12/12/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE When patients with implantable cardioverter defibrillators (ICD) develop symptomatic atrial fibrillation (AF), external direct current cardioversion (EDCCV), as well as internal cardioversion using their ICD, are the options available. It is currently unknown which of these two methods are more effective. We compared the effectiveness of EDCCV versus internal cardioversion to terminate AF in patients with a single-coil ICD. METHODS This randomized controlled trial (clinicaltrial.gov NCT03164395) enrolled consecutive patients with a single-coil ICD that presented with symptomatic AF of less than 1-year duration. They received either the maximum energy internal shock through the ICD or an EDCCV using transcutaneous pads of 200 J. The primary endpoint was a successful conversion to sinus rhythm after one shock. Crossover was permitted if the first shock was unsuccessful. RESULTS Thirty-one patients were enrolled in the study, including 16 in the internal ICD cardioversion group. The study included patients with a mean age of 59.5 ± 16.0 years, 41.9% females, median AF duration 1 month (interquartile range 1-3), 45.2% non-ischemic cardiomyopathies, mean EF 28.6 ± 16.0%, and 45.2% biventricular ICD. There were no significant differences in baseline clinical characteristics between the two groups. In the internal cardioversion group, 5/16 patients (31.3%) met the primary endpoint versus 14/15 (93.3%) in the EDCCV group, p < 0.001. All patients that failed the first shock were subsequently cardioverted externally. CONCLUSION Among patients with a single-coil ICD and symptomatic AF of less than 1 year, external direct current cardioversion is much more effective than internal shock through the ICD.
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Affiliation(s)
- Claude S Elayi
- University of Florida, 653 8th St W, Jacksonville, FL, 32209, USA.
| | - Kevin Parrott
- Baptist Health, 4000 Kresge Way, Louisville, KY, 40207, USA
| | - Farshid Etaee
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Jignesh Shah
- Cardiology, Gill Heart Institute and Lexington VA Medical Center, University of Kentucky, Lexington, KY, 40506, USA
| | - Steve Leung
- Cardiology, Gill Heart Institute and Lexington VA Medical Center, University of Kentucky, Lexington, KY, 40506, USA
| | - Maya Guglin
- Indiana University Health, 3777 Frontage Rd, Michigan City, IN, 46360, USA
| | - Elodie Elayi
- Cardiology, Gill Heart Institute and Lexington VA Medical Center, University of Kentucky, Lexington, KY, 40506, USA
| | - Michael Jessinger
- Cardiology, Gill Heart Institute and Lexington VA Medical Center, University of Kentucky, Lexington, KY, 40506, USA
| | - Gbolahan Ogunbayo
- Cardiology, Gill Heart Institute and Lexington VA Medical Center, University of Kentucky, Lexington, KY, 40506, USA
| | - John Catanzaro
- University of Florida, 653 8th St W, Jacksonville, FL, 32209, USA
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Neuzner J, Hohnloser SH, Kutyifa V, Glikson M, Dietze T, Mabo P, Vinolas X, Kautzner J, O'Hara G, Lawo T, Brachmann J, VanErven L, Gadler F, Appl U, Wang J, Connolly SJ, Healey JS. Effectiveness of single- vs dual-coil implantable defibrillator leads: An observational analysis from the SIMPLE study. J Cardiovasc Electrophysiol 2019; 30:1078-1085. [PMID: 30945798 DOI: 10.1111/jce.13943] [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: 01/16/2019] [Revised: 03/08/2019] [Accepted: 04/01/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Dual-coil leads (DC-leads) were the standard of choice since the first nonthoracotomy implantable cardioverter/defibrillator (ICD). We used contemporary data to determine if DC-leads offer any advantage over single-coil leads (SC-leads), in terms of defibrillation efficacy, safety, clinical outcome, and complication rates. METHODS AND RESULTS In the Shockless IMPLant Evaluation study, 2500 patients received a first implanted ICD and were randomized to implantation with or without defibrillation testing. Two thousand and four hundred seventy-five patients received SC-coil or DC-coil leads (SC-leads in 1025/2475 patients; 41.4%). In patients who underwent defibrillation testing (n = 1204), patients with both lead types were equally likely to achieve an adequate defibrillation safety margin (88.8% vs 91.2%; P = 0.16). There was no overall effect of lead type on the primary study endpoint of "failed appropriate shock or arrhythmic death" (adjusted HR 1.18; 95% CI, 0.86-1.62; P = 0.300), and on all-cause mortality (SC-leads: 5.34%/year; DC-leads: 5.48%/year; adjusted HR 1.16; 95% CI, 0.94-1.43; P = 0.168). However, among patients without prior heart failure (HF), and SC-leads had a significantly higher risk of failed appropriate shock or arrhythmic death (adjusted HR 7.02; 95% CI, 2.41-20.5). There were no differences in complication rates. CONCLUSION In this nonrandomized evaluation, there was no overall difference in defibrillation efficacy, safety, outcome, and complication rates between SC-leads and DC-leads. However, DC-leads were associated with a reduction in the composite of failed appropriate shock or arrhythmic death in the subgroup of non-HF patients. Considering riskier future lead extraction with DC-leads, SC-leads appears to be preferable in the majority of patients.
