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Taguchi Y, Ishikawa T, Matsumoto K, Narikawa M, Okazaki Y, Miyagawa S, Horigome A, Hosoda J. Subcutaneous air entrapment after subcutaneous implantable cardioverter defibrillator implantation evaluated by computed tomography. Pacing Clin Electrophysiol 2024; 47:496-502. [PMID: 38462721 DOI: 10.1111/pace.14962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/30/2024] [Accepted: 02/20/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Inappropriate shock (IAS) caused by subcutaneous air entrapment (AE) in an early period after subcutaneous implantable cardioverter defibrillator (S-ICD) implantation has been reported, however, no detailed data on air volume are available. We evaluated the subcutaneous air volume after implantation and its absorption rate one week after implantation. METHODS Patients who underwent S-ICD implantation in our hospital received chest CT scans immediately after implantation and followed up 1 week later. The total subcutaneous air volume, air around the generator, the distal electrode, and the proximal electrode within 3 cm were calculated using a three-dimensional workstation. Fat areas at the level of the lower edge of the generator were also analyzed. RESULT Fifteen patients received CT immediately after implantation. The mean age was 45.6 ± 17.9 (66.7% of men), and the mean body mass index was 24.3 ± 3.3. The three-incision technique was applied in seven patients and two-incision technique was in the latter eight patients. The mean total subcutaneous air volume was 18.54 ± 7.50 mL. Air volume around the generator, the distal electrode, and the proximal electrode were 11.05 ± 5.12, 0.72 ± 0.72, and 0.88 ± 0.87 mL, respectively. Twelve patients received a follow-up CT 1 week later. The mean total subcutaneous air was 0.25 ± 0.45 mL, showing a 98.7% absorption rate. CONCLUSION Although subcutaneous air was observed in all patients after S-ICD implantation, most of the air was absorbed within 1 week, suggesting a low occurrence of AE-related IAS after a week postoperation.
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Affiliation(s)
- Yuka Taguchi
- Department of Cardiology, Yokohama City University Graduate School of Medicine, Yokohama-City, Japan
| | - Toshiyuki Ishikawa
- Department of Cardiology, Yokohama City University Graduate School of Medicine, Yokohama-City, Japan
| | - Katsumi Matsumoto
- Department of Cardiology, Yokohama City University Graduate School of Medicine, Yokohama-City, Japan
| | - Masatoshi Narikawa
- Department of Cardiology, Yokohama City University Graduate School of Medicine, Yokohama-City, Japan
| | - Yoshinori Okazaki
- Department of Cardiology, Yokohama City University Graduate School of Medicine, Yokohama-City, Japan
| | - Shuichi Miyagawa
- Department of Cardiology, Yokohama City University Graduate School of Medicine, Yokohama-City, Japan
| | - Akira Horigome
- Department of Cardiology, Yokohama City University Graduate School of Medicine, Yokohama-City, Japan
| | - Junya Hosoda
- Department of Cardiology, Yokohama City University Graduate School of Medicine, Yokohama-City, Japan
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Crozier I, Haqqani H, Kotschet E, Wiggenhorn C, Lande J, Thompson A, Cheng A, Bhatia V, O’Donnell D. Three-year chronic follow-up from the pilot study of a substernal extravascular implantable cardioverter-defibrillator. Europace 2023; 25:euad301. [PMID: 37847230 PMCID: PMC10580370 DOI: 10.1093/europace/euad301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/30/2023] [Indexed: 10/18/2023] Open
Affiliation(s)
- Ian Crozier
- Department of Cardiology, Christchurch Hospital, 2 Riccarton Avenue, PO Bag 4710, Christchurch 8140, New Zealand
| | - Haris Haqqani
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia
| | - Emily Kotschet
- Department of Caridac Rhythm Services, Monash Medical Centre, Melbourne, Australia
| | | | - Jeff Lande
- Department of Cardiac Rhythm Managment, Medtronic Inc., Mounds View, MN, USA
| | - Amy Thompson
- Department of Cardiac Rhythm Managment, Medtronic Inc., Mounds View, MN, USA
| | - Alan Cheng
- Department of Cardiac Rhythm Managment, Medtronic Inc., Mounds View, MN, USA
| | - Varun Bhatia
- Department of Cardiac Rhythm Managment, Medtronic Inc., Mounds View, MN, USA
| | - David O’Donnell
- Department of Cardiology, The Austin Hospital, Melbourne, Australia
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Burke MC, Knops RE, Reddy V, Aasbo J, Husby M, Marcovecchio A, O'Connor M, Sanghera R, Scheck D, Pepplinkhuizen S, Ebner A. Initial Experience With Intercostal Insertion of an Extravascular ICD Lead Compatible With Existing Pulse Generators. Circ Arrhythm Electrophysiol 2023; 16:421-432. [PMID: 37582163 DOI: 10.1161/circep.123.011922] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/20/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND This study assessed safety and feasibility of a novel extravascular implantable cardioverter defibrillator (ICD) lead when inserted anteriorly through a rib space and connected to various commercially available ICD pulse generators (PGs) placed in either a left mid-axillary or left pectoral pocket. Currently available or investigational, extravascular-ICDs include a subcutaneous or subxiphoid lead connected to customized extravascular-ICD PGs. METHODS This novel extravascular-ICD (AtaCor Medical Inc, San Clemente, CA) employs a unique intercostal implant technique and is designed to function with commercial DF-4 ICD PGs. In this nonrandomized, single-center, acute study, 36 de novo or replacement ICD (transvenous ICD) patients enrolled to receive a concomitant extravascular-ICD lead inserted through an intercostal space along the left parasternal margin. extravascular-ICD leads were connected to DF-4 compatible ICD PGs positioned in either a left mid-axillary or pectoral pocket for acute sensing and defibrillation testing. Defibrillation testing started at 30 Joules (J) and stepped up or down in 5 to 10 joule increments depending on the success and limitations of the generator used. RESULTS Successful acute defibrillation using ≤35 J was noted in 100% of left mid-axillary PG subjects (n=27, mean 16.3±8.6 J) and 83% of left pectoral PG subjects (n=6, mean 21.0±8.4 J). Furthermore, 24 of 27 (89%) of patients tested with a left, mid-axillary intermuscular PG had successful VF conversion with defibrillation energies at least 10 J below the maximum delivered output of the device. All evaluable episodes (n=93) were automatically sensed, detected, and shocked. No serious device-related intraoperative adverse events were observed. CONCLUSIONS This first-in-human study documented the safe and reliable placement of a novel extravascular ICD lead with effective sensing and defibrillation of induced ventricular fibrillation using commercial DF-4 ICD PGs.
