1
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de Guillebon M, Garcia R, Debeugny S, Bader H, Probst V, Bidegain N, Narayanan K, Mansourati J, Menet A, Pierre O, Marquié C, Guy-Moyat B, Mondoly P, Chevallier P, Badenco N, Behar N, Jesel-Morel L, Bertrand P, Lellouche N, Deharo JC, Jacon P, Anselme F, Boveda S, Marijon E. Personalized Screening Before Subcutaneous Cardioverter Defibrillator Implantation: Usefulness and Outcomes in Clinical Practice - The S-ICD Screening SIS Prospective Study. Heart Rhythm 2024:S1547-5271(24)02654-7. [PMID: 38810921 DOI: 10.1016/j.hrthm.2024.05.043] [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: 01/22/2024] [Revised: 05/05/2024] [Accepted: 05/20/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Electrocardiographic (ECG) screening prior to S-ICD implantation is unsuccessful in around 10% of cases. A personalized screening method, by slightly moving the electrodes, to obtain a better R/T ratio has been described to overcome traditional screening failure. OBJECTIVE To assess to what extent a personalized screening method improves eligibility for S-ICD implantation and evaluate the inappropriate shock rate after such screening success. METHODS All consecutive patients eligible for an S-ICD implantation were prospectively recruited across 20 French centers between December 2019 to January 2022 (NCT04101253). In case of traditional screening failure, patients received a second personalized screening. If at least one vector was positive, the personalized screening was considered as successful, and the patient was eligible for implantation. RESULTS 474 patients were included in the study (mean age 50.4 ±14.1 years; 77.4% men). Traditional screening was successful in 456 (96.2%) cases. This figure rose to 98.3% (n=466; P=.002) when personalized screening was performed. All patients implanted after successful personalized screening had correct signal detection on initial device interrogation. Nevertheless, after one year follow-up, 3 (43%) of the 7 patients implanted with personalized experienced inappropriate shock (vs 18 (4.2%) out of the 427 patients with traditional screening and S-ICD implantation P=.003). CONCLUSION Traditional S-ICD screening was successful in our study in a very high proportion of patients. Considering the small improvement in success of screening and a higher rate of inappropriate shock, a strategy of personalized screening cannot be routinely recommended.
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Affiliation(s)
| | - Rodrigue Garcia
- Cardiology department, University Hospital of Poitiers, 86021 Poitiers, France
| | | | - Hugues Bader
- Cardiology department, Hospital of Pau, 64445 Pau, France
| | - Vincent Probst
- Cardiology department, University Hospital of Nantes, 44000 Nantes, France
| | | | - Kumar Narayanan
- Cardiology department, European Georges Pompidou Hospital, 75908 Paris, France; Cardiology department, Medicover Hospital, Hyderabad, India
| | - Jacques Mansourati
- Cardiology department, University hospital of Brest, 29200 Brest, France
| | - Aymeric Menet
- Cardiology department, Hospital of Saint Philibert, 59462 Lomme, France
| | - Ollitrault Pierre
- Cardiology department, University hospital of Caen, 14000 Caen, France
| | - Christelle Marquié
- Cardiology department, University hospital of Lille, 59000 Lille, France
| | - Benoît Guy-Moyat
- Cardiology department, University hospital of Limoges, 87000 Limoges, France
| | - Pierre Mondoly
- Cardiology department, Center University Hospital of Toulouse, 33000 Toulouse, France
| | | | - Nicolas Badenco
- Cardiology department, University hospital of la Pitié Salpétrière, 75000 Paris, France
| | - Nathalie Behar
- Cardiology department, University Hospital Pontchaillou, 35000 Rennes, France
| | - Laurence Jesel-Morel
- Cardiology department, University hospital of Strasbourg, 67000 Strasbourg, France
| | - Pierre Bertrand
- Cardiology department, University hospital of Tours, 37000 Tours, France
| | - Nicolas Lellouche
- Cardiology department, University hospital of Créteil, 94000 Créteil, France
| | - Jean-Claude Deharo
- Cardiology department, University hospital of Marseille, 13000 Marseille, France
| | - Peggy Jacon
- Cardiology department, University Hospital Grenoble Alpes, 38043 Grenoble, France
| | - Frédéric Anselme
- Cardiology department, University hospital of Rouen, 76000 Rouen, France
| | - Serge Boveda
- Cardiology department, Pasteur Clinic, 33000 Toulouse, France
| | - Eloi Marijon
- Cardiology department, European Georges Pompidou Hospital, 75908 Paris, France.