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Affiliation(s)
| | - Stefan H Hohnloser
- Department of Cardiology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Valentina Kutyifa
- Semmelweis University, Budapest, Hungary.,University of Rochester Medical Center, Rochester, New York
| | - Michael Glikson
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | | | | | | | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Gilles O'Hara
- Institute Universitaire de Cardiologie et de Pneumologie de, Quebec, QC, Canada
| | - Thomas Lawo
- Elisabeth Krankenhaus, Recklinghausen, Germany
| | | | | | | | - Ursula Appl
- Boston Scientific, Minneapolis, Minnesota.,Boston Scientific, Brussels, Belgium
| | - Jia Wang
- Population Health Research Institute, Hamilton, Canada
| | | | - Jeff S Healey
- Population Health Research Institute, Hamilton, Canada.,Mc Master University, Hamilton, Canada
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6
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Parikh V, Sauer A, Friedman PA, Sheldon SH. Management of cardiac implantable electronic devices in the presence of left ventricular assist devices. Heart Rhythm 2018; 15:1089-1096. [DOI: 10.1016/j.hrthm.2018.01.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Indexed: 10/18/2022]
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7
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Peddareddy L, Merchant FM, Leon AR, Smith P, Patel A, El-Chami MF. Effect of defibrillation threshold testing on effectiveness of the subcutaneous implantable cardioverter defibrillator. Pacing Clin Electrophysiol 2018; 41:996-1000. [PMID: 29893508 DOI: 10.1111/pace.13416] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/08/2018] [Accepted: 06/05/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Defibrillation threshold (DFT) testing is recommended with the subcutaneous implantable cardioverter defibrillator (SICD). OBJECTIVE To describe first shock efficacy for appropriate SICD therapies stratified by the presence of implant DFT testing. METHODS We reviewed all patients receiving SICDs at our institution and stratified them based on whether implant DFT testing was performed. Appropriate shocks were reviewed to see if ventricular tachycardia/ventricular fibrillation (VT/VF) terminated with a single shock. First shock efficacy was stratified by implant DFT status. RESULTS 178 patients implanted with SICDs and followed in our center were included in this study. Of these, 135 (76%) underwent DFT testing (DFT (+) group). In the DFT (+), 80 appropriate shocks were needed to treat 69 episodes of VT/VF. The first shock was effective in 61 out of 69 episodes (88.4%), whereas multiple shocks were required to terminate VT/VF in the remaining eight episodes. Among 43 patients without implant DFT testing (DFT (-) group), 20 appropriate shocks to treat 17 episodes of VT/VF occurred in seven patients. VT/VF was successfully terminated with the first shock in 16 out of 17 episodes (first shock efficacy 94.1 %). There was no significant difference in first shock effectiveness between those with and without implant DFT testing (P = 0.97). CONCLUSION A strategy that omits DFT testing at implant did not appear to compromise the effectiveness of the SICD. These data suggest that routine DFT testing at SICD implant might not be necessary. Randomized trials are needed to confirm this finding.
