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Leo M, Sharp AJ, Gala ABE, Pope MTB, Betts TR. Transvenous or subcutaneous implantable cardioverter defibrillator: a review to aid decision-making. J Interv Card Electrophysiol 2022:10.1007/s10840-022-01299-6. [PMID: 35835888 DOI: 10.1007/s10840-022-01299-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/06/2022] [Indexed: 01/08/2023]
Abstract
The implantable cardioverter-defibrillator (ICD) is a proven treatment for preventing sudden cardiac death. Transvenous leads are associated with significant mortality and morbidity, and the subcutaneous ICD (S-ICD) addresses this. However, it is not without limitations, in particular the absence of anti-tachycardia pacing. The decision of which device is most suitable for an individual patient is often complex. Here, we review the relative merits and weaknesses of both the transvenous and S-ICD. We summarise the available evidence for each device in particular patient cohorts, namely: ischaemic and non-ischaemic cardiomyopathy, idiopathic ventricular fibrillation, Brugada syndrome, long QT syndrome, arrhythmogenic right ventricular cardiomyopathy, and hypertrophic cardiomyopathy.
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Affiliation(s)
- Milena Leo
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alexander J Sharp
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - Andre Briosa E Gala
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Michael T B Pope
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Timothy R Betts
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Weigand S, O'Connor M, Blažek P, Kantenwein V, Friedrich L, Grebmer C, Schaarschmidt C, von Olshausen G, Reents T, Deisenhofer I, Lennerz C, Kolb C. Release of high-sensitive TROPonin T by implantation of an entirely subcutaneous Implantable Cardioverter-defibrillator compared to a conventional transvenous approach: the TROPIC registry. J Interv Card Electrophysiol 2020; 62:75-81. [PMID: 32959177 DOI: 10.1007/s10840-020-00874-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/10/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Implantation of a subcutaneous implantable cardioverter-defibrillator (S-ICD) has become an alternative option when a conventional transvenous approach is not suitable. The myocardial damage caused by S-ICD implantation appears to be minimal despite mandatory defibrillation threshold (DFT) testing. However, there has not been a direct comparison with the traditional transvenous placement of a single-chamber ICD (VVI-ICD). The aim of this study was to determine the extent of myocardial damage by analysing the changes in serum levels of cardiac enzymes after S-ICD implantation in comparison with VVI-ICD. METHODS In 43 patients who received an S-ICD system, differences in serum levels of high-sensitive troponin T (ΔhsTnT) and creatine kinase total (ΔCK) and muscle brain fraction (ΔCK-MB) were acquired by blood sampling before and the day after implantation. The control group consisted of 43 patients from the TropShock study who had received a transvenous VVI-ICD without DFT. RESULTS After S-ICD implantation and testing procedure, ΔhsTnT (0.000 ng/ml, IQR - 0.003-0.002 ng/ml) was significantly lower than after conventional VVI-ICD implantation (0.018 ng/ml, IQR 0.004-0.032 ng/ml; p < 0.001). There was no significant difference in CK (ΔCKS-ICD 85.0 U/I, IQR 30.5-225.8 U/I vs ΔCKVVI-ICD 69.5 U/I, IQR 22.9-172.3 U/I; p = 0.357), but there was a significant difference in CK-MB (ΔCK-MBS-ICD of - 0.60, IQR - 2.60-1.0 vs ΔCK-MBVVI-ICD 1.0, IQR - 1.08-3.18; p = 0.030). CONCLUSION S-ICD implantation causes less myocardial damage than VVI-ICD implantation evidenced by ΔhsTnT and ΔCK-MB.
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Affiliation(s)
- Severin Weigand
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany. .,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
| | - Matthew O'Connor
- Department of Cardiology, Wellington Hospital, Wellington, New Zealand
| | - Patrick Blažek
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Verena Kantenwein
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Lena Friedrich
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Christian Grebmer
- Abteilung für Elektrophysiologie, Kantonsspital Luzern, Herzzentrum, Lucerne, Switzerland
| | - Claudia Schaarschmidt
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Gesa von Olshausen
- Medizinische Klinik I, Klinikum rechts der Isar, Faculty of Medicine, Technische Universität München, Munich, Germany
| | - Tilko Reents
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Isabel Deisenhofer
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Carsten Lennerz
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Christof Kolb
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
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3
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Defibrillation testing during implantation of the subcutaneous implantable cardioverter-defibrillator: a necessary standard or becoming redundant? Neth Heart J 2020; 28:122-127. [PMID: 32780342 PMCID: PMC7419406 DOI: 10.1007/s12471-020-01448-4] [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] [Indexed: 12/14/2022] Open
Abstract
Since the publication of the SIMPLE and NORDIC trials, defibrillation testing (DFT) is rarely performed during routine implantation of transvenous implantable cardioverter-defibrillators (ICD). However, the results of these trials cannot be extrapolated to the later introduced subcutaneous ICD (S-ICD) and a class I recommendation to perform DFT during the implantation of these devices remains in the current guidelines. Due to the high conversion success rate of DFT on one hand, and the risk of complications on the other, a significant number of physicians omit DFT in S‑ICD recipients. Several retrospective analyses have assessed the safety of the omission of DFT and report contradicting results and recommendations. It is known that implant position, as well as device factors and patient characteristics, influence defibrillation success. A better comprehension of these factors and their relationship could lead to more reliable and safer alternatives to DFT. An ongoing randomised clinical trial, which is expected to end in 2023, is the first study to implement a method that assesses implant position to identify patients who are likely to fail their DFT.