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Affiliation(s)
- Martin C Burke
- CorVita Science Foundation, Chicago, IL (M.C.B.)
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, Academic Medical Center, the Netherlands (M.C.B., R.E.K., S.P.)
- AtaCor Medical, Inc., San Clemente, CA (M.C.B., M.H., A.M., M.O., R.S., D.S.)
| | - Reinoud E Knops
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, Academic Medical Center, the Netherlands (M.C.B., R.E.K., S.P.)
| | | | - Johan Aasbo
- Lexington Cardiology and Baptist Health, KY (J.A.)
| | - Michael Husby
- AtaCor Medical, Inc., San Clemente, CA (M.C.B., M.H., A.M., M.O., R.S., D.S.)
| | - Alan Marcovecchio
- AtaCor Medical, Inc., San Clemente, CA (M.C.B., M.H., A.M., M.O., R.S., D.S.)
| | - Mark O'Connor
- AtaCor Medical, Inc., San Clemente, CA (M.C.B., M.H., A.M., M.O., R.S., D.S.)
| | - Rick Sanghera
- AtaCor Medical, Inc., San Clemente, CA (M.C.B., M.H., A.M., M.O., R.S., D.S.)
| | - Don Scheck
- AtaCor Medical, Inc., San Clemente, CA (M.C.B., M.H., A.M., M.O., R.S., D.S.)
| | - Shari Pepplinkhuizen
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, Academic Medical Center, the Netherlands (M.C.B., R.E.K., S.P.)
| | - Adrian Ebner
- Cardiovascular Department, Sanatorio Italiano, Asunción, Paraguay (A.E.)
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Thompson AE, Christie M, Lentz L. Substernal Extravascular Implantable Cardioverter-Defibrillator System Infections in Large Animals. Int Heart J 2023; 64:724-731. [PMID: 37460324 DOI: 10.1536/ihj.22-553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
The extravascular implantable cardioverter-defibrillator (EV ICD) with lead implantation in the substernal space may provide clinical advantages over transvenous and subcutaneous systems. This is the first reported examination of substernal infection in large animals implanted with the EV ICD system.The system was implanted in 13 large animals (canine, porcine, and ovine). The porcine were co-implanted with a transvenous cardiac resynchronization therapy with defibrillator (CRT-D) system. Infection was promoted through a cadence of immunosuppressive monitors and study interventions. The animals were monitored for clinical presentation of infection over 12-18 weeks, and cultures were collected to confirm infection. Treatment was bifurcated: 1) some infections were treated only with antibiotics ( "antibiotics only" ), whereas 2) some infections were treated with system removal and antibiotics ( "antibiotics + explant" ). Histopathology was conducted at the study closure.Five infections were confirmed over the course of the study, four of which involved infection of the EV ICD system and one infection of only the concomitantly implanted transvenous CRT-D system without EV ICD-related infection. Among the four EV ICD infections, two of two infections treated with antibiotics only did not resolve whereas two of two infections treated with antibiotics + explant resolved, as shown by histology. The transvenous CRT-D system infection progressed to septicemia and endocarditis, requiring early study discontinuation. No EV ICD-related infection progressed to blood stream infection, and the sternal bone did not become infected when infection was present in the substernal tissues.The study findings suggest that EV ICD-related infections are treatable with system removal and antibiotic therapy.
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Thompson AE, Atwater B, Boersma L, Crozier I, Engel G, Friedman P, Rod Gimbel J, Knight BP, Manlucu J, Murgatroyd F, O'Donnell D, Kuschyk J, DeGroot P. The development of the extravascular defibrillator with substernal lead placement: A new Frontier for device-based treatment of sudden cardiac arrest. J Cardiovasc Electrophysiol 2022; 33:1085-1095. [PMID: 35478368 PMCID: PMC9321102 DOI: 10.1111/jce.15511] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/16/2022] [Accepted: 04/20/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The extravascular implantable cardioverter-defibrillato (EV ICD) system with substernal lead placement is a novel nontransvenous alternative to current commercially available ICD systems. The EV ICD provides defibrillation and pacing therapies without the potential long-term complications of endovascular lead placement but requires a new procedure for implantation with a safety profile under evaluation. METHODS This paper summarizes the development of the EV ICD, including the preclinical and clinical evaluations that have contributed to the system and procedural refinements to date. RESULTS Extensive preclinical research evaluations and four human clinical studies with >140 combined acute and chronic implants have enabled the development and refinement of the EV ICD system, currently in worldwide pivotal study. CONCLUSION The EV ICD may represent a clinically valuable solution in protecting patients from sudden cardiac death while avoiding the long-term consequences of transvenous hardware. The EV ICD offers advantages over transvenous and subcutaneous systems by avoiding placement in the heart and vasculature; relative to subcutaneous systems, EV ICD requires less energy for defibrillation, enabling a smaller device, and provides pacing features such as antitachycardia and asystole pacing in a single system.