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Affiliation(s)
| | - Faisal M Merchant
- Emory University School of Medicine, Department of Medicine, Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Angel R Leon
- Emory University School of Medicine, Department of Medicine, Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Paige Smith
- Emory University School of Medicine, Atlanta, GA, USA
| | | | - Mikhael F El-Chami
- Emory University School of Medicine, Department of Medicine, Division of Cardiology, Section of Electrophysiology, Emory University School of Medicine, Atlanta, GA, USA
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8
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Leshem E, Suleiman M, Laish-Farkash A, Konstantino Y, Glikson M, Barsheshet A, Goldenberg I, Michowitz Y. Contemporary rates and outcomes of single- vs. dual-coil implantable cardioverter defibrillator lead implantation: data from the Israeli ICD Registry. Europace 2018; 19:1485-1492. [PMID: 27702848 DOI: 10.1093/europace/euw199] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 06/02/2016] [Indexed: 11/12/2022] Open
Abstract
Aims Dual-coil leads were traditionally considered standard of care due to lower defibrillation thresholds (DFT). Higher complication rates during extraction with parallel progression in implantable cardioverter defibrillator (ICD) technology raised questions on dual coil necessity. Prior substudies found no significant outcome difference between dual and single coils, although using higher rates of DFT testing then currently practiced. We evaluated the temporal trends in implantation rates of single- vs. dual-coil leads and determined the associated adverse clinical outcomes, using a contemporary nation-wide ICD registry. Methods and results Between July 2010 and March 2015, 6343 consecutive ICD (n = 3998) or CRT-D (n = 2345) implantation patients were prospectively enrolled in the Israeli ICD Registry. A follow-up of at least 1 year of 2285 patients was available for outcome analysis. The primary endpoint was all-cause mortality. Single-coil leads were implanted in 32% of our cohort, 36% among ICD recipients, and 26% among CRT-D recipients. Secondary prevention indication was associated with an increased rate of dual-coil implantation. A significant decline in dual-coil leads with reciprocal incline of single coils was observed, despite low rates of DFT testing (11.6%) during implantation, which also declined from 31 to 2%. In the multivariate Cox model analysis, dual- vs. single-coil lead implantation was not associated with an increased risk of mortality [hazard ratio (HR) = 1.23; P= 0.33], heart failure hospitalization (HR = 1.34; P=0.13), appropriate (HR = 1.25; P= 0.33), or inappropriate ICD therapy (HR = 2.07; P= 0.12). Conclusion Real-life rates of single-coil lead implantation are rising while adding no additional risk. These results of single-coil safety are reassuring and obtained, despite low and contemporary rates of DFT testing.
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Affiliation(s)
- Eran Leshem
- Department of Cardiology, Tel-Aviv Medical Center, Tel Aviv, Israel
- Cardiovascular Institute, Beth Israel Deaconess Medical Center, 185 Pilgrim Rd, Boston, MA 02215, USA
| | | | | | | | - Michael Glikson
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Alon Barsheshet
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Ilan Goldenberg
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel
- IACT-Neufeld Cardiac Research Institute, Tel Hashomer, Israel
| | - Yoav Michowitz
- Department of Cardiology, Tel-Aviv Medical Center, Tel Aviv, Israel
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9
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The subcutaneous implantable cardioverter defibrillator--review of the recent data. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2018; 15:222-228. [PMID: 29721001 PMCID: PMC5919810 DOI: 10.11909/j.issn.1671-5411.2018.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The subcutaneous implantable cardioverter defibrillators (SICD) is an alternative to the transvenous ICD for the prevention of sudden cardiac death (SCD). Multiple studies have shown that the SICD is safe and effective in treating ventricular arrhythmias. While earlier studies mainly enrolled younger patients with channelopathies, more recent reports included patients with “typical” indications for ICD therapy for the prevention of SCD. In this review we summarize the data available to date on the SICD while highlighting its pros and cons.
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10
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Frankel DS, Burke MC, Callans DJ, Stivland TM, Duffy E, Epstein AE. Impact of Body Mass Index on Safety and Efficacy of the Subcutaneous Implantable Cardioverter-Defibrillator. JACC Clin Electrophysiol 2018; 4:652-659. [DOI: 10.1016/j.jacep.2017.11.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/27/2017] [Accepted: 11/30/2017] [Indexed: 11/26/2022]
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Almehmadi F, Manlucu J. Should Single-Coil Implantable Cardioverter Defibrillator Leads Be Used in all Patients? Card Electrophysiol Clin 2018; 10:59-66. [PMID: 29428142 DOI: 10.1016/j.ccep.2017.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The historical preference for dual-coil implantable cardioverter defibrillator leads stems from high defibrillation thresholds associated with old device platforms. The high safety margins generated by contemporary devices have rendered the modest difference in defibrillation efficacy between single- and dual-coil leads clinically insignificant. Cohort data demonstrating worse lead extraction outcomes and higher all-cause mortality have brought the incremental utility of an superior vena cava coil into question. This article summarizes the current literature and re-evaluates the utility of dual-coil leads in the context of modern device technology.