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2
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Weipert KF, Kostic S, Gökyildirim T, Johnson V, Chasan R, Gemein C, Rosenbauer J, Erkapic D, Schmitt J. Safety and Performance of the Subcutaneous Implantable Cardioverter Defibrillator Detection Algorithm INSIGHT TM in Pacemaker Patients. J Clin Med 2023; 13:129. [PMID: 38202136 PMCID: PMC10779836 DOI: 10.3390/jcm13010129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/17/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND The use of the S-ICD is limited by its inability to provide backup pacing. Combined use of the S-ICD with a pacemaker may be a good choice in certain situations, yet current experience concerning the compatibility is limited. The goal of this study was to determine the safety and efficacy of the S-ICD in patients with a pacemaker. METHODS A total of 74 consecutive patients with a bipolar pacemaker were prospectively enrolled. First, surface rhythm strips were recorded in all possible pacemaker stimulation modes, to screen for T-wave oversensing (TWOS). Second, a S-ICD functional dummy was placed epicutaneously on the patient in the typical implant position. The same standardized pacing protocol was used as mentioned above, and every stimulation mode was recorded via S-ECG in all vectors. RESULTS In 16 patients (21.6%), programmed stimulation would have led to VT/VF detection. Triggered episodes were due to counting of the pacing spike(s), QRS complex, premature ventricular contractions, and/or additional TWOS. Three cases triggered in the bipolar stimulation mode. Oversensing was associated with lung emphysema and a reduced QRS amplitude in the S-ECG. CONCLUSION The combination of an S-ICD and a pacemaker may lead to inadequate shock delivery due to oversensing, even under programmed bipolar stimulation. Oversensing cannot be sufficiently predicted by the screening tool in pacemaker patients. Testing with an epicutaneous S-ICD dummy in all vectors and stimulation settings is recommended in patients with pre-existing pacemakers.
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Affiliation(s)
- Kay F. Weipert
- Department of Cardiology, Rhythmology and Angiology, Medizinische Klinik II, Diakonie Klinikum Jung Stilling, 57074 Siegen, Germany; (R.C.); (J.R.); (D.E.)
| | - Srdjan Kostic
- Department of Cardiology, Kantonsspital Aarau, 5001 Aarau, Switzerland;
| | - Timur Gökyildirim
- Department of Cardiology, Lahn-Dill Kliniken, 35578 Wetzlar, Germany
| | - Victoria Johnson
- Department of Cardiology and Angiology, Medizinische Klinik I, Universitätsklinikum Gießen und Marburg, 35392 Giessen, Germany
| | - Ritvan Chasan
- Department of Cardiology, Rhythmology and Angiology, Medizinische Klinik II, Diakonie Klinikum Jung Stilling, 57074 Siegen, Germany; (R.C.); (J.R.); (D.E.)
| | - Christopher Gemein
- Department of Cardiology, Nephrology, Pneumology and Rhythmology, Klinikum Aschaffenburg-Alzenau, 63739 Aschaffenburg, Germany
| | - Josef Rosenbauer
- Department of Cardiology, Rhythmology and Angiology, Medizinische Klinik II, Diakonie Klinikum Jung Stilling, 57074 Siegen, Germany; (R.C.); (J.R.); (D.E.)