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Affiliation(s)
- Amy E. Thompson
- Medtronic Clinical ResearchMedtronic plcMounds ViewMinnesotaUSA
| | - Brett Atwater
- Cardiology/ElectrophysiologyInova Medical GroupMcleanVirginiaUSA
| | - Lucas Boersma
- Cardiology/ElectrophysiologySt. Antonius Hospital Nieuwegein and Amsterdam UMCNieuwegeinNetherlands
| | - Ian Crozier
- Cardiology/ElectrophysiologyChristchurch HospitalChristchurchNew Zealand
| | - Gregory Engel
- Cardiology/ElectrophysiologyPalo Alto Medical FoundationMountain ViewCaliforniaUSA
| | - Paul Friedman
- Cardiology/ElectrophysiologyMayo ClinicRochesterMinnesotaUSA
| | - J. Rod Gimbel
- Cardiology/ElectrophysiologyLutheran Medical GroupFort WayneIndianaUSA
| | - Bradley P. Knight
- Cardiology/ElectrophysiologyNorthwestern UniversityChicagoIndianaUSA
| | - Jaimie Manlucu
- Cardiology/ElectrophysiologyLondon Health Sciences CentreLondon, OntarioCanada
| | | | - David O'Donnell
- Cardiology/ElectrophysiologyGenesisCareHeidelbergVictoriaAustralia
| | - Juergen Kuschyk
- Cardiology/ElectrophysiologyUniversity of MannheimMannheimGermany
| | - Paul DeGroot
- Research & TechnologyMedtronic plc, Mounds ViewMinnesotaUSA
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Thompson AE, Marshall M, Lentz L, Mazzetti H. Three-Year Extraction Experience of a Novel Substernal Extravascular Defibrillation Lead in Sheep. Pacing Clin Electrophysiol 2022; 45:314-322. [PMID: 35048393 PMCID: PMC9302635 DOI: 10.1111/pace.14451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/09/2021] [Accepted: 01/02/2022] [Indexed: 11/28/2022]
Abstract
Background The extravascular implantable cardioverter‐defibrillator (EV ICD) with lead implantation in the substernal space may provide an alternative to transvenous and subcutaneous systems. This is the first‐reported chronic extraction experience for EV ICD leads. The aim of the study is to evaluate the chronic encapsulation and extractability of EV ICD leads. Methods Two EV ICD leads and one transvenous lead were implanted in each of 24 mature sheep. A subset of animals was evaluated yearly for histology and lead extractability. Extractions were performed using simple traction or extraction tools. Histology evaluated the encapsulating tissue. Results At 1 year, extraction was performed successfully for two of five EV ICD leads with traction alone using ≤3.1 kg‐force (kgf) and the remainder extracted successfully with extraction tools; no transvenous leads were removed with traction alone. At 2 years, no EV ICD or transvenous leads were extracted with traction alone, while at 3 years, one of eight EV ICD leads and two of four transvenous leads were extracted with traction (0.8 and ≤2.3 kgf, respectively). There was one observation of hemopericardium resulting in tamponade with EV ICD extraction but without injury to cardiovascular structures and related to the unique implant tract. Among transvenous leads, inversion of the ventricle with loss of cardiac output resulted in abandonment of traction for two animals. Conclusions Chronic extraction of EV ICD leads from the substernal space was successfully performed using traction and simple tools through 3 years in sheep with one observation of hemopericardium that did not originate from cardiovascular injury.
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John LA, Karimianpour A, Gold MR. The Role of Subcutaneous ICDs in the Prevention of Sudden Cardiac Death. US CARDIOLOGY REVIEW 2021. [DOI: 10.15420/usc.2021.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The ICD is an important therapy in the prevention of sudden cardiac death. The transvenous-ICD (TV-ICD) has been the primary device used for this purpose. However, mechanical and infectious complications occur with traditional TV-ICDs increasing morbidity and mortality. The subcutaneous-ICD (S-ICD) system was developed to circumvent some of these complications, but S-ICDs have their inherent set of limitations as well. These include inappropriate shock delivery, lack of bradycardia, antitachycardia or CRT pacing therapy and shorter device longevity. The S-ICD is now included in guidelines as an acceptable alternative to TV-ICDs among patients without pacing indications. This review discusses the rationale for S-ICDs by reviewing studies including the PRAETORIAN, PAS and UNTOUCHED trials.
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Affiliation(s)
- Leah A John
- Division of Cardiology, Medical University of South Carolina, Charleston, SC
| | | | - Michael R Gold
- Division of Cardiology, Medical University of South Carolina, Charleston, SC
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Molnár L, Crozier I, Haqqani H, O'Donnell D, Kotschet E, Alison J, Thompson AE, Bhatia VA, Papp R, Zima E, Jermendy Á, Apor A, Merkely B. The extravascular implantable cardioverter-defibrillator: characterization of anatomical parameters impacting substernal implantation and defibrillation efficacy. Europace 2021; 24:762-773. [PMID: 34662385 PMCID: PMC9071078 DOI: 10.1093/europace/euab243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/22/2021] [Indexed: 01/10/2023] Open
Abstract
Aims The aim of this study is to provide a thorough, quantified assessment of the substernal space as the site of extravascular implantable cardioverter-defibrillator (ICD) lead placement using computed tomography (CT) scans and summarizing adverse events and defibrillation efficacy across anatomical findings. Subcutaneous ICDs are an alternative to transvenous defibrillators but have limitations related to ICD lead distance from the heart. An alternative extravascular system with substernal lead placement has the potential to provide defibrillation at lower energy and pacing therapies from a single device. Methods and results A multi-centre, non-randomized, retrospective analysis of 45 patient CT scans quantitatively and qualitatively assessing bony, cardiac, vascular, and other organ structures from two human clinical studies with substernal lead placement. Univariate logistic regression was used to evaluate 15 anatomical parameters for impact on defibrillation outcome and adjusted for multiple comparisons. Adverse events were summarized. Substernal implantation was attempted or completed in 45 patients. Defibrillation testing was successful in 37 of 41 subjects (90%) using ≥10 J safety margin. There were two intra-procedural adverse events in one patient, including reaction to anaesthesia and an episode of transient atrial fibrillation during ventricular fibrillation induction. Anatomical factors associated with defibrillation failure included large rib cage width, myocardium extending very posteriorly, and a low heart position in the chest (P-values <0.05), though not significant adjusting for multiple comparisons. Conclusion Retrospective analysis demonstrates the ability to implant within the substernal space with low intra-procedural adverse events and high defibrillation efficacy despite a wide range of anatomical variability.
