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Caughron H, Bowman H, Raitt MH, Whooley MA, Tarasovsky G, Shen H, Matheny ME, Selzman KA, Wang L, Major J, Odobasic H, Dhruva SS. Cardiovascular implantable electronic device lead safety: Harnessing real-world remote monitoring data for medical device evaluation. Heart Rhythm 2023; 20:512-519. [PMID: 36586706 DOI: 10.1016/j.hrthm.2022.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 12/14/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Current methods to identify cardiovascular implantable electronic device lead failure include postapproval studies, which may be limited in scope, participant numbers, and attrition; studies relying on administrative codes, which lack specificity; and voluntary adverse event reporting, which cannot determine incidence or attribution to the lead. OBJECTIVE The purpose of this study was to determine whether adjudicated remote monitoring (RM) data can address these limitations and augment lead safety evaluation. METHODS Among 48,191 actively monitored patients with a cardiovascular implantable electronic device, we identified RM transmissions signifying incident lead abnormalities and, separately, identified all leads abandoned or extracted between April 1, 2019, and April 1, 2021. We queried electronic health record and Medicare fee-for-service claims data to determine whether patients had administrative codes for lead failure. We verified lead failure through manual electronic health record review. RESULTS Of the 48,191 patients, 1170 (2.4%) had incident lead abnormalities detected by RM. Of these, 409 patients had administrative codes for lead failure, and 233 of these 409 patients (57.0%) had structural lead failure verified through chart review. Of the 761 patients without administrative codes, 167 (21.9%) had structural lead failure verified through chart review. Thus, 400 patients with RM transmissions suggestive of lead abnormalities (34.2%) had structural lead failure. In addition, 200 patients without preceding abnormal RM transmissions had leads abandoned or extracted for structural failure, making the total lead failure cohort 600 patients (66.7% with RM abnormalities, 33.3% without). Patients with isolated right atrial or left ventricular lead failure were less likely to have lead replacement and administrative codes reflective of lead failure. CONCLUSION RM may strengthen real-world assessment of lead failure, particularly for leads where patients do not undergo replacement.
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Affiliation(s)
- Hope Caughron
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California; Division of Cardiology, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California
| | - Hilary Bowman
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California
| | - Merritt H Raitt
- Knight Cardiovascular Institute, Oregon Health and Sciences University, Portland, Oregon; Portland Veterans Affairs Health Care System, Portland, Oregon
| | - Mary A Whooley
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California; Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Gary Tarasovsky
- Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Hui Shen
- Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Michael E Matheny
- Geriatrics Research, Education, and Clinical Service, Tennessee Valley Veterans Affairs Health Care System, Nashville, Tennessee; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kimberly A Selzman
- Division of Cardiology, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah; Salt Lake City Veterans Affairs Health Care System, Salt Lake City, Utah
| | - Li Wang
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Jacqueline Major
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Hetal Odobasic
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Sanket S Dhruva
- Section of Cardiology, Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California.
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2
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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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3
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Alonso C, Marquie C, Defaye P, Clementy N, Mondoly P, Sadoul N, Boveda S, Hidden-Lucet F, Dompnier A, Da Costa A, Marijon E, Leclercq C, Caudron G, Piot O, Deharo JC. FRAGILE: FRench Attitude reGistry in case of ICD LEad replacement. Europace 2021; 23:389-394. [PMID: 33257986 DOI: 10.1093/europace/euaa290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 09/09/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS FRench Attitude reGistry in case of ICD LEad replacement (FRAGILE) registry was set-up to describe the attitude in different French institutions in case of implantable cardioverter-defibrillator (ICD) lead replacement, extraction, or abandonment and to compare outcomes in both groups. METHODS AND RESULTS Prospective observational study comparing two attitudes in case of ICD lead replacement, extraction, or abandonment. Primary endpoint describes the attitude in different French centres, collect parameters that may influence the decision. Secondary endpoint compares early and mid-term (2 years) complications in both groups.Between April 2013 and April 2017, 552 patients were included in 32 centres. 434 (78.6%) were male, mean patient's age was 60.3 ± 14.4 years. In 56.9% of the cases, the decision was to explant the lead. Patients in the extraction group were younger than in the abandonment group (56.7 ± 14.5 vs. 65 ± 12.7 P < 0.0001) and less likely to have comorbidities (46.5% vs. 58.3% of the patients P = 0.022). The mean lead dwelling time was significantly longer in the abandonment group as compared with the extraction group (7.6 ± 3.9 vs. 5.2 ± 3.1 years, P < 0.0001). There was no statistical difference between both groups concerning early and 2 years complications. CONCLUSION In this registry, the strategy in case of non-infected ICD lead replacement was mainly influenced by patient's age and comorbidities and lead dwelling time. No difference was observed in outcomes in both strategies.
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Affiliation(s)
- Christine Alonso
- CMC Ambroise Paré, 25-27 bd Victor Hugo, 92200 Neuilly-sur-Seine, France
| | | | | | | | | | | | | | | | | | | | | | | | | | - Olivier Piot
- Centre Cardiologique du Nord Saint-Denis, France
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4
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Elgaard AF, Johansen JB, Nielsen JC, Gerdes C, Riahi S, Philbert BT, Haarbo J, Melchior TM, Larsen JM. Long-term follow-up of abandoned transvenous defibrillator leads: a nationwide cohort study. Europace 2021; 22:1097-1102. [PMID: 32447372 DOI: 10.1093/europace/euaa086] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/26/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS Commonly, a dysfunctional defibrillator lead is abandoned and a new lead is implanted. Long-term follow-up data on abandoned leads are sparse. We aimed to investigate the incidence and reasons for extraction of abandoned defibrillator leads in a nationwide cohort and to describe extraction procedure-related complications. METHODS AND RESULTS All abandoned transvenous defibrillator leads were identified in the Danish Pacemaker and ICD Register from 1991 to 2019. The event-free survival of abandoned defibrillator leads was studied, and medical records of patients with interventions on abandoned defibrillator leads were audited for procedure-related data. We identified 740 abandoned defibrillator leads. Meantime from implantation to abandonment was 7.2 ± 3.8 years with mean patient age at abandonment of 66.5 ± 13.7 years. During a mean follow-up after abandonment of 4.4 ± 3.1 years, 65 (8.8%) abandoned defibrillator leads were extracted. Most frequent reason for extraction was infection (pocket and systemic) in 41 (63%) patients. Procedural outcome after lead extraction was clinical success in 63 (97%) patients. Minor complications occurred in 3 (5%) patients, and major complications in 1 (2%) patient. No patient died from complication to the procedure during 30-day follow-up after extraction. CONCLUSION More than 90% of abandoned defibrillator leads do not need to be extracted during long-term follow-up. The most common indication for extraction is infection. Abandoned defibrillator leads can be extracted with high clinical success rate and low risk of major complications at high-volume centres.
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Affiliation(s)
- Anders Fyhn Elgaard
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-20, 9000 Aalborg, Denmark
| | | | | | - Christian Gerdes
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-20, 9000 Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | | | - Jens Haarbo
- Department of Cardiology, Gentofte Hospital, Hellerup, Denmark
| | | | - Jacob Moesgaard Larsen
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-20, 9000 Aalborg, Denmark
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5
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Starck CT, Burger H, Osswald B, Hakmi S, Knaut M, Bimmel D, Bärsch V, Eitz T, Mierzwa M, Ghaffari N, Siebel A. HRS-Expertenkonsensus (2017) Sondenmanagement und -extraktion von kardialen elektronischen Implantaten sowie EHRA-Expertenkonsensus (2018) zur wissenschaftlichen Aufarbeitung von Sondenextraktionen. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2021. [DOI: 10.1007/s00398-021-00421-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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6
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Blažek P, O'Connor MJ, Weigand S, Grebmer C, Reif S, Fichtner S, Friedrich L, Reents T, Kottmaier M, Semmler V, Bourier F, Schunkert H, Deisenhofer I, Kolb C, Lennerz C. Security millimetre wave body scanner safe for patients with leadless pacemakers or subcutaneous implantable cardioverter-defibrillators. J Interv Card Electrophysiol 2020; 61:603-607. [PMID: 32860605 DOI: 10.1007/s10840-020-00830-x] [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: 05/16/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE This study was designed to evaluate the electromagnetic interference (EMI) effects and safety of the new security screening millimetre wave body scanners (MWBSs) for patients with rare cardiac implantable electronic devices (CIEDs). METHODS We identified 73 patients with either entirely subcutaneous implantable cardioverter-defibrillators (S-ICD) or leadless pacemakers (LPM) attending routine device follow-up. CIED programming was optimised for the detection of EMI occurrence, and high-voltage therapy was disabled. Patients then underwent millimetre wave body scans under continuous ECG monitoring. Scanning was performed at the recommended distance as well as in close proximity to the scanner emulating accidental exposure. CIED function was observed for EMI effects. RESULTS There were no episodes of inhibition of pacing in the leadless pacemaker subgroup, no oversensing in the S-ICD subgroup and no spontaneous device reprogramming in any group. There was no change in pacing or sensing thresholds, and S-ICD vector eligibility remained unchanged after scanning with the MWBS. No CIEDs were identified by the MWBS during the study. CONCLUSION No EMI events were detected during the use of MWBSs by patients with either S-ICDs or LPMs. This data should be reassuring for patients suggesting that they can undergo security body scans without worries or disclosure of their CIED status.