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Xu L, Kang F, Hu W, Liu X. Higher Concentration of Hypertonic Saline Shows Better Recovery Effects on Rabbits with Uncontrolled Hemorrhagic Shock. Med Sci Monit 2019; 25:8120-8130. [PMID: 31662580 PMCID: PMC6842271 DOI: 10.12659/msm.916937] [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] [Indexed: 11/14/2022] Open
Abstract
Background Our previous study found a novel fluid combination with better resuscitation effects under hypotensive condition at the early stage of uncontrolled hemorrhagic shock (UHS). However, the optimal recovery concentration of hypertonic saline in this fluid combination remains unknown. This experiment aimed to explore the optimal concentration. Material/Methods New Zealand white rabbits (n=40) were randomly divided into 5 groups, including a sham-operated group (SO), a shock non-treated group (SNT), a normal saline group (NS), and hypertonic saline groups (4.5% and 7.5%). We established an UHS model and administered various fluid combinations (dose-related sodium chloride solution+crystal-colloidal solution) to the groups followed by monitoring indexes of hemodynamic and renal function, measuring infusion volume and blood loss, and analyzing pathological morphology by hematoxylin and eosin staining. Results The hypertonic saline groups showed more stable hemodynamic indexes, reduced blood loss, fewer required infusions, and milder decreases in renal function than those of control groups (SNT and NS groups), and exhibited fewer pathological changes in the heart, lung, kidney, and liver. All indexes in the 4.5% and 7.5% groups were better than those of the NS group, and the hemodynamic indexes in the 7.5% group were more stable than those of the 4.5% group (P<0.05), with reduced blood loss and infusion volume and a milder decrease in renal function. Conclusions The novel fluid combination with 7.5% hypertonic saline group had a better recovery effect at the early stage of UHS before hemostasis compared to that of the 4.5% hypertonic saline group. This result may provide guidance for clinical fluid resuscitation.
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Affiliation(s)
- Lei Xu
- Department of Nursing, Air Force Medical University, Xi'an, Shanxi, China (mainland)
| | - Fengjuan Kang
- General Hospital of People's Liberation Army (PLA), Beijing, China (mainland)
| | - Wendong Hu
- Department of Aerospace Medicine, Air Force Medical University, Xi'an, Shanxi, China (mainland)
| | - Xiwen Liu
- Department of Nursing, Air Force Medical University, Xi'an, Shanxi, China (mainland)
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D'Onofrio A, Russo V, Bianchi V, Cavallaro C, Leonardi S, De Vivo S, Vecchione F, Rago A, Ammendola E, Tavoletta V, Atripaldi L, Mocavero PE, Nigro G. Effects of defibrillation shock in patients implanted with a subcutaneous defibrillator: a biomarker study. Europace 2019; 20:f233-f239. [PMID: 29095967 PMCID: PMC6140430 DOI: 10.1093/europace/eux330] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/27/2017] [Indexed: 11/13/2022] Open
Abstract
Aims Implantable cardioverter defibrillator (ICD) shocks are associated with a subsequent increased risk of death, and an elevation of cardiac enzymes has been measured after defibrillation testing (DFT). In an experimental swine study, subcutaneous ICD (S-ICD) shocks caused less myocardial damage than traditional ICD shocks. The aim of our study was to investigate the association between S-ICD shock and acute cardiac damage in humans, as evaluated by means of sensitive and highly specific circulating biomarkers. Methods and results We calculated the variation in the serum levels of high-sensitivity cardiac troponin I (hs-CTnI) and creatine kinase-MB mass concentration (CK-MB mass), measured before and after an S-ICD shock delivered during intraoperative DFT. We also measured the degree of haemodynamic stress, as the variation in the serum levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and copeptin (CP), after the S-ICD shock. We analysed 30 consecutive patients who received an S-ICD and who underwent DFT by means of a single 65 J shock. The levels of biomarkers did not change from baseline to 1 h post-shock, i.e. hs-CTnI (from 0.029 ± 0.005 ng/mL to 0.030 ± 0.005 ng/mL, P = 0.079) and CK-MB mass (from 1.37 ± 0.17 ng/mL to 1.41 ± 0.18, P = 0.080) and remained stable 6 and 24 h after DFT. The plasma NT-proBNP did not change, whereas CP levels were significantly higher at 1 h post-shock evaluation. However, 6 h after DFT, the levels had returned to the baseline and remained stable at 24 h. Conclusion The S-ICD shock did not seem to cause myocardial injuries. Although CP levels temporarily rose after DFT, they returned to basal levels within 6 h, which suggests that DFT does not have long-term prognostic implications. ICD shocks are associated with a subsequent increased risk of death, and an elevation of cardiac enzymes has been measured after DFT. We showed that serum levels of biomarkers of myocardial damage did not increase after high-energy DFT in patients who had undergone S-ICD device implantation. This suggests that S-ICD shock does not have long-term prognostic implications.