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Affiliation(s)
- Fahad Almehmadi
- Division of Cardiology, Department of Medicine, Western University, PO Box 5339, 339 Windermere Road, Room B6-127, London, Ontario N6A 5A5, Canada
| | - Jaimie Manlucu
- Division of Cardiology, Department of Medicine, Western University, PO Box 5339, 339 Windermere Road, Room B6-127, London, Ontario N6A 5A5, Canada.
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Yokoshiki H, Shimizu A, Mitsuhashi T, Furushima H, Sekiguchi Y, Manaka T, Nishii N, Ueyama T, Morita N, Okamura H, Nitta T, Hirao K, Okumura K. Survival and Heart Failure Hospitalization in Patients With Cardiac Resynchronization Therapy With or Without a Defibrillator for Primary Prevention in Japan - Analysis of the Japan Cardiac Device Treatment Registry Database. Circ J 2017. [PMID: 28626201 DOI: 10.1253/circj.cj-17-0234] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Randomized control trials comparing the effectiveness of cardiac resynchronization therapy devices, with (CRT-D) or without (CRT-P) a defibrillator, are scarce in heart failure patients with no prior sustained ventricular tachyarrhythmias.Methods and Results:The Japan Cardiac Device Treatment Registry (JCDTR) has data for 2714 CRT-D and 555 CRT-P recipients for primary prevention with an implantation date between January 2011 and August 2015. Of these patients, follow-up data were available for 717. Over the mean follow-up period of 21 months, Kaplan-Meier curves of survival free of combined events for all-cause death or heart failure hospitalization (whichever came first) diverged between the CRT-D (n=620) and CRT-P (n=97) groups with a rate of 22% vs. 42%, respectively, at 24 months (P=0.0011). However, this apparent benefit of CRT-D over CRT-P was no longer significant after adjustment for covariates. With regard to mortality, including heart failure death or sudden cardiac death, there was no significant difference between the 2 groups. CONCLUSIONS In patients without sustained ventricular tachyarrhythmias enrolled in the JCDTR, there was no significant difference in mortality between the CRT-D and CRT-P groups, despite a lower trend in CRT-D recipients. This study was limited by large clinical and demographic differences between the 2 groups.
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Affiliation(s)
- Hisashi Yokoshiki
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Akihiko Shimizu
- Faculty of Health Sciences, Yamaguchi Graduate School of Medicine
| | - Takeshi Mitsuhashi
- Cardiovascular Medicine, Jichi Medical University Saitama Medical Center
| | | | - Yukio Sekiguchi
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
| | | | - Nobuhiro Nishii
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Takeshi Ueyama
- Division of Cardiology, Department of Medicine and Clinical Sciences, Yamaguchi Graduate School of Medicine
| | - Norishige Morita
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital
| | - Hideo Okamura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School
| | - Kenzo Hirao
- Heart Rhythm Center, Tokyo Medical and Dental University
| | - Ken Okumura
- Cardiovascular Center, Saiseikai Kumamoto Hospital
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13
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Temporal Trends in and Factors Associated With Use of Single- Versus Dual-Coil Implantable Cardioverter-Defibrillator Leads. JACC Clin Electrophysiol 2017; 3:612-619. [DOI: 10.1016/j.jacep.2016.11.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 11/29/2016] [Accepted: 11/29/2016] [Indexed: 11/22/2022]
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Bänsch D, Bonnemeier H, Brandt J, Bode F, Svendsen JH, Ritter O, Aring J, Gutleben KJ, Schneider R, Felk A, Hauser T, Buchholz A, Hindricks G, Wegscheider K. Shock efficacy of single and dual coil electrodes—new insights from the NORDIC ICD Trial. Europace 2017; 20:971-978. [DOI: 10.1093/europace/eux075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 02/28/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Dietmar Bänsch
- Heart Center Rostock, Department of Internal Medicine I, Divisions of Cardiology, University Hospital Rostock, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany
| | - Hendrik Bonnemeier
- Department of Internal Medicine III Cardiology and Angiology, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straβe 3, 24105 Kiel, Germany
| | - Johan Brandt
- Arrhythmia Department, Skane University Hospital, SE-221 85 Lund, Sweden
| | - Frank Bode
- Medical Clinic II Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Jesper Hastrup Svendsen