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Affiliation(s)
- Levente Molnár
- Semmelweis University, Heart and Vascular Center, 68, Varosmajor Street, H-1122 Budapest, Hungary
| | - Ian Crozier
- Department of Cardiology, Christchurch Hospital, PO Box 4345, Christchurch, New Zealand
| | - Haris Haqqani
- Faculty of Medicine, University of Queensland, Department of Cardiology, Prince Charles Hospital, Brisbane, Australia
| | - David O'Donnell
- Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
| | - Emily Kotschet
- Monash Cardiac Rhythm Management Department, MonashHeart, Monash Medical Centre, 246 Clayton Road, Clayton, Melbourne, Victoria, 3168, Australia
| | - Jeffrey Alison
- Monash Cardiac Rhythm Management Department, MonashHeart, Monash Medical Centre, 246 Clayton Road, Clayton, Melbourne, Victoria, 3168, Australia
| | | | | | - Roland Papp
- Semmelweis University, Heart and Vascular Center, 68, Varosmajor Street, H-1122 Budapest, Hungary
| | - Endre Zima
- Semmelweis University, Heart and Vascular Center, 68, Varosmajor Street, H-1122 Budapest, Hungary
| | - Ádám Jermendy
- Semmelweis University, Heart and Vascular Center, 68, Varosmajor Street, H-1122 Budapest, Hungary
| | - Astrid Apor
- Semmelweis University, Heart and Vascular Center, 68, Varosmajor Street, H-1122 Budapest, Hungary
| | - Béla Merkely
- Semmelweis University, Heart and Vascular Center, 68, Varosmajor Street, H-1122 Budapest, Hungary
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Khurshid S, Chen W, Bode WD, Wasfy JH, Chhatwal J, Lubitz SA. Comparative Effectiveness of Implantable Defibrillators for Asymptomatic Brugada Syndrome: A Decision-Analytic Model. J Am Heart Assoc 2021; 10:e021144. [PMID: 34387130 PMCID: PMC8475040 DOI: 10.1161/jaha.121.021144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/28/2021] [Indexed: 11/16/2022]
Abstract
Background Optimal management of asymptomatic Brugada syndrome (BrS) with spontaneous type I electrocardiographic pattern is uncertain. Methods and Results We developed an individual-level simulation comprising 2 000 000 average-risk individuals with asymptomatic BrS and spontaneous type I electrocardiographic pattern. We compared (1) observation, (2) electrophysiologic study (EPS)-guided implantable cardioverter-defibrillator (ICD), and (3) upfront ICD, each using either subcutaneous or transvenous ICD, resulting in 6 strategies tested. The primary outcome was quality-adjusted life years (QALYs), with cardiac deaths (arrest or procedural-related) as a secondary outcome. We varied BrS diagnosis age and underlying arrest rate. We assessed cost-effectiveness at $100 000/QALY. Compared with observation, EPS-guided subcutaneous ICD resulted in 0.35 QALY gain/individual and 4130 cardiac deaths avoided/100 000 individuals, and EPS-guided transvenous ICD resulted in 0.26 QALY gain and 3390 cardiac deaths avoided. Compared with observation, upfront ICD reduced cardiac deaths by a greater margin (subcutaneous ICD, 8950; transvenous ICD, 6050), but only subcutaneous ICD improved QALYs (subcutaneous ICD, 0.25 QALY gain; transvenous ICD, 0.01 QALY loss), and complications were higher. ICD-based strategies were more effective at younger ages and higher arrest rates (eg, using subcutaneous devices, upfront ICD was the most effective strategy at ages 20-39.4 years and arrest rates >1.37%/year; EPS-guided ICD was the most effective strategy at ages 39.5-51.3 years and arrest rates 0.47%-1.37%/year, and observation was the most effective strategy at ages >51.3 years and arrest rates <0.47%/year). EPS-guided subcutaneous ICD was cost-effective ($80 508/QALY). Conclusions Device-based approaches (with or without EPS risk stratification) can be more effective than observation among selected patients with asymptomatic BrS. BrS management should be tailored to patient characteristics.