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Affiliation(s)
- Patrick Blažek
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Klinik an der Technischen Universität München, Munich, Germany
| | | | - Severin Weigand
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Klinik an der Technischen Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Christian Grebmer
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Klinik an der Technischen Universität München, Munich, Germany
| | - Sebastian Reif
- Klinik für Kardiologie und Internistische Intensivmedizin, Klinikum Bogenhausen, Munich, Germany
| | - Stephanie Fichtner
- Klinikum Großhadern, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Lena Friedrich
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Klinik an der Technischen Universität München, Munich, Germany
| | - Tilko Reents
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Klinik an der Technischen Universität München, Munich, Germany
| | - Marc Kottmaier
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Klinik an der Technischen Universität München, Munich, Germany
| | - Verena Semmler
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Klinik an der Technischen Universität München, Munich, Germany
| | - Felix Bourier
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Klinik an der Technischen Universität München, Munich, Germany
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Klinik an der Technischen Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Isabel Deisenhofer
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Klinik an der Technischen Universität München, Munich, Germany
| | - Christof Kolb
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Klinik an der Technischen Universität München, Munich, Germany
| | - Carsten Lennerz
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Klinik an der Technischen Universität München, Munich, Germany. .,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
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7
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Anderson JH, McElhinney DB, Aboulhosn J, Zhang Y, Ribichini F, Eicken A, Whisenant B, Jones T, Kornowski R, Dvir D, Cabalka AK. Management and Outcomes of Transvenous Pacing Leads in Patients Undergoing Transcatheter Tricuspid Valve Replacement. JACC Cardiovasc Interv 2020; 13:2012-2020. [PMID: 32800497 DOI: 10.1016/j.jcin.2020.04.054] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/21/2020] [Accepted: 04/28/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The aim of this study was to determine the prevalence of pacemaker lead-related complications following transcatheter tricuspid valve replacement (TTVR). BACKGROUND The rate of permanent pacemaker implantation following tricuspid valve (TV) surgery is high, and many patients have transvenous leads. The feasibility, safety, and outcomes of subsequently performing TTVR in the setting of transvenous pacemaker leads have not been established. METHODS The VIVID (Valve-in-Valve International Database) registry was used to review 329 patients who underwent TTVR following TV repair or replacement. Patients were subdivided into 3 cohorts for intergroup comparisons: no lead, epicardial lead, and transvenous lead (entrapped or not entrapped during the TTVR procedure). RESULTS Of 329 patients who underwent TTVR, 128 (39%) had prior pacing systems in place, 70 with epicardial and 58 with transvenous leads. A total of 31 patients had leads passing through the TV. Three patients had the right ventricular (RV) lead extracted prior to TTVR. The remaining 28 patients had the RV lead entrapped between the transcatheter TV implant and the surgical valve (n = 22) or the repaired TV (n = 6). One patient had displacement of the RV lead during the procedure, and 2 experienced lead failure during follow-up. Overall, there was no significant difference in the cumulative incidences of competing outcomes (death, TV reintervention, TV dysfunction) between patients with and those without pacing leads or entrapped RV leads. CONCLUSIONS TTVR in the setting of trans-TV pacemaker leads without lead extraction or re-replacement can be performed safely with a low risk for complications, offering an alternative to surgical TV replacement.
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Affiliation(s)
- Jason H Anderson
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota; Department of Cardiovascular Medicine, Division of Structural Heart Diseases, Mayo Clinic, Rochester, Minnesota.
| | - Doff B McElhinney
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California; Division of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Jamil Aboulhosn
- Ahmanson/UCLA Adult Congenital Heart Disease Center, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Yulin Zhang
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Flavio Ribichini
- Cardiovascular Division, Department of Medicine, University Hospital of Verona, Verona, Italy
| | - Andreas Eicken
- Department of Congenital Heart Diseases and Pediatric Cardiology, German Heart Center Munich, Munich, Germany
| | - Brian Whisenant
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah
| | - Thomas Jones
- Division of Pediatric Cardiology, Seattle Children's Hospital and University of Washington School of Medicine, Seattle, Washington
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel
| | - Danny Dvir
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington
| | - Allison K Cabalka
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota; Department of Cardiovascular Medicine, Division of Structural Heart Diseases, Mayo Clinic, Rochester, Minnesota
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8
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Mechanical conflicts at the tricuspid level. A rare cause of both atrial and ventricular lead damage. HeartRhythm Case Rep 2020; 6:491-494. [PMID: 32817825 PMCID: PMC7424305 DOI: 10.1016/j.hrcr.2020.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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9
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Resnic FS, Majithia A, Dhruva SS, Ssemaganda H, Robbins S, Marinac-Dabic D, Hewitt K, Ohno-Machado L, Reynolds MR, Matheny ME. Active Surveillance of the Implantable Cardioverter-Defibrillator Registry for Defibrillator Lead Failures. Circ Cardiovasc Qual Outcomes 2020; 13:e006105. [PMID: 32283971 DOI: 10.1161/circoutcomes.119.006105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several defibrillator leads have been recalled due to early lead failure leading to significant patient harm. Confirming the safety of contemporary defibrillator leads is essential to optimizing treatment for patients receiving implantable cardioverter-defibrillators (ICDs). We therefore sought to assess the comparative long-term safety of the 4 most commonly implanted ICD leads within the National Cardiovascular Data Registry ICD Registry. METHODS AND RESULTS A propensity-matched survival analysis of the ICD Registry was performed evaluating 4 contemporary ICD leads in patients receiving an ICD system for the first time. All patients in the ICD Registry aged ≥18 years who underwent an implant of an ICD between April 1, 2011 and March 31, 2016 were included. Monitoring of safety began with ICD implant and continued up to 5 years. A meaningful difference in ICD failure rate was defined as twice (or more) the lead failure rate observed in the propensity-matched comparator patients. Among the 374 132 patients who received a new ICD implant, no safety alerts were triggered for the primary safety end point of lead failure for any of the high energy leads studied. Estimated rates of freedom from lead failure at 5 years ranged from 97.7% to 98.9% for the 4 high-energy leads of interest. CONCLUSIONS Though limited by incomplete long-term outcomes ascertainment, active surveillance of the ICD Registry suggests that there were no meaningful differences in the rate of ICD high-energy lead survival for the 4 most commonly used high-energy ICD leads.
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Affiliation(s)
- Frederic S Resnic
- Comparative Effectiveness Research Institute, Lahey Hospital and Medical Center, Burlington, MA (F.S.R., A.M., H.S., S.R., M.R.R.).,Division of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA (F.S.R., A.M., M.R.R.).,Tufts School of Medicine, Boston, MA (F.S.R., M.R.R.)
| | - Arjun Majithia
- Comparative Effectiveness Research Institute, Lahey Hospital and Medical Center, Burlington, MA (F.S.R., A.M., H.S., S.R., M.R.R.).,Division of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA (F.S.R., A.M., M.R.R.).,Brigham and Women's Hospital, Boston, MA (A.M.)
| | - Sanket S Dhruva
- UCSF School of Medicine and Section of Cardiology, San Francisco VA Health Care System (S.S.D.)
| | - Henry Ssemaganda
- Comparative Effectiveness Research Institute, Lahey Hospital and Medical Center, Burlington, MA (F.S.R., A.M., H.S., S.R., M.R.R.)
| | - Susan Robbins
- Comparative Effectiveness Research Institute, Lahey Hospital and Medical Center, Burlington, MA (F.S.R., A.M., H.S., S.R., M.R.R.)
| | - Danica Marinac-Dabic
- Center for Devices and Radiological Health (CDRH), FDA, Silver Spring, MD (D.M.-D.)
| | - Kathleen Hewitt
- National Cardiovascular Data Registry, American College of Cardiology, Washington, DC (K.H.)
| | - Lucila Ohno-Machado
- Department of Biomedical Informatics, University of California San Diego Health, La Jolla (L.O.-M.)
| | - Matthew R Reynolds
- Comparative Effectiveness Research Institute, Lahey Hospital and Medical Center, Burlington, MA (F.S.R., A.M., H.S., S.R., M.R.R.).,Division of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA (F.S.R., A.M., M.R.R.).,Tufts School of Medicine, Boston, MA (F.S.R., M.R.R.)
| | - Michael E Matheny
- Geriatrics Research, Education, and Clinical Care Center, Tennessee Valley Healthcare System VA, Nashville (M.E.M.).,Departments of Biomedical Informatics, Biostatistics and Medicine, Vanderbilt University Medical Center, Nashville, TN (M.E.M.)
