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Magnani S, Ali H, Cappato R. Ten years of subcutaneous defibrillator therapy: Consolidated clinical evidence and future perspectives. J Cardiovasc Electrophysiol 2024; 35:601-607. [PMID: 38287171 DOI: 10.1111/jce.16171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 01/31/2024]
Abstract
The subcutaneous implantable cardioverter defibrillator (S-ICD) was developed as an alternative to the traditional transvenous implantable cardioverter defibrillator (TV-ICD), aiming to provide easier implantation, simplified detection algorithm of malignant ventricular arrhythmias and prevention from placing components in the cardiovascular system. The S-ICD is implanted subcutaneously or intramuscularly with the generator placed in the left midaxillary line and the lead tunneled subcutaneously in the left para-sternal region. Preimplant electrocardiogram screening is recommended to prevent implantation in patients at high risk of T wave over-sensing. Currently, the S-ICD is unsuitable for patients requiring pacing or cardiac resynchronization. Since the beginning, the S-ICD underwent extensive preclinical investigation until the first prospective multicentre trial demonstrating high efficacy and safety led to market release. While earlier studies focused on younger patients with higher ejection fraction, more recent studies showed favorable outcomes even in patients with comorbidities similar to those typically observed in patients receiving TV-ICD. The development of second and third generation devices has contributed to reduce inappropriate shocks and overcome previous limitations. The aim of this paper is to review the evidence in the literature over the past decade supporting S-ICD as a valid alternative to TV-ICD in terms of safety and efficacy, highlighting the improvements in technology, as well as outcomes.
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Affiliation(s)
- Silvia Magnani
- Arrhythmia and Electrophysiology Center, IRCCS Multimedica, Milan, Italy
| | - Hussam Ali
- Arrhythmia and Electrophysiology Center, IRCCS Multimedica, Milan, Italy
| | - Riccardo Cappato
- Arrhythmia and Electrophysiology Center, IRCCS Multimedica, Milan, Italy
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2
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Elkasaby MH, Khalefa BB, Yassin MNA, El-Hameed MMA, Elkoumi O, Al Hennawi H. Two-incision versus three-incision implantation technique of subcutaneous implantable cardioverter defibrillator: Systematic review and meta-analysis of 2076 patients. Pacing Clin Electrophysiol 2024; 47:281-291. [PMID: 38071455 DOI: 10.1111/pace.14902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/22/2023] [Accepted: 12/01/2023] [Indexed: 02/15/2024]
Abstract
INTRODUCTION The implantable cardioverter-defibrillator (ICD) was designed to detect and treat ventricular arrhythmias, which account for nearly half of all cardiovascular fatalities. Transvenous ICD (TV-ICD) complications were reduced by introducing subcutaneous ICD (S-ICD). S-ICD can be implanted using a three (3IT)- or two (2IT)-incision technique. This systematic review and meta-analysis was conducted to compare the 3IT to the 2IT. METHODS We searched medical electronic databases of Cochrane Central, Embase, PubMed, Scopus, and Web of Science (WOS) from the study's inception until March 8, 2023. We compared 2IT and 3IT techniques of S-ICDs in terms of procedural, safety, and efficacy outcomes. We used Review Manager software for the statistical analysis. We calculated the risk ratio (RR) with its 95% confidence interval (CI) for dichotomous variables; and the mean difference with its 95% CI for continuous variables. We measured the heterogeneity using the chi-squared and I-squared tests. If the data were heterogeneous, the random-effect (RE) model was applied; otherwise, the fixed-effect model (FE) was used. RESULTS We included three retrospective observational studies of 2076 patients, 1209 in the 2IT group and 867 in the 3IT. There was no statistically significant difference in erosion after S-ICD when 2IT compared with 3IT (RR = 0.27, 95% CI: [0.07, 1.02]; P = .05) (I2 = 0%, P = .90). There was no difference in risk of infection, lead dislocation, or inappropriate shock with either incision technique (RR = 0.78, 95% CI: [0.48, 1.29]; P = .34) (I2 = 0%, P = .71) and (RR = 0.37, 95% CI: [0.02, 8.14]; P = .53) (I2 = 66%, P = .05) respectively. Our meta-analysis showed that the efficacy of both techniques is comparable; Appropriate shock (RR = 0.94, 95% CI: [0.78, 1.12]; P = .48) (I2 = 0%, P = .81) and first shock efficacy (RR = 0.89, 95% CI: [0.44, 1.82]; P = .76) (I2 = 0%, P = .87). CONCLUSION 2IT and 3IT of S-ICD have comparable efficacy and complication rates; however, the 3IT exposes patients to an additional incision without any additional benefits. These findings may provide clinicians with a simpler method for subcutaneous ICD implantation and likely result in improved cosmetic outcomes. Before the 2IT technique can be considered the standard of care, randomized controlled trials (RCTs) must be conducted to assess its long-term safety and efficacy.