- Heart Center, Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen and Danish Arrhythmia Research Centre, University of Copenhagen, Blegdamsvej 9, 2100 København Ø, Denmark
| | - Oliver Ritter
- Department Cardiology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany
| | - Johannes Aring
- Department of Internal Medicine I, Divisions of Cardiology, Internal and Intersive Care Medicine, Hospital Leverkusen, Am Gesundheitspark 11, 51375 Leverkusen, Germany
| | - Klaus-Jürgen Gutleben
- Heart and Diabetes Center North Rhine-Westphalia, University Clinic, Ruhr-University Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany
| | - Ralph Schneider
- Heart Center Rostock, Department of Internal Medicine I, Divisions of Cardiology, University Hospital Rostock, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany
| | | | - Tino Hauser
- Biotronik, Woermannkehre 1, 12359 Berlin, Germany
| | - Anika Buchholz
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
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15
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Determinants of Subcutaneous Implantable Cardioverter-Defibrillator Efficacy. JACC Clin Electrophysiol 2017; 3:405-414. [DOI: 10.1016/j.jacep.2016.10.016] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 10/11/2016] [Accepted: 10/21/2016] [Indexed: 01/28/2023]
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Sunderland N, Kaura A, Murgatroyd F, Dhillon P, Scott PA. Outcomes with single-coil versus dual-coil implantable cardioverter defibrillators: a meta-analysis. Europace 2017; 20:e21-e29. [DOI: 10.1093/europace/euw438] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 12/20/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nicholas Sunderland
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Amit Kaura
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Francis Murgatroyd
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Para Dhillon
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Paul A Scott
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK
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17
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Kumar P, Baker M, Gehi AK. Comparison of Single-Coil and Dual-Coil Implantable Defibrillators. JACC Clin Electrophysiol 2017; 3:12-19. [DOI: 10.1016/j.jacep.2016.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 06/27/2016] [Accepted: 06/29/2016] [Indexed: 11/15/2022]
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18
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Jo U, Kim J, Hwang YM, Lee JH, Kim MS, Choi HO, Lee WS, Kwon CH, Ko GY, Yoon HK, Nam GB, Choi KJ, Kim YH. Transvenous Lead Extraction via the Inferior Approach Using a Gooseneck Snare versus Simple Manual Traction. Korean Circ J 2016; 46:186-96. [PMID: 27014349 PMCID: PMC4805563 DOI: 10.4070/kcj.2016.46.2.186] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 09/03/2015] [Accepted: 09/22/2015] [Indexed: 11/23/2022] Open
Abstract
Background and Objectives The number of patients with cardiac implantable electronic devices needing lead extraction is increasing for various reasons, including infections, vascular obstruction, and lead failure. We report our experience with transvenous extraction of pacemaker and defibrillator leads via the inferior approach of using a gooseneck snare as a first-line therapy and compare extraction using a gooseneck snare with extraction using simple manual traction. Subjects and Methods The study included 23 consecutive patients (43 leads) who underwent transvenous lead extraction using a gooseneck snare (group A) and 10 consecutive patients (17 leads) who underwent lead extraction using simple manual traction (group B). Patient characteristics, indications, and outcomes were analyzed and compared between the groups. Results The dwelling time of the leads was longer in group A (median, 121) than in group B (median, 56; p=0.000). No differences were noted in the overall procedural success rate (69.6% vs. 70%), clinical procedural success rate (82.6% vs. 90%), and lead clinical success rate (86% vs. 94.1%) between the groups. The procedural success rates according to lead type were 89.2% and 100% for pacing leads and 66.7% and 83.3% for defibrillator leads in groups A and B, respectively. Major complications were noted in 3 (mortality in 1) patients in group A and 2 patients in group B. Conclusion Transvenous extraction of pacemaker leads via an inferior approach using a gooseneck snare was both safe and effective. However, stand-alone transvenous extraction of defibrillator leads using the inferior approach was suboptimal.