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10
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Farkowski MM, Maciag A, Ciszewski J, Kowalik I, Syska P, Sterlinski M, Szwed H, Pytkowski M. The long term risk of lead failure in patients with cardiovascular implantable electronic devices undergoing catheter ablation. SCAND CARDIOVASC J 2019; 53:323-328. [DOI: 10.1080/14017431.2019.1653489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Michal M. Farkowski
- Heart Arrhythmia Ward, II Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland
| | - Aleksander Maciag
- Heart Arrhythmia Ward, II Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland
| | - Jan Ciszewski
- Heart Arrhythmia Ward, II Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland
| | - Ilona Kowalik
- Heart Arrhythmia Ward, II Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland
| | - Pawel Syska
- Heart Arrhythmia Ward, II Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland
| | - Maciej Sterlinski
- Department of Heart Arrhythmia, Institute of Cardiology, Warsaw, Poland
| | - Hanna Szwed
- Heart Arrhythmia Ward, II Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland
| | - Mariusz Pytkowski
- Heart Arrhythmia Ward, II Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland
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11
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van den Bruck JH, Sultan A, Plenge T, Seuthe K, Mödder T, Iliadis C, Stern D, Blankenheim T, Steven D, Lüker J. Incidence of myopotential induction in subcutaneous implantable cardioverter-defibrillator patients: Is the oversensing issue really solved? Heart Rhythm 2019; 16:1523-1530. [PMID: 31048064 DOI: 10.1016/j.hrthm.2019.04.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND The subcutaneous implantable cardioverter-defibrillator (S-ICD) has established its role in the prevention of sudden cardiac death in a defined population. Inappropriate shocks and device malfunction in S-ICD therapy may be caused by myopotential (MP) oversensing. OBJECTIVE The purpose of this study was to systematically evaluate a cohort of consecutive S-ICD patients for MP inducibility. METHODS After S-ICD implantation, all vectors (primary [PrimV], secondary [SecV], alternative [AltV]) were analyzed during isometric chest press (ICP), lifting and holding a 20-kg weight, and side plank exercise (SPE), supporting the body weight on the left arm. When MPs were induced, signal classification was assessed: adequate noise detection, induced undersensing (R waves classified as noise), and oversensing (noise annotated as R waves). In case of noise induction in the current vector, device reprogramming to a noise-free vector was done. RESULTS We systematically assessed 41 patients. In nearly all patients (90.2%), MPs were inducible. ICP was the most potent inductor of MPs. Whereas SecV (70.7%) and AltV (75.6%) were most vulnerable during ICP, PrimV was most affected during SPE (51.2%). In only a few cases did the S-ICD software distinguish correctly between MPs and QRS. MPs predominantly led to undersensing (up to 65.9%), but in up to 22% of patients MP-induced oversensing occurred but did not lead to tachycardia detection. No relation was seen between S-ICD lead and generator position and MP inducibility. CONCLUSION Induction of MPs during physical exercise was observed frequently. Although in most cases MP noise led to undersensing, oversensing events were commonly observed.
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Affiliation(s)
- Jan-Hendrik van den Bruck
- University of Cologne, Department of Electrophysiology, University Hospital Cologne, Cologne, Germany.
| | - Arian Sultan
- University of Cologne, Department of Electrophysiology, University Hospital Cologne, Cologne, Germany
| | - Tobias Plenge
- University of Cologne, Department of Electrophysiology, University Hospital Cologne, Cologne, Germany
| | - Katharina Seuthe
- University of Cologne, Department of Electrophysiology, University Hospital Cologne, Cologne, Germany
| | - Tim Mödder
- University of Cologne, Department of Electrophysiology, University Hospital Cologne, Cologne, Germany
| | - Christos Iliadis
- University of Cologne, Department of Electrophysiology, University Hospital Cologne, Cologne, Germany
| | - Daniel Stern
- University of Cologne, Department of Electrophysiology, University Hospital Cologne, Cologne, Germany
| | - Tatjana Blankenheim
- University of Cologne, Department of Electrophysiology, University Hospital Cologne, Cologne, Germany
| | - Daniel Steven
- University of Cologne, Department of Electrophysiology, University Hospital Cologne, Cologne, Germany
| | - Jakob Lüker
- University of Cologne, Department of Electrophysiology, University Hospital Cologne, Cologne, Germany
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12
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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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13
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Karnik AA, Helm RH, Monahan KM. Mechanisms and management of inappropriate therapy in subcutaneous implantable cardioverter defibrillators. J Cardiovasc Electrophysiol 2019; 30:402-409. [DOI: 10.1111/jce.13831] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/03/2018] [Accepted: 12/18/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Ankur A. Karnik
- Electrophysiology and Arrhythmia Service, Cardiology Division, Department of Medicine, Boston Medical CenterBoston Massachusetts
| | - Robert H. Helm
- Electrophysiology and Arrhythmia Service, Cardiology Division, Department of Medicine, Boston Medical CenterBoston Massachusetts
| | - Kevin M. Monahan
- Electrophysiology and Arrhythmia Service, Cardiology Division, Department of Medicine, Boston Medical CenterBoston Massachusetts
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14
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Melles MC, Yap SC, Bhagwandien RE, Sakhi R, Szili-Torok T, Theuns DA. Frequency of Need for Antitachycardia or Antibradycardia Pacing or Cardiac Resynchronization Therapy in Patients With a Single-Chamber Implantable Cardioverter-Defibrillator. Am J Cardiol 2018; 122:2068-2074. [PMID: 30340766 DOI: 10.1016/j.amjcard.2018.08.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 08/27/2018] [Accepted: 08/30/2018] [Indexed: 12/28/2022]
Abstract
The subcutaneous implantable cardioverter-defibrillator (S-ICD) is unable to deliver antitachycardia pacing (ATP), bradycardia pacing, and cardiac resynchronization therapy (CRT). However, little is known about the proportion of patients that develop the need for 1 of these features. We evaluated the potential suitability for a S-ICD at the time of first replacement in a cohort of patients with a transvenous single-chamber device who did not need bradycardia pacing at the time of implantation. The study cohort consisted of patients who received a transvenous single-chamber ICD between 1998 and September 2017. The primary end point was a combined end point of the need for atrial or ventricular pacing, development of a CRT indication, or termination of ventricular arrhythmias by ATP delivery. During a mean follow-up of 5.6 ± 1.9 years, 78 of 254 patients (31%) reached the primary end point. The 7 years' cumulative S-ICD suitability rate was 65.6% (95% confidence interval [CI] 58.5% to 71.7%). Event rates were 9.5% (95% CI 6.5% to 13.9%) at 1-year follow-up, and 28.0% (95% CI 22.8% to 34.2%) at 5 years' follow-up. For individual end points, incidence rates were 1.8 (95% CI 1.2 to 2.6) per 100-patient-years for CRT, 0.3 (95% CI 0.1 to 0.8) per 100-patient-years for pacing-dependency, and 4.9 (95% CI 3.8 to 6.3) per 100-patient-years for appropriate ATP therapy. No baseline variables for predicting S-ICD unsuitability were found. In conclusion, at the time of the first replacement, 69% of the patients with a single-chamber device would have been clinically eligible for the S-ICD. Incidence rates of developing a bradycardia pacing and CRT indication are low.