| | - Damir Erkapic
- Department of Cardiology, Rhythmology and Angiology, Medizinische Klinik II, Diakonie Klinikum Jung Stilling, 57074 Siegen, Germany; (R.C.); (J.R.); (D.E.)
| | - Jörn Schmitt
- Department of Cardiology, Pneumology and Angiology, Medizinische Klinik II, Westpfalz-Klinikum, 67655 Kaiserslautern, Germany;
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3
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Budrejko S, Zienciuk-Krajka A, Daniłowicz-Szymanowicz L, Kempa M. Comparison of Preoperative ECG Screening and Device-Based Vector Analysis in Patients Receiving a Subcutaneous Implantable Cardioverter-Defibrillator. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2186. [PMID: 38138289 PMCID: PMC10745078 DOI: 10.3390/medicina59122186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/06/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: Subcutaneous implantable cardioverter-defibrillators (S-ICDs) provide protection against sudden cardiac death from outside the cardiovascular system. ECG screening is a prerequisite for implantation, but the reproducibility of its results post-operatively in the device is only partial. We aimed to compare the results of ECG screening with device-based sensing vector analysis. Materials and Methods: We screened the hospital records of all S-ICD recipients in our clinic. All of them had pre-operative ECG screening performed (primary, secondary, and alternate vectors). The results were compared with device-based vector analysis to determine the relation of the pre- and post-operative vector availability. Results: Complete ECG screening and device-based vector analysis were obtained for 103 patients. At least two acceptable vectors were found in 97.1% of the patients pre-operatively and in 96.1% post-operatively. When comparing vectors in terms of agreement (OK or FAIL) pre- and post-operatively, in 89.3% of the patients, the result for the primary vector was the same in both situations; for the secondary, it was in 84.5%, and for the alternate, it was in 74.8% of patients, respectively. In 55.3% of patients, all three vectors were labeled the same (OK or FAIL); in 37.9%, two vectors had the same result, and in 6.8%, only one vector had the same result pre- and post-operatively. The number of available vectors was the same pre- and post-operatively in 62.1% of patients, while in 15.5%, it was lower, and in 22.3% of patients, it was higher than observed during screening. Conclusions: Routine clinical pre-operative screening allowed for a good selection of candidates for S-ICD implantation. All patients had at least one vector available post-operatively. The final number of vectors available in the device-based analysis in most patients was at least the same (or higher) than during screening. The repeatability of the positive result for a single vector was high.
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Affiliation(s)
- Szymon Budrejko
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdansk, Smoluchowskiego 17, 80-214 Gdansk, Poland; (A.Z.-K.); (L.D.-S.); (M.K.)
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4
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Kohli U, von Alvensleben J, Srinivasan C. Subcutaneous Implantable Cardioverter Defibrillators in Pediatrics and Congenital Heart Disease. Card Electrophysiol Clin 2023; 15:e1-e16. [PMID: 38030336 DOI: 10.1016/j.ccep.2023.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Subcutaneous implantable cardioverter defibrillators (S-ICDs) are being used with increased frequency in children and patients with congenital heart disease. Vascular access complexities, intracardiac shunts, and specific anatomies make these devices particularly appealing for some of these patients. Alternative screening, implantation, and programming techniques should be considered based on patient size, body habitus, anatomy, procedural history, and preference. Appropriate and inappropriate shock rates are generally comparable to those seen with transvenous devices. Complications such as infection can occur, although their severity is likely to be less than that seen with transvenous devices. Technical advances are likely to further broaden S-ICD applicability.