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Affiliation(s)
- Antonio D'Onofrio
- Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie, Monaldi, Ospedale Monaldi, Via Leonardo Bianchi 1, Naples, Italy
| | - Vincenzo Russo
- Chair of Cardiology, University of Campania "Luigi Vanvitelli", Monaldi, Ospedale Monaldi, Via Leonardo Bianchi 1, Naples, Italy
| | - Valter Bianchi
- Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie, Monaldi, Ospedale Monaldi, Via Leonardo Bianchi 1, Naples, Italy
| | - Ciro Cavallaro
- Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie, Monaldi, Ospedale Monaldi, Via Leonardo Bianchi 1, Naples, Italy
| | - Silvia Leonardi
- Hematology and Cellular Immunology (Clinical Biochemistry), Monaldi, Ospedale Monaldi, Via Leonardo Bianchi 1, Naples, Italy
| | - Stefano De Vivo
- Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie, Monaldi, Ospedale Monaldi, Via Leonardo Bianchi 1, Naples, Italy
| | - Filippo Vecchione
- Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie, Monaldi, Ospedale Monaldi, Via Leonardo Bianchi 1, Naples, Italy
| | - Anna Rago
- Chair of Cardiology, University of Campania "Luigi Vanvitelli", Monaldi, Ospedale Monaldi, Via Leonardo Bianchi 1, Naples, Italy
| | - Ernesto Ammendola
- Chair of Cardiology, University of Campania "Luigi Vanvitelli", Monaldi, Ospedale Monaldi, Via Leonardo Bianchi 1, Naples, Italy
| | - Vincenzo Tavoletta
- Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie, Monaldi, Ospedale Monaldi, Via Leonardo Bianchi 1, Naples, Italy
| | - Luigi Atripaldi
- Hematology and Cellular Immunology (Clinical Biochemistry), Monaldi, Ospedale Monaldi, Via Leonardo Bianchi 1, Naples, Italy
| | - Paola Elvira Mocavero
- Post Operative Intensive Care Unit, Monaldi, Ospedale Monaldi, Via Leonardo Bianchi 1, Naples, Italy
| | - Gerardo Nigro
- Chair of Cardiology, University of Campania "Luigi Vanvitelli", Monaldi, Ospedale Monaldi, Via Leonardo Bianchi 1, Naples, Italy
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Brewster J, Sexton T, Dhaliwal G, Charnigo R, Morales G, Parrott K, Darrat Y, Gurley J, Smyth S, Elayi CS. Acute Effects of Implantable Cardioverter-Defibrillator Shocks on Biomarkers of Myocardial Injury, Apoptosis, Heart Failure, and Systemic Inflammation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:344-352. [PMID: 28156007 DOI: 10.1111/pace.13037] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 12/14/2016] [Accepted: 01/02/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Implantable cardioverter-defibrillator (ICD) shocks are potentially associated with myocardial injury, altered hemodynamics, apoptosis, and inflammatory signaling. Their precise cellular impact can be explored after defibrillation testing (DFT) via biomarkers. We evaluated changes in biomarkers after ICD shocks during DFT. METHODS We prospectively enrolled outpatients presenting for first implantation of a cardiac device. Biomarkers indicative of myocardial injury, inflammation, and apoptosis were measured before and after implantation, and compared between patients receiving DFT (DFT+) to those not (DFT-). RESULTS Sixty-three patients were enrolled, 40 in the DFT+ group and 23 in the DFT- group. Average levels of troponin I, hsCRP, Calprotectin, N-terminal pro B-type natriuretic peptide (NTproBNP), and sFas increased by >50% after cardiac device implantation compared to baseline. Increase in troponin never exceeded the 50-fold upper limit of normal (2 ng/mL). Troponin trended higher in the DFT+ group at 8 hours (median 0.18 ng/mL, interquartile range [IQR] 0.11-0.48) versus the DFT- group (0.10 ng/mL, IQR 0.06-0.28, P = 0.0501); NTproBNP had a similar trend (P = 0.0581). sFas significantly increased in the DFT+ group from baseline (median 4663 pg/mL, IQR 2908-5679) to 24 hours (5039 pg/mL, IQR 3274-6261; P = 0.0338) but not in the DFT- group (P = 0.4705). CONCLUSION DFT testing is associated with acutely increased plasma levels of troponin and sFas, a biomarker of apoptosis, along with a trend toward higher NTproBNP.
