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Tsutsui K, Terazaki Y, Kanai R, Ishii M, Ohno S, Sasaki Y, Kitamura A, Kudo D, Sasaki W, Tanaka N, Narita M, Matsumoto K, Mori H, Ikeda Y, Arai T, Nakano S, Kato R. Postoperative intravenous patient-controlled analgesia improves pain management after subcutaneous implantable defibrillator implantation. J Arrhythm 2024; 40:349-355. [PMID: 38586843 PMCID: PMC10995597 DOI: 10.1002/joa3.13006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/23/2024] [Accepted: 02/13/2024] [Indexed: 04/09/2024] Open
Abstract
Objective Postoperative pain is a major issue with subcutaneous implantable cardioverter defibrillators (S-ICD). In 2020, we introduced intravenous patient-controlled analgesia (IV-PCA) in addition to the conventional, request-based analgesia for postoperative pain control in S-ICD. To determine the effect and safety, we quantitatively assessed the effect of IV-PCA after S-ICD surgery over conventional methods. Methods During the study period, a total of 113 consecutive patients (age, 50.1 ± 15.5 years: males, 101) underwent a de novo S-ICD implantation under general anesthesia. While the postoperative pain was addressed with either request-based analgesia (by nonsteroid anti-inflammatory drugs, N = 68, dubbed as "PCA absent") or fentanyl-based IV-PCA in addition to the standard care (N = 45, dubbed as "PCA present"). The degree of postoperative pain from immediately after surgery to 1 week were retrospectively investigated by the numerical rating scale (NRS) divided into four groups at rest and during activity (0: no pain, 1-3: mild pain, 4-6: moderate pain, 7-10: severe pain). Results Although IV-PCA was removed on Day 1, it was associated with continued better pain control compared to PCA absent group. At rest, the proportion of patients expressing pain (mild or more) was significantly lower in the PCA present group from Day 0 to Day 4. In contrast to at rest, a better pain control continued through the entire study period of 7 days. No serious adverse events were observed. A few patients experienced nausea in both groups and the inter-group difference was not found significant. Conclusion IV-PCA suppresses postoperative pain in S-ICD without major safety concerns.
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Affiliation(s)
- Kenta Tsutsui
- Department of CardiologySaitama Medical University International Medical CenterSaitamaJapan
| | - Yoshitaka Terazaki
- Department of NursingSaitama Medical University International Medical CenterSaitamaJapan
| | - Risa Kanai
- Department of NursingSaitama Medical University International Medical CenterSaitamaJapan
| | - Masako Ishii
- Department of NursingSaitama Medical University International Medical CenterSaitamaJapan
| | - Seika Ohno
- Department of AnesthesiologySaitama Medical University International Medical CenterSaitamaJapan
| | - Yoko Sasaki
- Department of AnesthesiologySaitama Medical University International Medical CenterSaitamaJapan
| | - Akira Kitamura
- Department of AnesthesiologySaitama Medical University International Medical CenterSaitamaJapan
| | - Daisuke Kudo
- Department of CardiologySaitama Medical University International Medical CenterSaitamaJapan
| | - Wataru Sasaki
- Department of CardiologySaitama Medical University International Medical CenterSaitamaJapan
| | - Naomichi Tanaka
- Department of CardiologySaitama Medical University International Medical CenterSaitamaJapan
| | - Masataka Narita
- Department of CardiologySaitama Medical University International Medical CenterSaitamaJapan
| | - Kazuhisa Matsumoto
- Department of CardiologySaitama Medical University International Medical CenterSaitamaJapan
| | - Hitoshi Mori
- Department of CardiologySaitama Medical University International Medical CenterSaitamaJapan
| | - Yoshifumi Ikeda
- Department of CardiologySaitama Medical University International Medical CenterSaitamaJapan
| | - Takahide Arai
- Department of CardiologySaitama Medical University International Medical CenterSaitamaJapan
| | - Shintaro Nakano
- Department of CardiologySaitama Medical University International Medical CenterSaitamaJapan
| | - Ritsushi Kato
- Department of CardiologySaitama Medical University International Medical CenterSaitamaJapan
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Migliore F, Pittorru R, De Lazzari M, Cipriani A, Bauce B, Marra MP, Giacomin E, Dall'Aglio P, Accinelli S, Iliceto S, Corrado D. Third-generation subcutaneous implantable cardioverter defibrillator and intermuscular two-incision implantation technique in patients with Arrhythmogenic cardiomyopathy: 3-year follow-up. Int J Cardiol 2023; 382:33-39. [PMID: 37059308 DOI: 10.1016/j.ijcard.2023.04.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/07/2023] [Accepted: 04/11/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND Long-term data on the potential advantages of combining the third-generation subcutaneous implantable cardioverter defibrillator (S-ICD) with modern software upgrade including the "SMART Pass", modern programming strategies and the intermuscular (IM) two-incision implantation technique in arrhythmogenic cardiomyopathy (ACM) with different phenotypic variants are lacking. In this study we evaluated the long-term outcome of patients with ACM who underwent third-generation S-ICD (Emblem, Boston Scientific) and IM two-incision technique. METHODS The study population included 23 consecutive patients [70% male, median age 31 (24-46) years] diagnosed with ACM with different phenotypic variants who received third-generation S-ICD implantation with the IM two-incision technique. RESULTS During a median follow-up of 45.5 months [16-65], 4 patients (17.4%) received a at least one inappropriate shock (IS), with median annual event rate of 4.5%. Extra-cardiac oversensing (myopotential) during effort represented the only cause of IS. No IS due to T-wave oversensing (TWOS) were recorded. Only one patient (4.3%) experienced device-related complication consisting of premature cell battery depletion requiring device replacement. No device explantation because of need for anti-tachycardia pacing or ineffective therapy occurred. There was no significant difference between patients who did and did not experienced IS with regard to baseline clinical, ECG and technical characteristics. Five patients (21.7%) received appropriate shock on ventricular arrythmias. CONCLUSIONS According to our finding, although the third-generation S-ICD implanted with the IM two-incision technique appears to be associated with a low risk of complications and IS due to cardiac oversensing, the risk of IS due to myopotential mainly during effort should be considered.
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Affiliation(s)
- Federico Migliore
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
| | - Raimondo Pittorru
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Manuel De Lazzari
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Alberto Cipriani
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Barbara Bauce
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Martina Perazzolo Marra
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Enrico Giacomin
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Pietro Dall'Aglio
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Stefano Accinelli
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Sabino Iliceto
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Domenico Corrado
- Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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Khanra D, Hamid A, Patel P, Tomson J, Abdalla A, Khan N, Dowd R, Chandan N, Osagie C, Jinadu T, Velu S, Arya A, Spencer C, Barr C, Petkar S. A real‐world experience of subcutaneous and transvenous implantable cardiac defibrillators—comparison with the
PRAETORIAN
study. J Arrhythm 2022; 38:199-212. [PMID: 35387142 PMCID: PMC8977574 DOI: 10.1002/joa3.12687] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 11/06/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Dibbendhu Khanra
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - Abdul Hamid
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - Peysh Patel
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - John Tomson
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - Ahmed Abdalla
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - Nasrin Khan
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - Rory Dowd
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - Nakul Chandan
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - Christopher Osagie
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - Tomilola Jinadu
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - Selvakumar Velu
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - Anita Arya
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - Charles Spencer
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - Craig Barr
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
| | - Sanjiv Petkar
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and Devices Royal Wolverhampton NHS Trust UK
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