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Affiliation(s)
- Shaan Khurshid
- Cardiology DivisionMassachusetts General HospitalBostonMA
- Cardiovascular Research CenterMassachusetts General HospitalBostonMA
| | - Wanyi Chen
- Institute for Technology AssessmentMassachusetts General HospitalBostonMA
| | - Weeranun D. Bode
- Cardiac Arrhythmia ServiceMassachusetts General HospitalBostonMA
| | - Jason H. Wasfy
- Cardiology DivisionMassachusetts General HospitalBostonMA
- Cardiovascular Research CenterMassachusetts General HospitalBostonMA
| | - Jagpreet Chhatwal
- Institute for Technology AssessmentMassachusetts General HospitalBostonMA
| | - Steven A. Lubitz
- Cardiology DivisionMassachusetts General HospitalBostonMA
- Cardiovascular Research CenterMassachusetts General HospitalBostonMA
- Cardiac Arrhythmia ServiceMassachusetts General HospitalBostonMA
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10
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van der Stuijt W, Quast AFBE, Baalman SWE, de Wilde KC, Brouwer TF, Wilde AAM, Knops RE. Complications related to elective generator replacement of the subcutaneous implantable defibrillator. Europace 2021; 23:395-399. [PMID: 33197266 PMCID: PMC7947576 DOI: 10.1093/europace/euaa263] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 08/07/2020] [Indexed: 11/27/2022] Open
Abstract
Aims To guarantee uninterrupted function of the subcutaneous implantable cardioverter-defibrillator (S-ICD), the pulse generator needs to be surgically replaced before the battery is depleted. The risks related to this replacement substantially impact long-term outcome for S-ICD recipients, as the majority will undergo one or several of these procedures in their lifetime. We aim to describe the procedural characteristics of the replacement procedure and to provide an insight in the complications associated with these replacements. Methods and results In this retrospective analysis, data from replacement procedures and follow-up visits were collected from all patients who underwent elective S-ICD generator replacement in our tertiary centre from June 2014 until November 2019. Original device position was assessed using the PRAETORIAN score. Complications were defined as those requiring surgical intervention, systemic antibiotic treatment, or device extraction. Seventy-two patients were included, with a median follow-up of 1.9 years (IQR 0.6–3.3 years) after replacement. Battery depletion occurred after 5.9 ± 0.7 years. The pulse generator was repositioned in patients with a PRAETORIAN score ≥90 to minimize the defibrillation threshold. Although there was an increase in impedance compared to the implant procedure, first shock conversion rate during defibrillation testing was 91.4% with a success rate of 100% after multiple attempts. Two patients developed a complication after, respectively, 9 and 21 months, resulting in a complication rate of 1.4% per year. Conclusion With a median follow-up of 1.9 years, this study shows a low complication rate after S-ICD replacement, with a first shock conversion rate of 91.4%.
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Affiliation(s)
- Willeke van der Stuijt
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, AMC, PO Box 22700, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Anne-Floor B E Quast
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, AMC, PO Box 22700, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Sarah W E Baalman
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, AMC, PO Box 22700, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Koen C de Wilde
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, AMC, PO Box 22700, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Tom F Brouwer
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, AMC, PO Box 22700, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Arthur A M Wilde
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, AMC, PO Box 22700, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Reinoud E Knops
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, AMC, PO Box 22700, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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11
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Gebran A, Refaat MM. Long-term evaluation of a novel extravascular implantable cardioverter defibrillator. J Cardiovasc Electrophysiol 2021; 32:2379-2380. [PMID: 34314084 DOI: 10.1111/jce.15184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 07/25/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Anthony Gebran
- Division of Trauma Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marwan M Refaat
- Division of Cardiology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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12
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Savarimuthu S, Roy S, Obeidat M, Harky A. Subcutaneous implantable cardioverter defibrillator: Can it overtake its transvenous counterpart. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1413-1420. [PMID: 33878197 DOI: 10.1111/pace.14246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/22/2021] [Accepted: 04/11/2021] [Indexed: 11/29/2022]
Abstract
Over the past decade, the emergence of the subcutaneous implantable cardioverter defibrillator (S-ICD) has provided cardiologists with an option to provide both primary or secondary prevention treatment of sudden cardiac death (SCD) without the associated risks that come with the use of intracardiac leads. S-ICD may prove to be a useful option in those who are young, have thromboembolic risk, immunodeficiency states, unfavorable anatomy due to adult congenital heart disease (ACHD). This article reviews the existing literature to determine whether S-ICD can prove to be a safe alternative in comparison to Transvenous implantable cardioverter defibrillator (TV-ICD) and in which patient population should S-ICD be considered over TV-ICD.
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Affiliation(s)
| | - Saswata Roy
- Department of Gastroenterology, Musgrove Park hospital, Taunton, UK
| | - Mohammed Obeidat
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Amer Harky
- Faculty of Cardiothoracic surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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13
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Singh P, Afzal MR, Weiss R. Perioperative considerations during implantation of the subcutaneous defibrillator: State‐of‐the‐art review. Pacing Clin Electrophysiol 2020; 43:1451-1458. [DOI: 10.1111/pace.14072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 09/08/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Prabhpreet Singh
- Division of Cardiovascular Medicine Wexner Medical Center, The Ohio State University Medical Center Columbus Ohio
| | - Muhammad Rizwan Afzal
- Division of Cardiovascular Medicine Wexner Medical Center, The Ohio State University Medical Center Columbus Ohio
| | - Raul Weiss
- Division of Cardiovascular Medicine Wexner Medical Center, The Ohio State University Medical Center Columbus Ohio
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14
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First-in-Human Chronic Implant Experience of the Substernal Extravascular Implantable Cardioverter-Defibrillator. JACC Clin Electrophysiol 2020; 6:1525-1536. [DOI: 10.1016/j.jacep.2020.05.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/15/2020] [Accepted: 05/21/2020] [Indexed: 01/10/2023]
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15
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Subcutaneous Implantable Cardioverter-Defibrillator Lead Extraction. JACC Clin Electrophysiol 2020; 6:863-870. [DOI: 10.1016/j.jacep.2020.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/19/2020] [Accepted: 04/08/2020] [Indexed: 02/07/2023]
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16
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Boersma LV, Merkely B, Neuzil P, Crozier IG, Akula DN, Timmers L, Kalarus Z, Sherfesee L, DeGroot PJ, Thompson AE, Lexcen DR, Knight BP. Therapy From a Novel Substernal Lead. JACC Clin Electrophysiol 2019; 5:186-196. [DOI: 10.1016/j.jacep.2018.11.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/11/2018] [Accepted: 11/01/2018] [Indexed: 10/27/2022]
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17
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Al-Ghamdi B. Subcutaneous Implantable Cardioverter Defibrillators: An Overview of Implantation Techniques and Clinical Outcomes. Curr Cardiol Rev 2019; 15:38-48. [PMID: 30014805 PMCID: PMC6367695 DOI: 10.2174/1573403x14666180716164740] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 07/09/2018] [Accepted: 07/10/2018] [Indexed: 11/22/2022] Open
Abstract
Sudden Cardiac Death (SCD) is a significant health problem worldwide. Multiple randomized controlled trials have shown that Implantable Cardioverter Defibrillators (ICDs) are effective life-saving management option for individuals at risk of SCD in both primary and secondary prevention. Although the conventional transvenous ICDs (TV-ICDs) are safe and effective, there are potential complications associated with its use, including localized pocket or wound infection or systematic infection, a vascular access related complication such as pneumothorax, and venous thrombosis, and lead related complications such as dislodgement, malfunction, and perforation. Furthermore, transvenous leads placement may not be feasible in certain patients like those with venous anomaly or occlusion, or with the presence of intracardiac shunts. Transvenous leads extraction, when needed, is associated with considerable morbidity & mortality and requires significant skills and costs. Totally subcutaneous ICD (S-ICD) is designed to afford the same life-saving benefit of the conventional TV-ICDs while avoiding the shortcomings of the TV-leads and to simplify the implant techniques and hence expand the use of ICDs in clinical practice. It becomes commercially available after receiving CE mark in 2009, and its use increased significantly after its FDA approval in 2012. This review aims to give an overview of the S-ICD system components, implantation procedure, clinical indications, safety, efficacy, and future directions.