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15
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Theuns DAMJ, Bhagwandien RE, Szili-Torok T, Zijlstra F, Yap SC. Evaluation of recurrent ventricular tachyarrhythmias in patients who survived out-of-hospital cardiac arrest due to ventricular fibrillation: eligibility for subcutaneous implantable defibrillator therapy. J Interv Card Electrophysiol 2018; 55:317-323. [PMID: 30478809 PMCID: PMC6694073 DOI: 10.1007/s10840-018-0490-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 11/14/2018] [Indexed: 11/30/2022]
Abstract
Purpose The subcutaneous implantable defibrillator (S-ICD) was developed to avoid complications related to transvenous leads. A trade-off with the S-ICD is the inability to deliver antitachycardia pacing (ATP). Data is scarce about the recurrence and characteristics of ventricular tachyarrhythmias (VTa) during a follow-up in survivors of out-of-hospital cardiac arrest due to ventricular fibrillation (OHCA-VF). The aim of the study is to determine the characteristics of VTa triggering ICD therapy in order to assess whether survivors of OHCA-VF are eligible candidates for the S-ICD. Methods All OHCA-VF patients who received a transvenous ICD were identified, 378 patients, age 57 ± 14 years, predominantly male (76%) with ischemic heart disease (58%). Arrhythmic endpoints were appropriate ICD therapies for any ventricular arrhythmia. Results Over a median follow-up of 4.5 years, 690 VTa in 91 patients (24%) were terminated by ICD therapy; 70% of patients had < 5 VTa with ICD therapy. VTa with cycle length ≤ 300 ms were mainly (82%) treated by shock, while 83% of VTa with cycle length > 300 ms were treated by ATP. The presence of a remote myocardial infarction (OR 2.07; 95% CI 1.08–3.97) and LVEF ≤ 0.35 (OR 2.09; 95% CI 1.09–4.00) were significantly associated with the occurrence of VTa with cycle length > 300 ms. Conclusion S-ICD implantation may be reasonable in survivors of OHCA-VF who present without a remote myocardial infarction and LVEF > 35%.
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Affiliation(s)
- Dominic A M J Theuns
- Department of Cardiology, Erasmus MC, Room RG-632, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Rohit E Bhagwandien
- Department of Cardiology, Erasmus MC, Room RG-632, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Tamas Szili-Torok
- Department of Cardiology, Erasmus MC, Room RG-632, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Felix Zijlstra
- Department of Cardiology, Erasmus MC, Room RG-632, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Sing-Chien Yap
- Department of Cardiology, Erasmus MC, Room RG-632, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
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16
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Theuns DA, Brouwer TF, Jones PW, Allavatam V, Donnelley S, Auricchio A, Knops RE, Burke MC. Prospective blinded evaluation of a novel sensing methodology designed to reduce inappropriate shocks by the subcutaneous implantable cardioverter-defibrillator. Heart Rhythm 2018; 15:1515-1522. [DOI: 10.1016/j.hrthm.2018.05.011] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Indexed: 11/26/2022]
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17
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Device updates successfully reduce T‑wave oversensing and inappropriate shocks in subcutaneous ICD patients. Neth Heart J 2018; 26:606-611. [PMID: 30250998 PMCID: PMC6288039 DOI: 10.1007/s12471-018-1160-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aims To analyse the impact of device and software updates on the prevention of T‑wave oversensing (TWOS) and inappropriate shocks (IS) in subcutaneous ICD (S-ICD) patients. Background TWOS is a feared complication after implantation. It may lead to harmful IS. To date, specific strategies to reduce these events are lacking. Methods In this retrospective single-centre trial we analysed 146 S‑ICD patients who were implanted between 2010 and 2016. In all eligible consecutive patients (n = 139), follow-up of at least 6 weeks was studied. The incidence of TWOS/IS was analysed in patients receiving a 2nd generation S‑ICD (Emblem-S-ICD) between 2014 and 2016 (Emblem). Their outcome was compared with a control group (SQ) treated with the SQ1010 device between 2010 and 2014, who were followed up for a maximum of 2 years. Furthermore, to test if the software update SMR8 reduces inappropriate shocks in the SQ1010-S-ICD population, the incidence of TWOS/IS was evaluated before and after update installation. Results Basic characteristics and indications for S‑ICD implantation were similar in both groups. However, the cumulative incidence of TWOS/IS was significantly decreased in Emblem vs. SQ (SQ: 15.4%, n = 14/91 vs. Emblem 4.2%, n = 2/48; p = 0.049). Furthermore, with regards to the SQ population we also observed a trend towards a significant reduction of TWOS/IS after installation of the software update SMR8 in 2014 (before update: 13.4%, n = 11/82 vs. after update: 4.6%, 3/65, p = 0.07). Conclusion 2nd generation devices but probably also the SMR8 software update reduce the incidence of TWOS/IS in S‑ICD patients.
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18
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Sakhi R, Yap SC, Michels M, Schinkel AFL, Kauling RM, Roos-Hesselink JW, Theuns DAMJ. Evaluation of a novel automatic screening tool for determining eligibility for a subcutaneous implantable cardioverter-defibrillator. Int J Cardiol 2018; 272:97-101. [PMID: 30005832 DOI: 10.1016/j.ijcard.2018.07.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 06/25/2018] [Accepted: 07/05/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND The manufacturer has developed a new ECG screening tool to determine eligibility for the subcutaneous ICD (S-ICD), the "automatic screening tool" (AST), which may render manual ECG-screening unnecessary. The aim of the study was to determine the eligibility for the S-ICD using two methods (manual ECG-screening versus AST) in different patient categories including patients with cardiomyopathy, congenital heart disease and inherited primary arrhythmia syndrome. METHODS We prospectively evaluated the ECG suitability for an S-ICD in consecutive patients at our outpatient clinic between February and June 2017. The primary endpoint of the study was ECG eligibility defined as at least 1 successful vector in both supine and sitting postures. RESULTS A total of 254 patients (167 men; mean age 45 ± 16 years) were screened using both methods. Overall, there was a high ECG eligibility using either method (93% versus 92%, P = 0.45). Overall agreement between both methods was 94%. Patients with hypertrophic cardiomyopathy (HCM) more often had a failed screening test using either test in comparison to the patients without HCM (manual: odds ratio [OR] 3.3, 95% confidence interval [CI] 1.2-9.3, P = 0.02; AST: OR 3.0, 95% CI 1.2-7.6, P = 0.02). CONCLUSION AST showed a high agreement with manual ECG-screening for S-ICD. Overall there was a high ECG eligibility for S-ICD, although patients with HCM had a lower passing rate irrespective of the screening method.
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Affiliation(s)
- Rafi Sakhi
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Sing-Chien Yap
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Michelle Michels
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Arend F L Schinkel
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - R Martijn Kauling
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
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19
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Koneru JN, Jones PW, Hammill EF, Wold N, Ellenbogen KA. Risk Factors and Temporal Trends of Complications Associated With Transvenous Implantable Cardiac Defibrillator Leads. J Am Heart Assoc 2018; 7:JAHA.117.007691. [PMID: 29748177 PMCID: PMC6015312 DOI: 10.1161/jaha.117.007691] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background The transvenous implantable cardioverter‐defibrillator (ICD) lead is the most common source of complications in a traditional ICD system. This investigation aims to determine the incidence, predictors, and costs associated with these complications using a large insurance database. Methods and Results Data from the OptumLabs™ Data Warehouse, which include diagnosis, physician and procedure codes, and claims from patient hospitalizations, were analyzed. Patients with a de novo ICD or cardiac resynchronization therapy defibrillator implanted from January 1, 2003, through June 30, 2015, were included; those who did not have continuous coverage beginning 1 year before implantation were excluded, resulting in 40 837 patients followed up over an average of 2.3±2.1 years. Patients were followed up until they had the procedure or their last active date in the database. Of 20 580 device procedures, 2165 (5.3%) and 771 (1.9%) had mechanical and infectious complications, respectively. The 5‐year rate of freedom from mechanical complication was 92.0% and 89.3% for ICDs and cardiac resynchronization therapy defibrillators, respectively. Infectious complications were more likely in patients with a history of atrial fibrillation, diabetes mellitus, and renal disease, and the risk increased with subsequent device procedures. Younger age, female sex, lack of comorbidities, and implantations between 2003 and 2008 were associated with more mechanical complications. Conclusions Incidence of mechanical and infectious complications of transvenous ICD leads over long‐term follow‐up is much higher in the real world than in clinical studies. In our study cohort, 1 of 4 transvenous ICD leads had mechanical complications when followed up to 10 years. The high rate of reintervention leads to additional complications.