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Affiliation(s)
- Utkarsh Kohli
- Division of Pediatric Cardiology, Department of Pediatrics, West Virginia University School of Medicine and West Virginia University Children's Heart Center, 64 Medical Center Drive, Robert C. Byrd Health Science Center, PO Box 9214, Morgantown, WV 26506-9214, USA.
| | - Johannes von Alvensleben
- Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, Aurora, CO 80045 720-777-1234, USA
| | - Chandra Srinivasan
- The Children's Hospital of Philadelphia; University of Perelman School of Medicine, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
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5
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Ghanta SN, Alotaibi B, Paydak H, Mounsey JP, Vallurupalli S, Devabhaktuni S. Inappropriate Subcutaneous Implantable Cardioverter-defibrillator Shocks-A Rare Case of Triple Counting. J Innov Card Rhythm Manag 2023; 14:5670-5674. [PMID: 38155720 PMCID: PMC10752427 DOI: 10.19102/icrm.2023.14121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/20/2023] [Indexed: 12/30/2023] Open
Abstract
Sudden cardiac death (SCD) caused by ventricular tachyarrhythmias is a significant contributor to cardiovascular deaths worldwide. Implantable cardioverter-defibrillators (ICDs) have shown efficacy in preventing and reducing mortality from SCD, but traditional transvenous ICDs have inherent challenges and drawbacks, such as lead fractures, lead-associated endocarditis, and lead failure. To address these issues, subcutaneous ICDs (S-ICDs) have been developed. S-ICDs lack pacing capacity but are a valid alternative for patients at high risk for infection or with difficult venous access. Pre-implantation screening can help prevent inappropriate device shocks. We present a case in which a patient received inappropriate S-ICD therapy, which was attributed to the triple counting of P-, R-, and T-waves in a patient with sinus rhythm. This is an unusual occurrence, and, to the best of our knowledge, there are only a limited number of case reports documenting inappropriate shocks due to the oversensing of P-waves and T-waves.
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Affiliation(s)
- Sai Nikhila Ghanta
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Bader Alotaibi
- Department of Medicine, Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Hakan Paydak
- Department of Medicine, Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - J. Paul Mounsey
- Department of Medicine, Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Srikanth Vallurupalli
- Department of Medicine, Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Subodh Devabhaktuni
- Department of Medicine, Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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6
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Nesti M, Russo V, Palamà Z, Panchetti L, Garibaldi S, Startari U, Mirizzi G, Piacenti M, Rossi A, Sciarra L. The Subcutaneous Implantable Cardioverter-Defibrillator: A Patient Perspective. J Clin Med 2023; 12:6675. [PMID: 37892812 PMCID: PMC10607293 DOI: 10.3390/jcm12206675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/06/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023] Open
Abstract
The subcutaneous implantable cardioverter-defibrillator (S-ICD) is a new technology for the management of ICD patients. But what is the patients' perspective? Previous studies on the transvenous ICD (TV-ICD) showed that device implantation is related not only to anxiety and depression because of the fear of ICD shocks, but also to many biopsychosocial factors like body image changes, perceived reduction of socialization and limitation in professional and sports activities. Anxiety and distress are more evident in younger women because of aesthetic reasons. The scar size and the position of the S-ICD can help these patients and positively influence their social relationships. Moreover, the position of the S-ICD reduces possible complications from catheters due to stress injury and can improve patients' professional life by avoiding some work activity limitations. An S-ICD can be also a good option for athletes in avoiding subclavian crash and reducing inappropriate shocks. However, some questions remain unsolved because an S-ICD is not suitable for patients with indications for pacing, cardiac resynchronization therapy or anti-tachycardia pacing. In conclusion, the use of an S-ICD can assist physicians in reducing the negative impact of implantation on the well-being of some groups of patients by helping them to avoid depression and anxiety as well as improving their noncompliance with their medical treatment.