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Affiliation(s)
- Bandar Al-Ghamdi
- Heart Center, College of Medicine, King Faisal Specialist Hospital & Research Centre, Zahrawi St, Al Maather, Riyadh 12713, Saudi Arabia.,Alfaisal University, College of Medicine, King Faisal Specialist Hospital & Research Centre, Zahrawi St, Al Maather, Riyadh 12713, Saudi Arabia
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18
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Stellbrink C, Hansky B, Meyer zu Vilsendorf D. Sondenlose Schrittmacher und subkutan implantierbare Kardioverter-Defibrillatoren. Internist (Berl) 2018; 59:999-1010. [DOI: 10.1007/s00108-018-0476-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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19
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Ito N, Kurabayashi M, Okishige K, Hirao K. Subcutaneous implantable cardioverter-defibrillator implantation for ventricular fibrillation caused by coronary artery spasm: a case report. Eur Heart J Case Rep 2018; 2:yty074. [PMID: 31020152 PMCID: PMC6176977 DOI: 10.1093/ehjcr/yty074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 06/10/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND Coronary artery spasm usually has a good prognosis, except when it induces lethal ventricular arrhythmias. Implantable cardioverter-defibrillator (ICD) implantation in addition to optimal medical therapy including prescription of coronary vasodilators and smoking cessation is a therapeutic option for coronary artery spasm patients who present with lethal ventricular arrhythmia. Subcutaneous ICDs are now available as an alternative to conventional transvenous ICDs. CASE SUMMARY We report the first case of a 50-year-old Japanese male without any structural heart disease who presented with ventricular fibrillation caused by coronary artery spasm, and underwent subcutaneous ICD implantation for secondary prevention of sudden cardiac death (SCD). We attributed his aborted SCD to coronary artery spasm based on findings of cardiac catheterization including acetylcholine provocation test and cardiac electrophysiological study. During the 1 year of follow-up, the patient discharged on calcium channel blockers and nicorandil has been free of angina, ventricular arrhythmias, and appropriate ICD therapy. DISCUSSION Coronary artery spasm patients with aborted SCD may be good candidates for implantation of subcutaneous ICDs, because most of them have no need for concomitant bradycardia therapy, cardiac resynchronization therapy, or anti-tachycardia pacing therapy.
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Affiliation(s)
- Naruhiko Ito
- Division of Cardiology, Yokohama City Minato Red Cross Hospital, 3-12-1 Shin-Yamashita, Naka-Ward, Yokohama, Japan, Corresponding author. Tel: +81 45 628 6100, Fax: +81 45 628 6101, . This case report was reviewed by Daniel Scherr, Justin Luermans, Thomas Johnson, and Mark Philip Cassar
| | - Manabu Kurabayashi
- Division of Cardiology, Yokohama City Minato Red Cross Hospital, 3-12-1 Shin-Yamashita, Naka-Ward, Yokohama, Japan
| | - Kaoru Okishige
- Division of Cardiology, Yokohama City Minato Red Cross Hospital, 3-12-1 Shin-Yamashita, Naka-Ward, Yokohama, Japan
| | - Kenzo Hirao
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ward, Tokyo, Japan
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20
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Bettin M, Rath B, Ellermann C, Leitz P, Reinke F, Köbe J, Eckardt L, Frommeyer G. Follow-up of the first patients with a totally subcutaneous ICD in Germany from implantation till battery depletion. Clin Res Cardiol 2018; 108:16-21. [DOI: 10.1007/s00392-018-1296-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 06/11/2018] [Indexed: 10/14/2022]
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21
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Essandoh MK, Mark GE, Aasbo JD, Joyner CA, Sharma S, Decena BF, Bolin ED, Weiss R, Burke MC, McClernon TR, Daoud EG, Gold MR. Anesthesia for subcutaneous implantable cardioverter‐defibrillator implantation: Perspectives from the clinical experience of a U.S. panel of physicians. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:807-816. [DOI: 10.1111/pace.13364] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 02/25/2018] [Accepted: 03/18/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Michael K. Essandoh
- Department of AnesthesiologyThe Ohio State University Wexner Medical Center Columbus OH USA
| | - George E. Mark
- Department of CardiologyCooper University Hospital Camden NJ USA
| | - Johan D. Aasbo
- The Heart Institute of ProMedica Toledo Hospital Toledo OH USA
| | - Charles A Joyner
- Department of CardiologyLevinson Heart Hospital at Chippenham and Johnston Willis Medical Center Richmond VA USA
| | - Saumya Sharma
- Department of ElectrophysiologyMcGovern Medical School ‐ University of Texas Health Science Center Houston TX USA
| | - Beningo F Decena
- Department of CardiologyTucson Medical Center and Northwest Medical Center Tucson AZ USA
| | - Eric D Bolin
- Department of Anesthesia and Perioperative MedicineMedical University of South Carolina Charleston SC USA
| | - Raul Weiss
- Division of Cardiovascular Medicine, Department of Internal MedicineThe Ohio State University Wexner Medical Center Columbus OH USA
| | | | | | - Emile G. Daoud
- Division of Cardiovascular Medicine, Department of Internal MedicineThe Ohio State University Wexner Medical Center Columbus OH USA
| | - Michael R. Gold
- Division of CardiologyMedical University of South Carolina Charleston SC USA