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Affiliation(s)
- Uk Jo
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun Kim
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - You-Mi Hwang
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji-Hyun Lee
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min-Su Kim
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyung-Oh Choi
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Woo-Seok Lee
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang-Hee Kwon
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi-Young Ko
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun-Ki Yoon
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi-Byoung Nam
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee-Joon Choi
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - You-Ho Kim
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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19
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Larsen JM, Hjortshøj SP, Nielsen JC, Johansen JB, Petersen HH, Haarbo J, Johansen MB, Margrethe Thøgersen A. Single-coil and dual-coil defibrillator leads and association with clinical outcomes in a complete Danish nationwide ICD cohort. Heart Rhythm 2016; 13:706-12. [DOI: 10.1016/j.hrthm.2015.11.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Indexed: 11/29/2022]
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20
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Okamura H, Friedman PA, Inoue Y, Noda T, Aiba T, Yasuda S, Ogawa H, Kamakura S, Kusano K, Espinosa RE. Single-Coil Defibrillator Leads Yield Satisfactory Defibrillation Safety Margin in Hypertrophic Cardiomyopathy. Circ J 2016; 80:2199-203. [DOI: 10.1253/circj.cj-16-0428] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hideo Okamura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
- Division of Cardiovascular Diseases, Mayo Clinic
| | | | - Yuko Inoue
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hisao Ogawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Shiro Kamakura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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21
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Infection and mortality after implantation of a subcutaneous ICD after transvenous ICD extraction. Heart Rhythm 2016; 13:157-64. [DOI: 10.1016/j.hrthm.2015.08.039] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Indexed: 11/20/2022]
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22
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Hsu JC, Saxon LA, Jones PW, Wehrenberg S, Marcus GM. Utilization trends and clinical outcomes in patients implanted with a single- vs a dual-coil implantable cardioverter-defibrillator lead: Insights from the ALTITUDE Study. Heart Rhythm 2015; 12:1770-5. [DOI: 10.1016/j.hrthm.2015.04.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Indexed: 11/25/2022]
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23
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Cronin EM, Zweibel SL. Single-Coil Implantable Cardioverter Defibrillator Leads Remained the Preferred Option. Am J Cardiol 2015; 116:490-1. [PMID: 26002991 DOI: 10.1016/j.amjcard.2015.04.037] [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: 03/23/2015] [Accepted: 04/29/2015] [Indexed: 11/16/2022]
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Abstract
Implantable cardioverter-defibrillator (ICD) leads have to fulfill particular requirements: safe pacing and sensing, detection, and termination of ventricular tachyarrhythmias, if necessary by (multiple) high-energy shocks. At the same time, their implantation has to be simple, they need to provide excellent long-term stability and they must be completely and safely extractable. Numerous technical developments have enabled currently available ICD leads to fulfill these expectations to a high extent. However, some changes of lead design, materials, and manufacturing processes have led to increased lead failure, especially in two lead models (Medtronic Sprint Fidelis®, St. Jude Medical Riata®). The high rate of lead failure was identified only several years after market release, in part because there are no appropriate registries of ICD leads. This review presents background and developments of ICD lead technology and their association with the clinical usage of ICD therapy. To also benefit patients with only slightly-to-moderately increased risk of ventricular tachyarrhythmia, optimum ICD therapy requires optimal leads and sufficiently experienced implanters.
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Affiliation(s)
- Carsten W Israel
- Klinik für Innere Medizin - Kardiologie, Diabetologie & Nephrologie, Evangelisches Krankenhaus Bielefeld, Burgsteig 13, 33617, Bielefeld, Deutschland,
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25
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Safety and Efficacy of the Totally Subcutaneous Implantable Defibrillator. J Am Coll Cardiol 2015; 65:1605-1615. [DOI: 10.1016/j.jacc.2015.02.047] [Citation(s) in RCA: 393] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 02/01/2015] [Accepted: 02/16/2015] [Indexed: 11/20/2022]
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26
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Failure rates of single- versus dual-coil nonrecalled sprint quattro defibrillator leads. Am J Cardiol 2015; 115:202-5. [PMID: 25465935 DOI: 10.1016/j.amjcard.2014.10.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 10/14/2014] [Accepted: 10/14/2014] [Indexed: 11/20/2022]
Abstract
Electrical failure is more common in single-coil compared with dual-coil implantable cardioverter defibrillator (ICD) leads in the case of the recalled Riata lead. Single-coil leads are however favored in most patients given their lower risk of extraction. We therefore evaluated the failure-free survival of single- versus dual-coil ICD leads not included in Food and Drug Administration recalls. All patients receiving a Medtronic transvenous Sprint Quattro single- or dual-coil ICD lead were included in this analysis. Leads were followed to the end point of electrical failure. A total of 1,020 dual-coil and 631 single-coil ICD leads were implanted at our institution from November 2000 to March 2014. As expected, dual-coil leads had a longer follow-up time (3.4 ± 2.6 years vs 1.3 ± 1.0 years, p <0.001) because they were approved many years earlier by the Food and Drug Administration. The overall lead survival rates free from electrical failure at 1, 2, and 3 years after implantation were 98.8%, 98.2%, and 95.1%, respectively, for the single-coil leads versus 99.7%, 99.4%, and 99.3%, respectively, for the dual-coil leads (p = 0.0013). In conclusion, single-coil leads are associated with higher electrical failure rates compared with dual-coil leads even for nonrecalled lead models from the same family and manufacturer. These findings have implications on the choice of ICD lead at the time of device implantation.