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Affiliation(s)
- Martina Nesti
- Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (L.P.); (S.G.); (U.S.); (G.M.); (M.P.); (A.R.)
| | - Vincenzo Russo
- Cardiology Unit, Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”—Monaldi Hospital, 80126 Naples, Italy;
| | - Zefferino Palamà
- Electrophysiology Service, Division of Cardiology, Casa di Cura Villa Verde, 74121 Taranto, Italy;
| | - Luca Panchetti
- Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (L.P.); (S.G.); (U.S.); (G.M.); (M.P.); (A.R.)
| | - Silvia Garibaldi
- Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (L.P.); (S.G.); (U.S.); (G.M.); (M.P.); (A.R.)
| | - Umberto Startari
- Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (L.P.); (S.G.); (U.S.); (G.M.); (M.P.); (A.R.)
| | - Gianluca Mirizzi
- Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (L.P.); (S.G.); (U.S.); (G.M.); (M.P.); (A.R.)
| | - Marcello Piacenti
- Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (L.P.); (S.G.); (U.S.); (G.M.); (M.P.); (A.R.)
| | - Andrea Rossi
- Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (L.P.); (S.G.); (U.S.); (G.M.); (M.P.); (A.R.)
| | - Luigi Sciarra
- Department of Cardiology (UTIC), Università degli Studi dell’Aquila, 67100 L’Aquila, Italy;
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7
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Guarracini F, Preda A, Bonvicini E, Coser A, Martin M, Quintarelli S, Gigli L, Baroni M, Vargiu S, Varrenti M, Forleo GB, Mazzone P, Bonmassari R, Marini M, Droghetti A. Subcutaneous Implantable Cardioverter Defibrillator: A Contemporary Overview. Life (Basel) 2023; 13:1652. [PMID: 37629509 PMCID: PMC10455445 DOI: 10.3390/life13081652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023] Open
Abstract
The difference between subcutaneous implantable cardioverter defibrillators (S-ICDs) and transvenous ICDs (TV-ICDs) concerns a whole extra thoracic implantation, including a defibrillator coil and pulse generator, without endovascular components. The improved safety profile has allowed the S-ICD to be rapidly taken up, especially among younger patients. Reports of its role in different cardiac diseases at high risk of SCD such as hypertrophic and arrhythmic cardiomyopathies, as well as channelopathies, is increasing. S-ICDs show comparable efficacy, reliability, and safety outcomes compared to TV-ICD. However, some technical issues (i.e., the inability to perform anti-bradycardia pacing) strongly limit the employment of S-ICDs. Therefore, it still remains only an alternative to the traditional ICD thus far. This review aims to provide a contemporary overview of the role of S-ICDs compared to TV-ICDs in clinical practice, including technical aspects regarding device manufacture and implantation techniques. Newer outlooks and future perspectives of S-ICDs are also brought up to date.
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Affiliation(s)
- Fabrizio Guarracini
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Alberto Preda
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Eleonora Bonvicini
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Alessio Coser
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Marta Martin
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Silvia Quintarelli
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Lorenzo Gigli
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Matteo Baroni
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Sara Vargiu
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Marisa Varrenti
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Giovanni Battista Forleo
- Department of Thoracic Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Turin, Italy;
| | - Patrizio Mazzone
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Roberto Bonmassari
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Massimiliano Marini
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Andrea Droghetti
- Cardiology Unit, Luigi Sacco University Hospital, 20157 Milan, Italy;
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8
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Honarbakhsh S, Protonotarios A, Monkhouse C, Hunter RJ, Elliott PM, Lambiase PD. Right ventricular function is a predictor for sustained ventricular tachycardia requiring anti-tachycardic pacing in arrhythmogenic ventricular cardiomyopathy: insight into transvenous vs. subcutaneous implantable cardioverter defibrillator insertion. Europace 2023; 25:euad073. [PMID: 37213071 PMCID: PMC10202497 DOI: 10.1093/europace/euad073] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 02/14/2023] [Indexed: 05/23/2023] Open
Abstract