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22
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Boriani G, Merino J, Wright DJ, Gadler F, Schaer B, Landolina M. Battery longevity of implantable cardioverter-defibrillators and cardiac resynchronization therapy defibrillators: technical, clinical and economic aspects. An expert review paper from EHRA. Europace 2018; 20:1882-1897. [DOI: 10.1093/europace/euy066] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 05/02/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Josè Merino
- Arrhythmia and Robotic Electrophysiology Unit, Hospital Universitario La Paz, Universidad Europea, Madrid, Spain
| | - David J Wright
- Cardiology Division, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Fredrik Gadler
- Heart and Vascular Theme, Karolinska Institute of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Beat Schaer
- Department of Cardiology, University Hospital of Basel, Switzerland
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23
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Quast AFBE, van Dijk VF, Yap SC, Maass AH, Boersma LVA, Theuns DA, Knops RE. Six-year follow-up of the initial Dutch subcutaneous implantable cardioverter-defibrillator cohort: Long-term complications, replacements, and battery longevity. J Cardiovasc Electrophysiol 2018; 29:1010-1016. [DOI: 10.1111/jce.13498] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 03/26/2018] [Accepted: 03/30/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Anne-Floor B. E. Quast
- Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
| | | | - Sing-Chien Yap
- Department of Cardiology; Erasmus Medical Center; Rotterdam the Netherlands
| | - Alexander H. Maass
- Department of Cardiology, University Medical Center Groningen; University of Groningen; Groningen the Netherlands
| | | | - Dominic A. Theuns
- Department of Cardiology; Erasmus Medical Center; Rotterdam the Netherlands
| | - Reinoud E. Knops
- Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
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24
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Sholevar DP, Tung S, Kuriachan V, Leong-Sit P, Roukoz H, Engel G, Kutalek SP, Akula D, Thompson AE, Christie MG, Ostanniy M, Molin F. Feasibility of extravascular pacing with a novel substernal electrode configuration: The Substernal Pacing Acute Clinical Evaluation study. Heart Rhythm 2018; 15:536-542. [DOI: 10.1016/j.hrthm.2017.11.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Indexed: 11/29/2022]
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25
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Turnage TA, Kpaeyeh Jr JA, Gold MR. The Subcutaneous Implantable Cardioverter-Defibrillator: New Insights and Expanding Populations. US CARDIOLOGY REVIEW 2018. [DOI: 10.15420/usc.2017:37:1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Implantable cardioverter defibrillators (ICDs) have become a mainstay of treatment in patients at risk for sudden cardiac death. The majority of contemporary ICDs are implanted transvenously; however, this approach carries acute procedural and long-term risks. The subcutaneous ICD (S-ICD) was developed, in part, to circumvent some of these adverse events or as an alternative option in patients unable to undergo transvenous implantation. Early promising trials evaluating the S-ICD were small and focused on niche populations. More recently, larger trials included broader populations with worse heart failure and co-morbidities that may be more representative of typical ICD recipients. These studies have consistently demonstrated positive results. This review describes the S-ICD system, implantation, and the safety and efficacy of the device.
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26
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Abstract
The trans-venous implantable cardioverter defibrillator (TV-ICD) is effective in treating life-threatening ventricular arrhythmia and reduces mortality in high-risk patients. However, there are significant short- and long-term complications that are associated with intravascular leads. These shortcomings are mostly relevant in young patients with long life expectancy and low risk of death from non-arrhythmic causes. Drawbacks of trans-venous leads recently led to the development of the entirely subcutaneous implantable cardioverter defibrillator (S-ICD). The S-ICD does not require vascular access or permanent intravascular defibrillation leads. Therefore, it is expected to overcome many complications associated with conventional ICDs. This review highlights data on safety and efficacy of the S-ICD and is envisioned to help in identifying the role of this device in clinical practice.
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27
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Abstract
Battery depletion is the most common reason for device reoperation, which is associated with significant patient morbidity and mortality. This article describes the history of pacing and defibrillation power supplies and the factors that determine the longevity of pacing and defibrillator generators with a special emphasis on factors that can be adjusted or controlled by the implanting and following physician. Optimization of longevity is attained through device selection; shock minimization; avoidance of prolonged radiofrequency telemetry; selection of higher impedance vectors; avoidance of long pulse duration when possible; and avoidance of unnecessary feature activation, such as continuous electrogram storage.