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Affiliation(s)
- Jordan Brewster
- Krannert Institute of Cardiology, Indiana University, Indianapolis, Indiana
| | - Travis Sexton
- Department of Cardiology, University of Kentucky and VAMC, Lexington, Kentucky
| | - Gary Dhaliwal
- Department of Cardiology, University of Kentucky and VAMC, Lexington, Kentucky
| | - Richard Charnigo
- Department of Cardiology, University of Kentucky and VAMC, Lexington, Kentucky
| | - Gustavo Morales
- Department of Cardiology, University of Kentucky and VAMC, Lexington, Kentucky
| | - Kevin Parrott
- Department of Cardiology, University of Kentucky and VAMC, Lexington, Kentucky
| | - Yousef Darrat
- Department of Cardiology, University of Kentucky and VAMC, Lexington, Kentucky
| | - John Gurley
- Department of Cardiology, University of Kentucky and VAMC, Lexington, Kentucky
| | - Susan Smyth
- Department of Cardiology, University of Kentucky and VAMC, Lexington, Kentucky
| | - Claude S Elayi
- Department of Cardiology, University of Kentucky and VAMC, Lexington, Kentucky
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Doz P, Sperzel J. Value of The Wearable Cardioverter Defibrillator (WCD) as a Bridging-Therapy before Implantation of a Cardioverter Defibrillator (ICD). J Atr Fibrillation 2016; 8:1247. [PMID: 27909469 DOI: 10.4022/jafib.1247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 01/22/2016] [Accepted: 02/09/2016] [Indexed: 01/30/2023]
Abstract
Wearable cardioverter defibrillators (WCD), initially available in 2002, have recently experienced more routine use in many institutions as a means of preventing sudden cardiac death (SCD) prior to implantable cardioverter defibrillator (ICD) evaluation or implantation. WCD differ from ICD by their noninvasive nature, making them well suited for patient populations who have a chance for significant cardiac recovery (such as after an acute myocardial infarction). Despite their noninvasive nature, WCD treatment of sustained ventricular tachyarrhythmias is highly successful. An additional feature is the use of response buttons, which reduces the number of conscious shocks. Duration of use varies by condition but is typically several weeks to several months. Numerous studies have shown good compliance with WCD use and excellent efficacy. Although few prospective studies have been published, several are in progress including a randomized control trial of high risk patients after myocardial infarction. WCD use is rapidly gaining popularity for patients with recent myocardial infarction, recent-onset cardiomyopathies, and acute or subacute myocarditis. Surgical delays in implanting an indicated ICD or after ICD removal are also common. WCD removal occurs when the patient either qualifies for an ICD implantation or is determined to no longer have elevated SCD risk.
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Affiliation(s)
- Priv Doz
- Kerckhoff-Klinik GmbH, Kardiologie, Elektrophysiologie, Bad Nauheim, Germany
| | - Johannes Sperzel
- Kerckhoff-Klinik GmbH, Kardiologie, Elektrophysiologie, Bad Nauheim, Germany
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Lim TSE, Tan BY, Ho KL, Lim CYP, Teo WS, Ching CK. Initial experience of subcutaneous implantable cardioverter defibrillators in Singapore: a case series and review of the literature. Singapore Med J 2015; 56:580-5. [PMID: 26512151 DOI: 10.11622/smedj.2015154] [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: 11/18/2022]
Abstract
Transvenous implantable cardioverter defibrillators are a type of implantable cardiac device. They are effective at reducing total and arrhythmic mortality in patients at risk of sudden cardiac death. Subcutaneous implantable cardioverter defibrillators (S-ICDs) are a new alternative that avoids the disadvantages of transvenous lead placement. In this case series, we report on the initial feasibility and safety of S-ICD implantation in Singapore.