AIMS Arrhythmogenic right ventricular cardiomyopathy (ARVC) patients develop ventricular arrhythmias (VAs) responsive to anti-tachycardia pacing (ATP). However, VA episodes have not been characterized in accordance with the device therapy, and with the emergence of the subcutaneous implantable cardioverter defibrillator (S-ICD), the appropriate device prescription in ARVC remains unclear. Study aim was to characterize VA events in ARVC patients during follow-up in accordance with device therapy and elicit if certain parameters are predictive of specific VA events. METHODS AND RESULTS This was a retrospective single-centre study utilizing prospectively collated registry data of ARVC patients with ICDs. Forty-six patients were included [54.0 ± 12.1 years old and 20 (43.5%) secondary prevention devices]. During a follow-up of 12.1 ± 6.9 years, 31 (67.4%) patients had VA events [n = 2, 6.5% ventricular fibrillation (VF), n = 14], 45.2% VT falling in VF zone resulting in ICD shock(s), n = 10, 32.3% VT resulting in ATP, and n = 5, 16.1% patients had both VT resulting in ATP and ICD shock(s). Lead failure rates were high (11/46, 23.9%). ATP was successful in 34.5% of patients. Severely impaired right ventricular (RV) function was an independent predictor of VT resulting in ATP (hazard ratio 16.80, 95% confidence interval 3.74-75.2; P < 0.001) with a high predictive accuracy (area under the curve 0.88, 95%CI 0.76-1.00; P < 0.001). CONCLUSION VA event rates are high in ARVC patients with a majority having VT falling in the VF zone resulting in ICD shock(s). S-ICDs could be of benefit in most patients with ARVC with the absence of severely impaired RV function which has the potential to avoid consequences of the high burden of lead failure.
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Affiliation(s)
- Shohreh Honarbakhsh
- The Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS trust, West Smithfield, London WC1 8BE, UK
- William Harvey Research Institute, Queen Mary’s University of London, London, E1, UK
| | - Alexander Protonotarios
- The Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS trust, West Smithfield, London WC1 8BE, UK
| | - Christopher Monkhouse
- The Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS trust, West Smithfield, London WC1 8BE, UK
| | - Ross J Hunter
- The Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS trust, West Smithfield, London WC1 8BE, UK
| | - Perry M Elliott
- The Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS trust, West Smithfield, London WC1 8BE, UK
| | - Pier D Lambiase
- The Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS trust, West Smithfield, London WC1 8BE, UK
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9
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ElRefai M, Abouelasaad M, Wiles BM, Dunn AJ, Coniglio S, Zemkoho AB, Morgan J, Roberts PR. Correlation analysis of deep learning methods in S-ICD screening. Ann Noninvasive Electrocardiol 2023:e13056. [PMID: 36920649 DOI: 10.1111/anec.13056] [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: 12/11/2022] [Revised: 01/12/2023] [Accepted: 02/26/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Machine learning methods are used in the classification of various cardiovascular diseases through ECG data analysis. The concept of varying subcutaneous implantable cardiac defibrillator (S-ICD) eligibility, owing to the dynamicity of ECG signals, has been introduced before. There are practical limitations to acquiring longer durations of ECG signals for S-ICD screening. This study explored the potential use of deep learning methods in S-ICD screening. METHODS This was a retrospective study. A deep learning tool was used to provide descriptive analysis of the T:R ratios over 24 h recordings of S-ICD vectors. Spearman's rank correlation test was used to compare the results statistically to those of a "gold standard" S-ICD simulator. RESULTS A total of 14 patients (mean age: 63.7 ± 5.2 years, 71.4% male) were recruited and 28 vectors were analyzed. Mean T:R, standard deviation of T:R, and favorable ratio time (FVR)-a new concept introduced in this study-for all vectors combined were 0.21 ± 0.11, 0.08 ± 0.04, and 79 ± 30%, respectively. There were statistically significant strong correlations between the outcomes of our novel tool and the S-ICD simulator (p < .001). CONCLUSION Deep learning methods could provide a practical software solution to analyze data acquired for longer durations than current S-ICD screening practices. This could help select patients better suited for S-ICD therapy as well as guide vector selection in S-ICD eligible patients. Further work is needed before this could be translated into clinical practice.