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Affiliation(s)
- Jay A Montgomery
- Vanderbilt Heart and Vascular Institute, Medical Center East, 5th Floor, 1215 21st Avenue South, Nashville, TN 37232, USA.
| | - Christopher R Ellis
- Vanderbilt Heart and Vascular Institute, Medical Center East, 5th Floor, 1215 21st Avenue South, Nashville, TN 37232, USA
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28
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Bogush N, Espinosa RE, Cannon BC, Wackel PL, Okamura H, Friedman PA, McLeod CJ. Selecting the right defibrillator in the younger patient: Transvenous, epicardial or subcutaneous? Int J Cardiol 2018; 250:133-138. [DOI: 10.1016/j.ijcard.2017.09.213] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 09/16/2017] [Accepted: 09/29/2017] [Indexed: 01/22/2023]
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29
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Phan K, Ha H, Kabunga P, Kilborn MJ, Toal E, Sy RW. Systematic Review of Defibrillation Threshold Testing at De Novo Implantation. Circ Arrhythm Electrophysiol 2016; 9:e003357. [DOI: 10.1161/circep.115.003357] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 03/14/2016] [Indexed: 11/16/2022]
Abstract
Background—
Recent results from the largest multicenter randomized trial (Shockless IMPLant Evaluation [SIMPLE]) on defibrillation threshold (DFT) testing suggest that while shock testing seems safe, it does not reduce the risk of failed shocks or prolong survival. A contemporary systematic review of DFT versus no-DFT testing at the time of implantable cardioverter–defibrillator implantation was performed to evaluate the current evidence and to assess the impact of the SIMPLE study.
Methods and Results—
Electronic searches were performed using 6 databases from their inception to March 2014. Relevant studies investigating implant DFT were identified. Data were extracted and analyzed according to predefined clinical end points. Predefined outcomes for interrogation were all-cause mortality, composite end point of implantable cardioverter–defibrillator efficacy (arrhythmic deaths and ineffective shocks), and composite safety end point (the sum of complications recorded at 30 days). Meta-analysis was performed including 13 studies and 9740 patients. No significant differences between DFT versus no-DFT cohorts were found in terms of all-cause mortality (risk ratio, 0.90; 95% confidence interval, 0.71–1.15;
P
=0.41), composite efficacy outcome (risk ratio, 1.24; 95% confidence interval, 0.65–3.37;
P
=0.51), and 30-day postimplant complications (risk ratio, 1.18; 95% confidence interval, 0.87–1.60;
P
=0.29). No significant difference was found in the trends observed when the results of the SIMPLE study were excluded or included.
Conclusions—
This systematic review of contemporary data suggests a modest average effect of DFT, if any, in terms of mortality, shock efficacy, or safety. Therefore, DFT testing should no longer be compulsory during de novo implantation. However, DFT testing may still be clinically relevant in specific patient populations.
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Affiliation(s)
- Kevin Phan
- From the Faculty of Medicine, Sydney Medical School (K.P., M.J.K., R.W.S.), Department of Cardiology, Westmead Clinical School (K.P.), and Department of Cardiology, Royal Prince Alfred Hospital (P.K., M.J.K., E.T., R.W.S.), University of Sydney, Sydney, Australia; and Faculty of Medicine, St. Vincent’s Clinical School, University of New South Wales, Sydney, Australia (H.H.)
| | - Hakeem Ha
- From the Faculty of Medicine, Sydney Medical School (K.P., M.J.K., R.W.S.), Department of Cardiology, Westmead Clinical School (K.P.), and Department of Cardiology, Royal Prince Alfred Hospital (P.K., M.J.K., E.T., R.W.S.), University of Sydney, Sydney, Australia; and Faculty of Medicine, St. Vincent’s Clinical School, University of New South Wales, Sydney, Australia (H.H.)
| | - Peter Kabunga
- From the Faculty of Medicine, Sydney Medical School (K.P., M.J.K., R.W.S.), Department of Cardiology, Westmead Clinical School (K.P.), and Department of Cardiology, Royal Prince Alfred Hospital (P.K., M.J.K., E.T., R.W.S.), University of Sydney, Sydney, Australia; and Faculty of Medicine, St. Vincent’s Clinical School, University of New South Wales, Sydney, Australia (H.H.)
| | - Michael J. Kilborn
- From the Faculty of Medicine, Sydney Medical School (K.P., M.J.K., R.W.S.), Department of Cardiology, Westmead Clinical School (K.P.), and Department of Cardiology, Royal Prince Alfred Hospital (P.K., M.J.K., E.T., R.W.S.), University of Sydney, Sydney, Australia; and Faculty of Medicine, St. Vincent’s Clinical School, University of New South Wales, Sydney, Australia (H.H.)
| | - Edward Toal
- From the Faculty of Medicine, Sydney Medical School (K.P., M.J.K., R.W.S.), Department of Cardiology, Westmead Clinical School (K.P.), and Department of Cardiology, Royal Prince Alfred Hospital (P.K., M.J.K., E.T., R.W.S.), University of Sydney, Sydney, Australia; and Faculty of Medicine, St. Vincent’s Clinical School, University of New South Wales, Sydney, Australia (H.H.)
| | - Raymond W. Sy
- From the Faculty of Medicine, Sydney Medical School (K.P., M.J.K., R.W.S.), Department of Cardiology, Westmead Clinical School (K.P.), and Department of Cardiology, Royal Prince Alfred Hospital (P.K., M.J.K., E.T., R.W.S.), University of Sydney, Sydney, Australia; and Faculty of Medicine, St. Vincent’s Clinical School, University of New South Wales, Sydney, Australia (H.H.)
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30
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Panna ME, Miles WM. The Subcutaneous Implantable Cardioverter-Defibrillator: A Practical Review and Real-World Use and Application. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2016. [DOI: 10.15212/cvia.2015.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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31
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Lewis GF, Gold MR. Safety and Efficacy of the Subcutaneous Implantable Defibrillator. J Am Coll Cardiol 2016; 67:445-454. [DOI: 10.1016/j.jacc.2015.11.026] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 11/05/2015] [Indexed: 10/22/2022]
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