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Affiliation(s)
- Jayanthi N Koneru
- VCU School of Medicine, Medical College of Virginia Hospitals, Richmond, VA
| | - Paul W Jones
- Boston Scientific, Marlborough, MA.,OptumLabs, Cambridge, MA
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20
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Keiler J, Schulze M, Sombetzki M, Heller T, Tischer T, Grabow N, Wree A, Bänsch D. Neointimal fibrotic lead encapsulation - Clinical challenges and demands for implantable cardiac electronic devices. J Cardiol 2017; 70:7-17. [PMID: 28583688 DOI: 10.1016/j.jjcc.2017.01.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 01/16/2017] [Indexed: 01/09/2023]
Abstract
Every tenth patient with a cardiac pacemaker or implantable cardioverter-defibrillator implanted is expected to have at least one lead problem in his lifetime. However, transvenous leads are often difficult to remove due to thrombotic obstruction or extensive neointimal fibrotic ingrowth. Despite its clinical significance, knowledge on lead-induced vascular fibrosis and neointimal lead encapsulation is sparse. Although leadless pacemakers are already available, their clinical operating range is limited. Therefore, lead/tissue interactions must be further improved in order to improve lead removals in particular. The published data on the coherences and issues related to lead associated vascular fibrosis and neointimal lead encapsulation are reviewed and discussed in this paper.
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Affiliation(s)
- Jonas Keiler
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany.
| | - Marko Schulze
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany
| | - Martina Sombetzki
- Department for Tropical Medicine and Infectious Diseases, Rostock University Medical Center, Rostock, Germany
| | - Thomas Heller
- Institute of Diagnostic and Interventional Radiology, Rostock University Medical Center, Rostock, Germany
| | - Tina Tischer
- Heart Center Rostock, Department of Internal Medicine, Divisions of Cardiology, Rostock University Medical Center, Rostock, Germany
| | - Niels Grabow
- Institute for Biomedical Engineering, Rostock University Medical Center, Rostock, Germany
| | - Andreas Wree
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany
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21
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2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction. Heart Rhythm 2017; 14:e503-e551. [PMID: 28919379 DOI: 10.1016/j.hrthm.2017.09.001] [Citation(s) in RCA: 718] [Impact Index Per Article: 102.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Indexed: 02/06/2023]
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22
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Boveda S, Lenarczyk R, Haugaa K, Fumagalli S, Madrid AH, Defaye P, Broadhurst P, Dagres N. Implantation of subcutaneous implantable cardioverter defibrillators in Europe: results of the European Heart Rhythm Association survey. Europace 2017; 18:1434-9. [PMID: 27582309 DOI: 10.1093/europace/euw258] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 05/11/2016] [Indexed: 12/13/2022] Open
Abstract
AIMS The purpose of this European Heart Rhythm Association (EHRA) survey is to provide an overview of the current use of subcutaneous cardioverter defibrillators (S-ICDs) across a broad range of European centres. METHODS AND RESULTS A questionnaire was sent via the internet to centres participating in the EHRA electrophysiology research network. Questions included standards of care and policies used for patient management, indications, and techniques of implantation of the S-ICDs. In total, 52 centres replied to the questionnaire. More than one-fourth of the responding centres does not implant the S-ICD (n = 14, 27%). The majority reported to have implanted <10 (50%) or 10-29 (23%) S-ICDs during the last 12 months. Lack of reimbursement (25%), non-availability (19%), and cost of the device (25%) seem to limit the use of the S-ICD. The most commonly reported indications for S-ICD implantation are a difficult vascular access (82%), a history of previous complicated transvenous ICD (8O%), young age (69%), or an anticipated higher risk of infection (63%). Inappropriate therapies were the most frequently reported major problems (38%), but the majority of respondents (51%) never encountered any issue after an S-ICD implantation. Most of the respondents (83%) anticipate significant increase of S-ICD use within the next 2 years. CONCLUSION This survey provides a contemporary insight into S-ICD implantation and management in the European electrophysiology centres, showing different approaches, depending on local policies. Cost issues or lack of reimbursement strongly influence the dissemination of the device. However, most respondents retain that S-ICD use will significantly increase in a very short time.
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Affiliation(s)
- Serge Boveda
- Department of Cardiology, Cardiac Arrhythmias Management Department, Clinique Pasteur, 45 Avenue de Lombez, 31076 Toulouse, France
| | - Radoslaw Lenarczyk
- Department of Cardiology, Congenital Heart Disease and Electrotherapy, Silesian Medical University, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Kristina Haugaa
- Department of Cardiology and Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Oslo, Norway University of Oslo, Oslo, Norway
| | - Stefano Fumagalli
- Intensive Care Unit, Geriatric Cardiology and Medicine Division, Experimental and Clinical Medicine Department, University of Florence and AOU Careggi, Florence, Italy
| | | | - Pascal Defaye
- Arrhythmia Department, University Hospital Grenoble-Alps, 38043 Grenoble, France
| | - Paul Broadhurst
- Consultant Cardiologist, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, UK
| | - Nikolaos Dagres
- Department of Electrophysiology, University of Leipzig-Heart Center, Leipzig, Germany
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23
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Ferrero P, Ali H, Barman P, Foresti S, Lupo P, D’Elia E, Cappato R, Stuart AG. Entirely subcutaneous defibrillator and complex congenital heart disease: Data on long-term clinical follow-up. World J Cardiol 2017; 9:547-552. [PMID: 28706590 PMCID: PMC5491472 DOI: 10.4330/wjc.v9.i6.547] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 01/31/2017] [Accepted: 05/24/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To describe the long-term follow-up of patients with complex congenital heart disease who underwent subcutaneous implantable cardiac defibrillator (S-ICD), focusing on local complications, appropriate and inappropriate shocks.
METHODS Patients with complex congenital heart disease underwent S-ICD implant in two centers with the conventional technique. Data at follow-up were retrieved from clinical notes and institutional database.
RESULTS Eight patients were implanted in two centres between 2010 and 2016. Median age at implant was 37.5 years (range 13-57). All patients who were deemed suitable for S-ICD implant passed the pre-procedural screening. Three patients were previously implanted with a anti-bradycardia device, one of whom with CRT. In one patient the device was explanted due to local infection. During the total median follow-up of 874 d, one patient had an appropriate and one inappropriate shock triggered by fast atrial tachycardia. None of the patients had inappropriate shocks secondary to T wave oversensing or electrical interference with anti- bradycardia devices.
CONCLUSION S-ICD appears to be effective and safe in patients with complex congenital heart disease.
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24
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Karnik AA, Helm RH, Monahan KM. Oversensing of atrial fibrillatory waves in a subcutaneous implantable cardioverter-defibrillator. HeartRhythm Case Rep 2017; 3:e1-e6. [PMID: 28491810 PMCID: PMC5419807 DOI: 10.1016/j.hrcr.2016.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Ankur A. Karnik
- Address reprint requests and correspondence: Dr Ankur A. Karnik, Electrophysiology and Arrhythmia Service, Cardiology Division, Department of Medicine, Boston Medical Center and the Boston University School of Medicine, 88 E Newton St, Boston, MA 02118.Electrophysiology and Arrhythmia Service, Cardiology Division, Department of Medicine, Boston Medical Center, Boston University School of Medicine88 E Newton StBostonMA02118
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25
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Mesquita J, Cavaco D, Ferreira A, Lopes N, Santos PG, Carvalho MS, Haas A, Costa F, Carmo P, Morgado F, Adragão P, Mendes M. Effectiveness of subcutaneous implantable cardioverter-defibrillators and determinants of inappropriate shock delivery. Int J Cardiol 2017; 232:176-180. [DOI: 10.1016/j.ijcard.2017.01.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 01/02/2017] [Accepted: 01/04/2017] [Indexed: 01/14/2023]
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26
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Angel B, Overcash J, Fischer W, Fontaine JM. Surgical and electrophysiological considerations in the management of a patient with a subcutaneous implantable cardioverter-defibrillator undergoing coronary artery bypass surgery. HeartRhythm Case Rep 2016; 3:58-62. [PMID: 28491769 PMCID: PMC5420013 DOI: 10.1016/j.hrcr.2016.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Brett Angel
- Division of Cardiology and Cardiothoracic Surgery, Drexel University College of Medicine and Hahnemann University Hospital, Philadelphia, Pennsylvania
| | | | - Wade Fischer
- Division of Cardiology and Cardiothoracic Surgery, Drexel University College of Medicine and Hahnemann University Hospital, Philadelphia, Pennsylvania
| | - John M Fontaine
- Division of Cardiology and Cardiothoracic Surgery, Drexel University College of Medicine and Hahnemann University Hospital, Philadelphia, Pennsylvania
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27
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Malagù M, Ferri A, Mancuso O, Trevisan F, Nardozza M, Bertini M. Implantable cardioverter defibrillator management: an update. Future Cardiol 2016; 12:673-688. [PMID: 27762625 DOI: 10.2217/fca-2016-0031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Implantable cardioverter defibrillator (ICD) is the cornerstone of primary and secondary prevention of sudden cardiac death. In 35 years of technologic improvement and clinical trials, there has been a continuous increase in implantation rate. Purpose of this review is to point out and discuss every aspect related to actual ICD management, investigating implantation procedure and predischarge care, office and remote monitoring follow-up, diagnostic evaluations, management of patients with suspected therapies or malfunctions, heart failure, surgery, radiotherapy and endoscopic procedures. Also, ICD backface such as infections and other complications will be discussed. Finally, we will focus on interesting future perspectives for this setting of patients.