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Affiliation(s)
- Mohamed ElRefai
- Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Faculty of Medicine, University of Southampton, Southampton, UK
| | - Mohamed Abouelasaad
- Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Anthony J Dunn
- School of Mathematical Sciences, University of Southampton, UK
| | | | - Alain B Zemkoho
- School of Mathematical Sciences, University of Southampton, UK
| | - John Morgan
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Paul R Roberts
- Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Faculty of Medicine, University of Southampton, Southampton, UK
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10
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Appropriate Inappropriate Shocks: Inappropriate Oversensing during Slow Ventricular Tachycardia in a Patient with a Subcutaneous Implantable Cardioverter Defibrillator. HeartRhythm Case Rep 2023; 9:222-226. [PMID: 37101675 PMCID: PMC10123930 DOI: 10.1016/j.hrcr.2022.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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11
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ElRefai M, Menexi C, Abouelasaad M, Tsoi V, Roberts PR. Insights on subcutaneous implantable cardiac defibrillator eligibility using standard screening practices. J Interv Card Electrophysiol 2022:10.1007/s10840-022-01453-0. [PMID: 36525169 DOI: 10.1007/s10840-022-01453-0] [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: 10/07/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Mohamed ElRefai
- Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
- Faculty of Medicine, University of Southampton, Southampton, UK.
| | - Christina Menexi
- Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mohamed Abouelasaad
- Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Victor Tsoi
- Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Paul R Roberts
- Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
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12
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Shockingly shiny shoes-Inappropriate discharge from a subcutaneous defibrillator. HeartRhythm Case Rep 2022; 9:101-104. [PMID: 36860754 PMCID: PMC9968909 DOI: 10.1016/j.hrcr.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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13
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The subcutaneous implantable cardioverter-defibrillator should be considered for all patients with an implantable cardioverter-defibrillator indication. Heart Rhythm O2 2022; 3:589-596. [PMID: 36340497 PMCID: PMC9626906 DOI: 10.1016/j.hroo.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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14
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Boersma LV, El-Chami M, Steinwender C, Lambiase P, Murgatroyd F, Mela T, Theuns DAMJ, Khelae SK, Kalil C, Zabala F, Stuehlinger M, Lenarczyk R, Clementy N, Tamirisa KP, Rinaldi CA, Knops R, Lau CP, Crozier I, Boveda S, Defaye P, Deharo JC, Botto GL, Vassilikos V, Oliveira MM, Tse HF, Figueroa J, Stambler BS, Guerra JM, Stiles M, Marques M. Practical considerations, indications, and future perspectives for leadless and extravascular cardiac implantable electronic devices: a position paper by EHRA/HRS/LAHRS/APHRS. Europace 2022; 24:1691-1708. [PMID: 35912932 DOI: 10.1093/europace/euac066] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Lucas V Boersma
- Cardiology Department, St Antonius Hospital, Nieuwegein, The Netherlands.,Cardiology Department, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Mikhael El-Chami
- Medicine/Cardiology Department, Emory University, Atlanta, GA, USA
| | - Clemens Steinwender
- Department of Cardiology and Internal Intensive Care, Kepler University Hospital Linz, Krankenhausstraße 9, Linz, Austria
| | - Pier Lambiase
- Department of Cardiology, UCL & Barts Heart Centre, Institute of Cardiovascular Science, UCL, Barts Heart Centre, London, UK
| | | | - Theofania Mela
- Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Dominic A M J Theuns
- Erasmus MC, Cardiology, Clinical Electrophysiology, CA Rotterdam, The Netherlands