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Affiliation(s)
| | - Boon Yew Tan
- Department of Cardiology, National Heart Centre, Singapore
| | - Kah Leng Ho
- Department of Cardiology, National Heart Centre, Singapore
| | | | - Wee Siong Teo
- Department of Cardiology, National Heart Centre, Singapore
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De Maria E, Olaru A, Cappelli S. The entirely subcutaneous defibrillator (s-icd): state of the art and selection of the ideal candidate. Curr Cardiol Rev 2015; 11:180-6. [PMID: 25158682 PMCID: PMC4356726 DOI: 10.2174/1573403x10666140827094126] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 08/17/2014] [Accepted: 08/18/2014] [Indexed: 02/02/2023] Open
Abstract
The traditional transvenous defibrillator has been one of the greatest advancement in Cardiology in the last 30 years and has demonstrated to reduce arrhythmic and total mortality in selected patients. However the traditional defibrillator can have a high price to pay in terms of complications, the "weakest link" being the transvenous/endocardial leads. The entirely subcutaneous defibrillator (S-ICD) has recently entered into the clinical scenario and represents a valid alternative to the transvenous device. S-ICD can provide substantial advantages, especially among some subgroups of patients (i.e. after device infection, in young patients and arrhythmogenic syndromes). However, given its characteristics, it is fundamental to choose patients that can benefit the most. In this review we will describe advantages and limitations of the SICD and point-out how to select the "ideal candidate" for the implantation.
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Affiliation(s)
| | | | - Stefano Cappelli
- EP Cath Lab, Cardiology Unit, Ramazzini Hospital, Via Molinari, Carpi (Modena), Zip Code 41012, Italy.
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10
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Patel KHK, Lambiase PD. The subcutaneous ICD-current evidence and challenges. Cardiovasc Diagn Ther 2014; 4:449-59. [PMID: 25610802 PMCID: PMC4278039 DOI: 10.3978/j.issn.2223-3652.2014.12.02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 12/07/2014] [Indexed: 02/01/2023]
Abstract
The subcutaneous implantable cardioverter-defibrillator (S-ICD) represents an exciting development in ICD technology. It has relative advantages over traditional transvenous systems, particularly for young patients in whom the lifetime risk of device-related complications may be deemed to be unacceptably high. While data relating to device longevity and long term safety profile is yet to be accrued, several recent studies have demonstrated good clinical efficacy comparable to transvenous ICDs. Indeed, new techniques have also been developed to simplify the S-ICD implantation procedure and attempts have been made to address challenges pertaining to T-wave oversensing to reduce the delivery of inappropriate shocks. The impact of inappropriate shocks and lack of anti-tachycardia pacing (ATP) function are not only contentious matters, but also have important implications for patients in whom the S-ICD would be suitable. It is envisaged that subsequent models of this device will be less cumbersome, with the possibility that an entirely leadless pacemaker-defibrillator will one day be possible. Although the S-ICD may not completely replace transvenous devices in its current form, evidence suggests that it is a viable alternative particularly in preventing sudden cardiac death in non-pacing dependent patients.
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Affiliation(s)
| | - Pier D Lambiase
- Department of Cardiology, The Heart Hospital, University College London, London W1G 8PH, UK
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KUSCHYK JÜRGEN, MILASINOVIC GORAN, KÜHLKAMP VOLKER, ROBERTS PAULR, ZABEL MARKUS, MOLIN FRANCK, SHOROFSKY STEPHEN, STROMBERG KURTD, DEGROOT PAULJ, MURGATROYD FRANCISD. A Multicenter Study of Shock Pathways for Subcutaneous Implantable Defibrillators. J Cardiovasc Electrophysiol 2013; 25:29-35. [DOI: 10.1111/jce.12281] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 07/30/2013] [Accepted: 08/12/2013] [Indexed: 11/29/2022]
Affiliation(s)
- JÜRGEN KUSCHYK
- Department of Medicine-Cardiology; University Medical Centre; Mannheim Germany
| | - GORAN MILASINOVIC
- Clinical Centre of Serbia Institute for Cardiovascular Diseases; Belgrade Serbia
| | | | | | - MARKUS ZABEL
- Department of Cardiology; Georg-August-Universität; Heart Centre Göttingen Göttingen Germany
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