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Affiliation(s)
- Michele Malagù
- Department of Cardiology, University of Ferrara, S Anna Hospital, Ferrara, Italy
| | - Alessandra Ferri
- Department of Cardiology, University of Ferrara, S Anna Hospital, Ferrara, Italy
| | - Ottavia Mancuso
- Department of Cardiology, University of Ferrara, S Anna Hospital, Ferrara, Italy
| | - Filippo Trevisan
- Department of Cardiology, University of Ferrara, S Anna Hospital, Ferrara, Italy
| | - Marianna Nardozza
- Department of Cardiology, University of Ferrara, S Anna Hospital, Ferrara, Italy
| | - Matteo Bertini
- Department of Cardiology, University of Ferrara, S Anna Hospital, Ferrara, Italy
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Kristensen AE, Larsen JM, Nielsen JC, Johansen JB, Haarbo J, Petersen HH, Riahi S. Validation of defibrillator lead performance registry data: insight from the Danish Pacemaker and ICD Register. Europace 2016; 19:1187-1192. [DOI: 10.1093/europace/euw226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 06/27/2016] [Indexed: 11/14/2022] Open
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Herman AR, Gardner M, Steinberg C, Yeung-Lai-Wah JA, Healey JS, Leong-Sit P, Krahn AD, Chakrabarti S. Long-term right ventricular implantable cardioverter-defibrillator lead performance in arrhythmogenic right ventricular cardiomyopathy. Heart Rhythm 2016; 13:1964-70. [DOI: 10.1016/j.hrthm.2016.06.021] [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] [Received: 11/25/2015] [Indexed: 11/26/2022]
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Algorithm-Based Screening May Improve Patient Selection for the Subcutaneous Implantable Defibrillator. JACC Clin Electrophysiol 2016; 2:605-614. [DOI: 10.1016/j.jacep.2016.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 02/12/2016] [Accepted: 02/18/2016] [Indexed: 11/17/2022]
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Advancements in technology for patients with congenital heart disease: Implantable rhythm devices. PROGRESS IN PEDIATRIC CARDIOLOGY 2016. [DOI: 10.1016/j.ppedcard.2016.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Treskes RW, van der Velde ET, Barendse R, Bruining N. Mobile health in cardiology: a review of currently available medical apps and equipment for remote monitoring. Expert Rev Med Devices 2016; 13:823-30. [PMID: 27477584 DOI: 10.1080/17434440.2016.1218277] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Recent developments in implantable cardioverter-defibrillators (ICDs) and smartphone technology have increased the possibilities for remote monitoring. It is the purpose of this review to give an overview of these new possibilities. AREAS COVERED Remote monitoring in ICD allows for early detection of lead fractures and remote follow-up of patients. Possible limitations are the lack of standardization and the possible unsafety of the data stored on the ICD. Secondly, remote monitoring of health parameters using smartphone compatible wearables and smartphone medical apps is addressed. Possible limitations include the fact that the majority of smartphone apps are unregulated by the regulatory authorities and privacy issues such as selling of app-generated data to third parties. Lastly, clinical studies with smartphone apps are discussed. Expert commentary: New technologies in ICDs and smartphones have the potential to be used for remote monitoring. However, unreliability of smartphone technology, inadequate legislation and lack of reimbursement impede implementation.
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Affiliation(s)
| | | | - Rogier Barendse
- b Department of Cardiology , Erasmus MC , Rotterdam , Netherlands
| | - Nico Bruining
- b Department of Cardiology , Erasmus MC , Rotterdam , Netherlands
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Willcox ME, Prutkin JM, Bardy GH. Recent developments in the subcutaneous ICD. Trends Cardiovasc Med 2016; 26:526-35. [DOI: 10.1016/j.tcm.2016.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 03/12/2016] [Accepted: 03/12/2016] [Indexed: 11/29/2022]
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Piccini JP, Allen LA, Kudenchuk PJ, Page RL, Patel MR, Turakhia MP. Wearable Cardioverter-Defibrillator Therapy for the Prevention of Sudden Cardiac Death: A Science Advisory From the American Heart Association. Circulation 2016; 133:1715-27. [PMID: 27022063 DOI: 10.1161/cir.0000000000000394] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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35
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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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Hai JJ, Lim ETS, Chan CP, Chan YS, Chan KK, Chong D, Ho KL, Tan BY, Teo WS, Ching CK, Tse HF. First clinical experience of the safety and feasibility of total subcutaneous implantable defibrillator in an Asian population. Europace 2016; 17 Suppl 2:ii63-8. [PMID: 26842117 DOI: 10.1093/europace/euv144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS The safety and feasibility of a subcutaneous implantable cardioverter-defibrillator (S-ICD) has been demonstrated in the treatment of life-threatening ventricular tachyarrhythmias (VT). Nonetheless, its safety and feasibility in an Asian population with smaller body-build is unclear. METHODS AND RESULTS Twenty-one Asian patients who underwent S-ICD from 1 April 2014 to 2 February 2015 in five institutions in Hong Kong and Singapore were retrospectively reviewed. Twenty-one patients with a mean age of 50.0 ± 14.1 years (range 29-77 years, 82.6% male) were included. Among them, 17 (81.0%) were Chinese, 3 (14.3%) were Malay, and 1 (4.8%) was Indian. Their mean body mass index was 23.0 ± 4.0 kg/m(2). An S-ICD was implanted for primary and secondary prevention in 13 (61.9%) and 8 (38.1%) patients, respectively. The indications included Brugada syndrome (n = 6, 28.6%), ischaemic cardiomyopathy (CMP, n = 6, 28.6%), dilated CMP (n = 4, 19.0%), hypertrophic CMP (n = 2, 9.5%), and idiopathic ventricular fibrillation (n = 2, 9.5%). Three patients (14.3%) had prior infected transvenous ICD. There were no acute complications but eight wound complications (persistent wound bleeding requiring intervention = 2; delayed wound healing: upper sternal wound = 3; generator site = 1; local wound infection = 2) were observed in six (28.2%) patients. After a mean follow-up of 107.2 ± 81.3 days (range of 14-254 days), one patient underwent three successful appropriate shocks for treatment of VTs. No inappropriate therapy was documented. CONCLUSION Our initial experience shows that S-ICD is a feasible treatment for VT among an Asian population with smaller body-build. There was nonetheless a relatively high rate of wound complications.