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27
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Lambiase PD, Barr C, Theuns DAMJ, Knops R, Neuzil P, Johansen JB, Hood M, Pedersen S, Kääb S, Murgatroyd F, Reeve HL, Carter N, Boersma L. Worldwide experience with a totally subcutaneous implantable defibrillator: early results from the EFFORTLESS S-ICD Registry. Eur Heart J 2014; 35:1657-65. [PMID: 24670710 PMCID: PMC4076663 DOI: 10.1093/eurheartj/ehu112] [Citation(s) in RCA: 367] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Aims The totally subcutaneous implantable-defibrillator (S-ICD) is a new alternative to the conventional transvenous ICD system to minimize intravascular lead complications. There are limited data describing the long-term performance of the S-ICD. This paper presents the first large international patient population collected as part of the EFFORTLESS S-ICD Registry. Methods and results The EFFORTLESS S-ICD Registry is a non-randomized, standard of care, multicentre Registry designed to collect long-term, system-related, clinical, and patient reported outcome data from S-ICD implanted patients since June 2009. Follow-up data are systematically collected over 60-month post-implant including Quality of Life. The study population of 472 patients of which 241 (51%) were enrolled prospectively has a mean follow-up duration of 558 days (range 13–1342 days, median 498 days), 72% male, mean age of 49 ± 18 years (range 9–88 years), 42% mean left ventricular ejection fraction. Complication-free rates were 97 and 94%, at 30 and 360 days, respectively. Three hundred and seventeen spontaneous episodes were recorded in 85 patients during the follow-up period. Of these episodes, 169 (53%) received therapy, 93 being for Ventricular Tachycardia/Fibrillation (VT/VF). One patient died of recurrent VF and severe bradycardia. Regarding discrete VT/VF episodes, first shock conversion efficacy was 88% with 100% overall successful clinical conversion after a maximum of five shocks. The 360-day inappropriate shock rate was 7% with the vast majority occurring for oversensing (62/73 episodes), primarily of cardiac signals (94% of oversensed episodes). Conclusion The first large cohort of real-world data from an International patient S-ICD population demonstrates appropriate system performance with clinical event rates and inappropriate shock rates comparable with those reported for conventional ICDs. Clinical trial registration URL: http://www.clinicaltrials.gov. Unique identifier NCT01085435.
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Affiliation(s)
- Pier D Lambiase
- Cardiology Department, The Heart Hospital, Institute of Cardiovascular Science, University College London, 16-18 Westmoreland Street, W1G 8PH London, UK
| | - Craig Barr
- Cardiology Department, Russells Hall Hospital, Dudley, UK
| | - Dominic A M J Theuns
- Department of Clinical Electrophysiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Reinoud Knops
- Department of Cardiology and Electrophysiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Petr Neuzil
- Department of Cardiology, Homnolka Hospital, Prague, Czech Republic
| | - Jens Brock Johansen
- Department of Cardiology, Electrophysiology Section, Odense University Hospital, Odense, Denmark
| | | | - Susanne Pedersen
- Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Stefan Kääb
- Division of Electrophysiology, Campus Grosshadern, University of Munich, Munich, Germany
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GILLIS ANNEM. Single or Dual Coil Defibrillation Leads? Let's Keep it Simple! J Cardiovasc Electrophysiol 2013; 24:1253-4. [DOI: 10.1111/jce.12229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- ANNE M. GILLIS
- Department of Cardiac Sciences, University of Calgary; Libin Cardiovascular Institute of Alberta; Calgary Alberta Canada
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