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Affiliation(s)
- Mohamed Hamouda Elkasaby
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Medical Research Group of Egypt (MRGE), Arlington, Massachusetts, USA
| | - Basma Badrawy Khalefa
- Medical Research Group of Egypt (MRGE), Arlington, Massachusetts, USA
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mazen Negmeldin Aly Yassin
- Medical Research Group of Egypt (MRGE), Arlington, Massachusetts, USA
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Malak Mohamed Abd El-Hameed
- Medical Research Group of Egypt (MRGE), Arlington, Massachusetts, USA
- Faculty of Medicine, Zagazig University, Al-Sharqia, Egypt
| | - Omar Elkoumi
- Medical Research Group of Egypt (MRGE), Arlington, Massachusetts, USA
- Faculty of Medicine, Suez University, Suez, Egypt
| | - Hussam Al Hennawi
- Department of Internal Medicine, Jefferson Abington Hospital, Abington, Pennsylvania, USA
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3
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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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Khanra D, Hamid A, Patel P, Tomson J, Abdalla A, Khan N, Dowd R, Chandan N, Osagie C, Jinadu T, Velu S, Arya A, Spencer C, Barr C, Petkar S. A real‐world experience of subcutaneous and transvenous implantable cardiac defibrillators—comparison with the
PRAETORIAN
study. J Arrhythm 2022; 38:199-212. [PMID: 35387142 PMCID: PMC8977574 DOI: 10.1002/joa3.12687] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 11/06/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Dibbendhu Khanra
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - Abdul Hamid
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - Peysh Patel
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - John Tomson
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - Ahmed Abdalla
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - Nasrin Khan
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - Rory Dowd
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - Nakul Chandan
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - Christopher Osagie
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - Tomilola Jinadu
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - Selvakumar Velu
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - Anita Arya
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - Charles Spencer
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - Craig Barr
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - Sanjiv Petkar
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
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5
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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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6
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Francia P, Adduci C, Angeletti A, Ottaviano L, Perrotta L, De Vivo S, Bongiorni MG, Migliore F, Russo AD, De Filippo P, Caravati F, Nigro G, Palmisano P, Viani S, D'Onofrio A, Lovecchio M, Valsecchi S, Ziacchi M. Acute shock efficacy of the subcutaneous implantable cardioverter-defibrillator according to the implantation technique. J Cardiovasc Electrophysiol 2021; 32:1695-1703. [PMID: 33969578 DOI: 10.1111/jce.15081] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/19/2021] [Accepted: 05/01/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The traditional technique for subcutaneous implantable cardioverter defibrillator (S-ICD) implantation involves three incisions and a subcutaneous (SC) pocket. An intermuscular (IM) 2-incision technique has been recently adopted. AIMS We assessed acute defibrillation efficacy (DE) of S-ICD (DE ≤65 J) according to the implantation technique. METHODS We analyzed consecutive patients who underwent S-ICD implantation and DE testing at 53 Italian centers. Regression analysis was used to determine the association between DFT and implantation technique. RESULTS A total of 805 patients were enrolled. Four groups were assessed: IM + 2 incisions (n = 546), SC + 2 incisions (n = 133), SC + 3 incisions (n = 111), and IM + 3 incisions (n = 15). DE was ≤65 J in 782 (97.1%) patients. Patients with DE ≤65 J showed a trend towards lower body mass index (25.1 vs. 26.5; p = .12), were less frequently on antiarrhythmic drugs (13% vs. 26%; p = .06) and more commonly underwent implantation with the 2-incision technique (85% vs. 70%; p = .04). The IM + 2-incision technique showed the lowest defibrillation failure rate (2.2%) and shock impedance (66 Ohm, interquartile range: 57-77). On multivariate analysis, the 2-incision technique was associated with a lower incidence of shock failure (hazard ratio: 0.305; 95% confidence interval: 0.102-0.907; p = .033). Shock impedance was lower with the IM than with the SC approach (66 vs. 70 Ohm p = .002) and with the 2-incision than the 3-incision technique (67 vs. 72 Ohm; p = .006). CONCLUSIONS In a large population of S-ICD patients, we observed a high defibrillation success rate. The IM + 2-incision technique provides lower shock impedance and a higher likelihood of successful defibrillation.
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Affiliation(s)
- Pietro Francia
- Division of Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza University, Rome, Italy
| | - Carmen Adduci
- Division of Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza University, Rome, Italy
| | - Andrea Angeletti
- Department of Experimental, Diagnostic, and Specialty Medicine, Institute of Cardiology, Policlinico S.Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Luca Ottaviano
- Unit of Arrhythmia and Electrophysiology, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Laura Perrotta
- Arrhythmic Disease Unit, University of Florence, Florence, Italy
| | - Stefano De Vivo
- Monaldi Hospital, "Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie", Naples, Italy
| | - Maria Grazia Bongiorni
- Division of Second Cardiology, Department of Cardio-Thoracic and Vascular, University Hospital of Pisa, Pisa, Italy
| | - Federico Migliore
- Division of Cardiology, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Paolo De Filippo
- Department of Cardiac and Vascular Sciences, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Fabrizio Caravati
- Department of Heart and Vessels, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Gerardo Nigro
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli," Monaldi Hospital, Naples, Italy, Naples, Italy
| | - Pietro Palmisano
- Department of Cardiology, "Card. G. Panico" Hospital, Tricase, Lecce, Italy
| | - Stefano Viani
- Division of Second Cardiology, Department of Cardio-Thoracic and Vascular, University Hospital of Pisa, Pisa, Italy
| | - Antonio D'Onofrio
- Monaldi Hospital, "Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie", Naples, Italy
| | | | | | - Matteo Ziacchi
- Department of Experimental, Diagnostic, and Specialty Medicine, Institute of Cardiology, Policlinico S.Orsola-Malpighi, University of Bologna, Bologna, Italy
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7
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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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8
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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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