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Affiliation(s)
- Jo Jo Hai
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | | | - Chin-Pang Chan
- Cardiology Division, Department of Medicine, Prince of Wales Hospital, Hong Kong
| | - Yat-Sun Chan
- Cardiology Division, Department of Medicine, Prince of Wales Hospital, Hong Kong
| | - Kwok-Keung Chan
- Cardiology Division, Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - Daniel Chong
- Department of Cardiology, National Heart Center Singapore, Singapore
| | - Kah-Leng Ho
- Department of Cardiology, National Heart Center Singapore, Singapore
| | - Boon-Yew Tan
- Department of Cardiology, National Heart Center Singapore, Singapore
| | - Wee-Siong Teo
- Department of Cardiology, National Heart Center Singapore, Singapore
| | - Chi-Keong Ching
- Department of Cardiology, National Heart Center Singapore, Singapore
| | - Hung-Fat Tse
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong Research Center of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
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Brouwer TF, Driessen AH, Olde Nordkamp LR, Kooiman KM, de Groot JR, Wilde AA, Knops RE. Surgical Management of Implantation-Related Complications of the Subcutaneous Implantable Cardioverter-Defibrillator. JACC Clin Electrophysiol 2016; 2:89-96. [DOI: 10.1016/j.jacep.2015.09.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/09/2015] [Accepted: 09/24/2015] [Indexed: 10/22/2022]
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Providência R, Kramer DB, Pimenta D, Babu GG, Hatfield LA, Ioannou A, Novak J, Hauser RG, Lambiase PD. Transvenous Implantable Cardioverter-Defibrillator (ICD) Lead Performance: A Meta-Analysis of Observational Studies. J Am Heart Assoc 2015; 4:e002418. [PMID: 26518666 PMCID: PMC4845221 DOI: 10.1161/jaha.115.002418] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 08/19/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite the widespread use of implantable cardioverter-defibrillators (ICDs) in clinical practice, concerns exist regarding ICD lead durability. The performance of specific lead designs and factors determining this in large populations need clarification. METHODS AND RESULTS The Medline, Embase, and Cochrane Collaboration databases were searched for studies including ≥2 of the most commonly implanted leads. The Mantel-Haenszel random-effects model was used. Seventeen studies were selected, including a total of 49 871 patients-5538 implanted with Durata (St. Jude Medical Inc), 10 605 with Endotak Reliance (Boston Scientific), 16 119 with Sprint Quattro (Medtronic Corp), 11 709 with Sprint Fidelis (Medtronic Corp), and 5900 with Riata (St. Jude Medical Inc)-with follow-up of 136 509 lead-years. Although the Durata lead presented a numerically higher rate, no statistically significant differences in the mean incidence of lead failure (0.29%-0.45% per year) were observed in comparison of the 3 nonrecalled leads. A higher event rate was documented with the Riata (1.0% per-year increase) and Sprint Fidelis (>2.0% per-year increase) leads compared with nonrecalled leads. An indication of increased incidence of Durata lead failure versus Sprint Quattro and Endotak Reliance leads was observed in 1 of 3 included studies, allowing for comparison of purely electrical lead failure, but this requires further evaluation. CONCLUSIONS Endotak Reliance (8F), Sprint Quattro (8F), and Durata (7F) leads displayed low annual incidence of failure; however, long-term follow-up data are still scarce. More data are needed to clarify the performance and safety of the Durata lead.
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Affiliation(s)
- Rui Providência
- The Heart HospitalUniversity College of London Hospitals NHS TrustLondonUnited Kingdom
- Barts Heart CentreBarts Health NHS TrustLondonUnited Kingdom
| | - Daniel B. Kramer
- Cardiac ElectrophysiologyBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA
| | - Dominic Pimenta
- University College of London Hospitals NHS TrustLondonUnited Kingdom
| | - Girish G. Babu
- The Heart HospitalUniversity College of London Hospitals NHS TrustLondonUnited Kingdom
| | | | | | - Jan Novak
- Solothurner Spitaeler AGSolothurnSwitzerland
| | | | - Pier D. Lambiase
- The Heart HospitalUniversity College of London Hospitals NHS TrustLondonUnited Kingdom
- University College of LondonUnited Kingdom
- Barts Heart CentreBarts Health NHS TrustLondonUnited Kingdom
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Steinberg C, Padfield GJ, Hahn E, Flavelle S, McILROY C, VAN Bremen O, Yeung-Lai-Wah JA, Kerr CR, Deyell MW, Tung SK, Andrade JG, Bennett MT, Bashir JG, Krahn AD, Chakrabarti S. Lead Integrity Alert Is Useful for Assessment of Performance of Biotronik Linox Leads. J Cardiovasc Electrophysiol 2015; 26:1340-5. [PMID: 26471861 DOI: 10.1111/jce.12832] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 08/23/2015] [Accepted: 08/25/2015] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Medtronic's Lead Integrity Alert (LIA) software algorithm is useful for detecting abnormal parameters across various ICD-lead families. However, its utility in the assessment of the Biotronik Linox™ family of high-voltage (HV) leads is unknown. METHODS We conducted a retrospective cohort study to assess the performance of the LIA algorithm to detect abnormalities and lead failure in Linox ICD-leads. All LIA-enabled Medtronic devices connected to an active Linox lead were included. The alerts were adjudicated by 2 blinded electrophysiologists and correlated with clinical data. RESULTS Between 2008 and 2012, data from 208 patients with 564 patient-years of follow-up were available for analysis. The median follow-up duration was 32 (IQR 21-41 months). Twenty-one LIA triggers were noted in 20 different patients. The median delay until a positive LIA was 32 months (IQR 21-41 months) postimplant with a 5-year lead survival free from LIA of 76%. Ninety-five percent (19/20) LIA alerts were true lead failures. The most common LIA triggers were short V-V intervals (85%) and nonsustained ventricular tachycardia (85%). Abrupt changes of the ICD-lead impedance occurred in 5/20 triggers. Inappropriate ICD-shocks were strongly associated with a positive LIA (30% vs. 7.4%; P = 0.006). Of the explanted Linox leads 53% had visible abnormalities. The sensitivity, specificity, and positive predictive value for lead failure in the presence of a LIA trigger were 87%, 99.5%, and 95.2%, respectively. CONCLUSIONS A positive LIA trigger in Biotronik Linox ICD-leads is highly predictive of lead failure. LIA is useful in ongoing surveillance of lead performance.
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Affiliation(s)
- Christian Steinberg
- Heart Rhythm Services, University of British Columbia, British Columbia, Canada
| | - Gareth J Padfield
- Heart Rhythm Services, University of British Columbia, British Columbia, Canada
| | - Edna Hahn
- Heart Rhythm Services, University of British Columbia, British Columbia, Canada
| | - Sheila Flavelle
- Heart Rhythm Services, University of British Columbia, British Columbia, Canada
| | - Cheryl McILROY
- Heart Rhythm Services, University of British Columbia, British Columbia, Canada
| | - Otto VAN Bremen
- Heart Rhythm Services, University of British Columbia, British Columbia, Canada
| | | | - Charles R Kerr
- Heart Rhythm Services, University of British Columbia, British Columbia, Canada
| | - Marc W Deyell
- Heart Rhythm Services, University of British Columbia, British Columbia, Canada
| | - Stanley K Tung
- Heart Rhythm Services, University of British Columbia, British Columbia, Canada
| | - Jason G Andrade
- Heart Rhythm Services, University of British Columbia, British Columbia, Canada
| | - Matthew T Bennett
- Heart Rhythm Services, University of British Columbia, British Columbia, Canada
| | - Jamil G Bashir
- Heart Rhythm Services, University of British Columbia, British Columbia, Canada
| | - Andrew D Krahn
- Heart Rhythm Services, University of British Columbia, British Columbia, Canada
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Marangou J, Paul V. Current Attitudes on Cardiac Devices in Heart Failure: A Review. Clin Ther 2015; 37:2206-14. [DOI: 10.1016/j.clinthera.2015.08.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/12/2015] [Accepted: 08/17/2015] [Indexed: 01/14/2023]
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Longevity of the Subcutaneous Implantable Defibrillator. Circ Arrhythm Electrophysiol 2015; 8:1159-63. [DOI: 10.1161/circep.115.002953] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/24/2015] [Indexed: 02/06/2023]
Abstract
Background—
The recent advent of subcutaneous implantable cardioverter defibrillators (S-ICDs) has provided investigators with a safe and effective new therapy in patients at risk of sudden cardiac death. At present, no data are available with regard to the longevity of these new devices. This study evaluated the longevity of the S-ICD system.
Methods and Results—
All patients enrolled in the European Regulatory Trial were included in the analysis. During follow-up, time and causes of device replacement or explantation were assessed and categorized. Device longevity was estimated using Kaplan–Meier analysis. Fifty-five patients were followed for a median of 5.8 years. During follow-up, 26 (47%) patients underwent device replacement and 5 (9%) underwent device explantation. Median time to replacement was 5.0 years (Q1–Q3, 4.4–5.6 years). Replacement was caused by battery depletion in 25 patients (92%), of which 5 within 1.5 years because of premature battery depletion, and by infection in 1 patient (2%). Replacement for a transvenous ICD system was required in 4 patients (7%) because of ineffective defibrillation in 1 (0.003 per patient-year), need for resynchronization therapy in 2 (0.01 per patient-year), and for antibradycardia pacing in 1 (0.003 per patient-year). At 5 years follow-up, 71% of devices were still in service.
Conclusions—
This study provides the first estimate of S-ICD system longevity since its introduction in clinical practice. Median longevity of the first generation S-ICD system was 5.0 years. The majority of devices were replaced because of battery depletion.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01117792.
