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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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Zhang L, Li X, Liang Y, Wang J, Li M, Pan L, Chen X, Qin S, Bai J, Wang W, Su Y, Ge J. Real-world evidence for the use of subcutaneous implantable cardioverter-defibrillators in China: A single-center experience. Herz 2023; 48:462-469. [PMID: 37540305 DOI: 10.1007/s00059-023-05192-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 05/26/2023] [Accepted: 05/27/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Subcutaneous implantable cardioverter-defibrillators (S-ICDs) have been shown to be non-inferior to transvenous ICDs in the prevention of sudden cardiac death (SCD), but there is still a lack of evidence from clinical trials in China. We investigated whether S‑ICD implantation in the Chinese population is safe and feasible and should be promoted in the future. METHODS Consecutive patients undergoing S‑ICD implantation at our center were enrolled in this retrospective study. Data were collected within the median follow-up period of 554 days. Data concerning patient selection, implantation procedures, complications, and episodes of shock were analyzed. RESULTS In total, 70.2% of all 47 patients (median age = 39 years) were included for secondary prevention of SCD with different etiologies. Vector screening showed that 98% of patients were with > 1 appropriate vector in all postures. An intraoperative defibrillation test was not performed on six patients because of the high risk of disease deterioration, while all episodes of ventricular fibrillation induced post implantation were terminated by one shock. As expected, no severe complications (e.g., infection and device-related complications) were observed, except for one case of delayed healing of the incision. Overall, 15 patients (31.9%) experienced appropriate shocks (AS) with all episodes terminated by one shock. Two patients (4.3%) experienced inappropriate shocks (IAS) due to noise oversensing, resulting in a high Kaplan-Meier IAS-free rate of 95.7%. CONCLUSION Based on appropriate patient selection and standardized implantation procedures, this real-world study confirmed the safety and efficacy of S‑ICD in Chinese patients, indicating that it may help to promote the prevention of SCD in China.
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Affiliation(s)
- Lei Zhang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Xietu Road, 1069, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Xiao Li
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Xietu Road, 1069, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yixiu Liang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Xietu Road, 1069, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Jingfeng Wang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Xietu Road, 1069, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Minghui Li
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Xietu Road, 1069, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Lei Pan
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Xietu Road, 1069, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Xueying Chen
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Xietu Road, 1069, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Shengmei Qin
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Xietu Road, 1069, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Jin Bai
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Xietu Road, 1069, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Wei Wang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Xietu Road, 1069, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yangang Su
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Xietu Road, 1069, Shanghai, China.
- National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China.
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Xietu Road, 1069, Shanghai, China.
- National Clinical Research Center for Interventional Medicine, Shanghai Clinical Research Center for Interventional Medicine, Shanghai, China.
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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: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [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 PRAETORIAN is the first randomized controlled trial that demonstrated the noninferiority of subcutaneous ICD (S-ICD) in comparison with transvenous ICD (TV-ICD). We retrospectively reviewed electronic records of patients with ICD implanted over the past 6 years, with the primary objective to compare our real-world single tertiary center experience with the randomized data from the PRAETORIAN study. Methods Seventy S-ICD patients were compared with 197 TV-ICD patients, from July 2014 to June 2020 retrospectively, over a median period of 1304 days (296-2451 days). Primary composite endpoints included inappropriate shocks and device-related malfunctions. Results Patients with S-ICD implantation were younger than those who received TV-ICD (mean, 49.7 years vs 63.9 years, p < .001). About 31.4% of S-ICDs were implanted for secondary prevention, and 58.6% of S-ICD patients had ischemic cardiomyopathy (ICM) with a median left ventricular ejection fraction of 32.5% (range: 10-67%). S-ICDs and TV-ICD had statistically similar inappropriate shocks (4.3% vs 4.6%, p = .78), device-related complications (11.4% vs 9.1%, p = .93), and the overall primary endpoints (15.7% vs 13.7%, p = .68). The findings remained the same even after age and gender adjustments and time-dependent analysis. Conclusion Although single-center experience with a small number of S-ICD patients, results of the PRAETORIAN study has been replicated in our real-world experience of S-ICD and TV-ICD implantations across diverse etiologies, indications, and age groups confirming the comparable performance of S-ICD and TV-ICD when implanted in selected patients.