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Srinivasan NT, Segal OR. Biventricular pacing and coronary sinus ICD lead implantation in a patient with a mechanical tricuspid valve replacement. J Cardiol Cases 2015; 12:180-182. [PMID: 30546590 DOI: 10.1016/j.jccase.2015.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/31/2015] [Accepted: 08/01/2015] [Indexed: 11/15/2022] Open
Abstract
A 49-year-old man was admitted with symptomatic, sustained monomorphic ventricular tachycardia. He had a previous history of AMP-kinase disease associated with hypertrophic cardiomyopathy and complete heart block, and a pre-existing dual chamber pacemaker. He also had a mechanical tricuspid valve replacement and mitral valve replacement, for severe tricuspid regurgitation from right ventricle (RV) lead-induced injury to the tricuspid valve and a fibroblastoma on the mitral valve. His pre-existing RV lead was maintained between the prosthetic valve annulus and the native annulus. Inability to place an implantable cardioverter-defibrillator (ICD) in the RV due to the presence of a mechanical tricuspid valve replacement represented a rare but challenging clinical scenario. Surgical epicardial lead placement or the use of a subcutaneous ICD (S-ICD) were possible alternatives. Traditional ICD lead placement was favored because of the broad QRS from RV pacing meaning that use of the S-ICD was not possible due to failure of the electrocardiogram to lie within the bounds of the screening template, and the perceived high risk of repeat thoracotomy. We describe the technique for ICD lead placement in a mid-lateral cardiac venous branch of the coronary sinus with the ability to deliver anti-tachycardia pacing and cardiac resynchronization. To our knowledge this is the first report of an ICD in the mid-lateral cardiac vein, with cardiac resynchronization. <Learning objective: This case describes the technique for implantable cardioverter-defibrillator placement in the coronary sinus with biventricular pacing in a patient with a mechanical tricuspid and pre-existing right ventricular endocardial lead. This technique represents a viable alternative to repeat thoracotomy and surgical lead placement, where the risks of complication, prolonged hospital stay and lead failure are high. It also offers the ability to deliver anti-tachycardia pacing and cardiac resynchronization.>.
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Affiliation(s)
- Neil T Srinivasan
- The Heart Hospital, University College Hospital, London, UK.,Institute of Cardiovascular Sciences, UCL, London, UK
| | - Oliver R Segal
- The Heart Hospital, University College Hospital, London, UK
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Piot O, Deballon R, Nitu D, Marquié C, da Costa A, Leclercq C, Defaye P, Sadoul N. Factors predicting Sprint Fidelis lead fracture: Results at 5years from a French multicentre registry. Arch Cardiovasc Dis 2015; 108:220-6. [DOI: 10.1016/j.acvd.2014.11.006] [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] [Received: 05/05/2014] [Revised: 11/01/2014] [Accepted: 11/04/2014] [Indexed: 11/16/2022]
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Gupta A, Subzposh F, Hankins SR, Kutalek SP. Subcutaneous implantable cardioverter-defibrillator implantation in a patient with a left ventricular assist device already in place. Tex Heart Inst J 2015; 42:140-3. [PMID: 25873825 DOI: 10.14503/thij-14-4166] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A 56-year-old man with ischemic cardiomyopathy, a biventricular implantable cardioverter-defibrillator (ICD), and a left ventricular assist device (LVAD) developed a pocket hematoma and infection after an ICD generator change. The biventricular ICD was extracted, and the patient was given a full course of antibiotics. Because he had no indications for bradycardia pacing or biventricular pacing, he was implanted with a subcutaneous ICD under full anticoagulation. There was no interference in sensing or shock delivery from the ICD. The LVAD readings were unchanged during and after the procedure. The patient had an uneventful postoperative course, and both devices were functioning normally. To our knowledge, this is the first reported case of the implantation of a subcutaneous ICD in the presence of an LVAD. This report illustrates that both devices can be implanted successfully in the same patient. In addition, the subcutaneous ICD minimizes the risk of bloodstream infections, which can be fatal in patients who have life-supporting devices such as an LVAD.
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Tsurugi T, Matsui S, Nakajima H, Nishii N, Honda T, Kaneko Y. Various mechanisms and clinical phenotypes in electrical short circuits of high-voltage devices: report of four cases and review of the literature. Europace 2015; 17:909-14. [DOI: 10.1093/europace/euv022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 01/27/2015] [Indexed: 11/13/2022] Open
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Nisam S, Reddy S. The story of ... a lead. Europace 2015; 17:677-88. [DOI: 10.1093/europace/euu391] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 12/03/2014] [Indexed: 11/13/2022] Open
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van der Heijden AC, Borleffs CJW, Buiten MS, Thijssen J, van Rees JB, Cannegieter SC, Schalij MJ, van Erven L. The clinical course of patients with implantable cardioverter-defibrillators: Extended experience on clinical outcome, device replacements, and device-related complications. Heart Rhythm 2015; 12:1169-76. [PMID: 25749138 DOI: 10.1016/j.hrthm.2015.02.035] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Large randomized trials demonstrated the beneficial effect of implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy-defibrillator (CRT-D) treatments in selected patients. Data on long-term follow-up of patients outside the setting of clinical trials are scarce. OBJECTIVE The aim of this study was to evaluate the long-term outcome of ICD and CRT-D recipients. METHODS All patients who underwent ICD (n = 1729 [57%]) or CRT-D (n = 1326 [43%]) implantation at the Leiden University Medical Center since 1996 were evaluated. Follow-up visits were performed every 3-6 months, and events were registered. Cumulative incidence curves of device therapy and device-related complications were adjusted for the competing risk of all-cause mortality. RESULTS After a median follow-up of 5.1 years (25th-75th percentile 3.1-7.8 years), 842 patients (28%) died. The cumulative incidence of all-cause mortality was 49% (95% confidence interval [CI] 45%-54%) in ICD recipients after 12 years of follow-up and 55% (95% CI 52%-58%) in CRT-D recipients after 8 years of follow-up. A total of 1081 patients (35%) received appropriate defibrillator therapy. The cumulative incidence of appropriate therapy in ICD patients was 58% (95% CI 54%-62%) after 12 years of follow-up and 39% (95% CI 35%-43%) in CRT-D patients after 8 years of follow-up. Twelve-year cumulative incidences of adverse events were 20% (95% CI 18%-22%) for inappropriate shock, 6% (95% CI 5%-8%) for device-related infection, and 17% (95% CI 14%-21%) for lead failure. CONCLUSION After long-term follow-up of ICD (12 years) and CRT-D (8 years) recipients, 49% of ICD recipients and 55% of CRT-D recipients had died. Appropriate ICD therapy was received by the majority (58%) of ICD recipients and by almost 40% of CRT-D recipients.
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Affiliation(s)
| | | | - Maurits S Buiten
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Joep Thijssen
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Johannes B van Rees
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lieselot van Erven
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
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BRISBEN AMYJ, BURKE MARTINC, KNIGHT BRADLEYP, HAHN STEPHENJ, HERRMANN KEITHL, ALLAVATAM VENUGOPAL, MAHAJAN DEEPA, SANGHERA RICK, GOLD MICHAELR. A New Algorithm to Reduce Inappropriate Therapy in the S-ICD System. J Cardiovasc Electrophysiol 2015; 26:417-423. [DOI: 10.1111/jce.12612] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 12/24/2014] [Accepted: 01/01/2015] [Indexed: 12/24/2022]
Affiliation(s)
| | - MARTIN C. BURKE
- Section of Cardiology, Department of Internal Medicine; University of Chicago; Chicago Illinois USA
| | - BRADLEY P. KNIGHT
- Division of Cardiology, Department of Internal Medicine; Northwestern University; Chicago Illinois USA
| | | | | | | | - DEEPA MAHAJAN
- Boston Scientific Corporation; St. Paul Minnesota USA
| | - RICK SANGHERA
- Boston Scientific Corporation; St. Paul Minnesota USA
| | - MICHAEL R. GOLD
- Division of Cardiology; Medical University of South Carolina; Charleston South Carolina USA
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Sanghera R, Sanders R, Husby M, Bentsen JG. Development of the subcutaneous implantable cardioverter-defibrillator for reducing sudden cardiac death. Ann N Y Acad Sci 2014; 1329:1-17. [DOI: 10.1111/nyas.12550] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Rick Sanghera
- Cardiac Rhythm Management Division; Boston Scientific Corporation; Arden Hills Minnesota
| | - Richard Sanders
- Cardiac Rhythm Management Division; Boston Scientific Corporation; Arden Hills Minnesota
| | - Michael Husby
- Cardiac Rhythm Management Division; Boston Scientific Corporation; Arden Hills Minnesota
| | - James G. Bentsen
- Cardiac Rhythm Management Division; Boston Scientific Corporation; Arden Hills Minnesota
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Johansen JB, Larsen JM, Nielsen JC. Need for real-world data on management of the (potentially) failing lead. Europace 2014; 16:1105-6. [DOI: 10.1093/europace/euu134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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