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Affiliation(s)
- Dibbendhu Khanra
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and DevicesRoyal Wolverhampton NHS TrustUK
| | - Abdul Hamid
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and DevicesRoyal Wolverhampton NHS TrustUK
| | - Peysh Patel
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and DevicesRoyal Wolverhampton NHS TrustUK
| | - John Tomson
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and DevicesRoyal Wolverhampton NHS TrustUK
| | - Ahmed Abdalla
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and DevicesRoyal Wolverhampton NHS TrustUK
| | - Nasrin Khan
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and DevicesRoyal Wolverhampton NHS TrustUK
| | - Rory Dowd
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and DevicesRoyal Wolverhampton NHS TrustUK
| | - Nakul Chandan
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and DevicesRoyal Wolverhampton NHS TrustUK
| | - Christopher Osagie
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and DevicesRoyal Wolverhampton NHS TrustUK
| | - Tomilola Jinadu
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and DevicesRoyal Wolverhampton NHS TrustUK
| | - Selvakumar Velu
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and DevicesRoyal Wolverhampton NHS TrustUK
| | - Anita Arya
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and DevicesRoyal Wolverhampton NHS TrustUK
| | - Charles Spencer
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and DevicesRoyal Wolverhampton NHS TrustUK
| | - Craig Barr
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and DevicesRoyal Wolverhampton NHS TrustUK
| | - Sanjiv Petkar
- New Cross Hospital, Heart and Lung Centre, Division of Electrophysiology and DevicesRoyal Wolverhampton NHS TrustUK
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Karimianpour A, John L, Gold MR. The Subcutaneous ICD: A Review of the UNTOUCHED and PRAETORIAN Trials. Arrhythm Electrophysiol Rev 2021; 10:108-112. [PMID: 34401183 PMCID: PMC8353550 DOI: 10.15420/aer.2020.47] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 02/17/2021] [Indexed: 11/05/2022] Open
Abstract
The ICD is an important part of the treatment and prevention of sudden cardiac death in many high-risk populations. Traditional transvenous ICDs (TV-ICDs) are associated with certain short- and long- term risks. The subcutaneous ICD (S-ICD) was developed in order to avoid these risks and complications. However, this system is associated with its own set of limitations and complications. First, patient selection is important, as S-ICDs do not provide pacing therapy currently. Second, pre-procedural screening is important to minimise T wave and myopotential oversensing. Finally, until recently, the S-ICD was primarily used in younger patients with fewer co-morbidities and less structural heart disease, limiting the general applicability of the device. S-ICDs achieve excellent rates of arrhythmia conversion and have demonstrated noninferiority to TV-ICDs in terms of complication rates in real-world studies. The objective of this review is to discuss the latest literature, including the UNTOUCHED and PRAETORIAN trials, and to address the risk of inappropriate shocks.
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Affiliation(s)
- Ahmadreza Karimianpour
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, US
| | - Leah John
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, US
| | - Michael R Gold
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, US
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Afzal MR, Okabe T, Hsu K, Cook S, Koppert T, Weiss R. How to minimize peri-procedural complications during subcutaneous defibrillator implant? Expert Rev Cardiovasc Ther 2020; 18:427-434. [DOI: 10.1080/14779072.2020.1784006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Muhammad R. Afzal
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Toshimasa Okabe
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kevin Hsu
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Schuyler Cook
- Department of Internal Medicine, Adena Regional Medical Center, Chillicothe, OH, USA
| | - Tanner Koppert
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Raul Weiss
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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