| | | | - Carlos Kalil
- Cardiology Department, Hospital São Francisco da Santa Casa de Misericórdia, Porto Alegre, Brazil
| | - Federico Zabala
- Electrophysiology Unit, Hospital San Martin de La Plata, Buenos Aires, Argentina
| | - Markus Stuehlinger
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Radoslaw Lenarczyk
- Department of Cardiology, Congenital Heart Disease and Electrotherapy, Medical University of Silesia, Silesian Center for Heart Disease, Curie-Sklodowska Str 9, 41-800 Zabrze, Poland
| | - Nicolas Clementy
- Cardiology Department, Centre Hospitalier Régional Universitaire de Tours, France
| | - Kamala P Tamirisa
- Cardiac Electrophysiology, Cardiac MRI, Texas Cardiac Arrhythmia Institute, 11970 N, Central Expressway, Dallas, TX, USA
| | | | - Reinoud Knops
- Cardiology Department, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Chu-Pak Lau
- Department of Medicine, Queen Mary Hospital, Suite 1303, Central Building, 1 Pedder Street, Central, Hong Kong
| | - Ian Crozier
- Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, 31076 Toulouse, France.,Universitair Ziekenhuis Brussel-VUB, Heart Rhythm Management Centre, Brussels, Belgium, and INSERM U970, 75908 Paris Cedex 15 France
| | - Pascal Defaye
- CHU Grenoble Alpes, Unite de Rythmologie Service De Cardiologie, CS10135, 38043 Grenoble Cedex 09, France
| | - Jean Claude Deharo
- Aix-Marseille Université, Faculté de Médecine, F-13385 Marseille, France.,Cardiology Department, Hospital de Santa Cruz, Lisbon, Portugal
| | | | - Vassilios Vassilikos
- Medical School, Aristotle University of Thessaloniki, Greece & Hippokrateio General Hospital, Thessaloniki, Greece
| | - Mario Martins Oliveira
- Department of Cardiology, Hospital Santa Marta, Rua Santa Marta, 1167-024 Lisbon, Portugal
| | - Hung Fat Tse
- The Cardiology Division, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.,Hong Kong-Guangdong Stem Cell and Regenerative Medicine Research Centre, The University of Hong Kong and Guangzhou Institutes of Biomedicine and Health, Hong Kong SAR, China
| | - Jorge Figueroa
- Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
| | - Bruce S Stambler
- Unidad de Arritmias y Marcapasos, Sanatorio Allende, Obispo Oro 42, CP 5000, Córdoba, Argentina
| | - Jose M Guerra
- Piedmont Heart Institute, 275 Collier Road Northwest, Suite 500, Atlanta, GA 30309, USA
| | - Martin Stiles
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Universidad Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Manlio Marques
- Waikato Clinical School, University of Auckland, Auckland, New Zealand.,National Institute of Cardiology Ignacio Chávez, Mexico City, Mexico
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15
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Fong KY, Ng CJR, Wang Y, Yeo C, Tan VH. Subcutaneous Versus Transvenous Implantable Defibrillator Therapy: A Systematic Review and Meta-Analysis of Randomized Trials and Propensity Score-Matched Studies. J Am Heart Assoc 2022; 11:e024756. [PMID: 35656975 PMCID: PMC9238723 DOI: 10.1161/jaha.121.024756] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Subcutaneous implantable cardioverter‐defibrillators (S‐ICDs) have been of great interest as an alternative to transvenous implantable cardioverter‐defibrillators (TV‐ICDs). No meta‐analyses synthesizing data from high‐quality studies have yet been published. Methods and Results An electronic literature search was conducted to retrieve randomized controlled trials or propensity score–matched studies comparing S‐ICD against TV‐ICD in patients with an implantable cardioverter‐defibrillator indication. The primary outcomes were device‐related complications and lead‐related complications. Secondary outcomes were inappropriate shocks, appropriate shock, all‐cause mortality, and infection. All outcomes were pooled under random‐effects meta‐analyses and reported as risk ratios (RRs) and 95% CIs. Kaplan–Meier curves of device‐related complications were digitized to retrieve individual patient data and pooled under a 1‐stage meta‐analysis using Cox models to determine hazard ratios (HRs) of patients undergoing S‐ICD versus TV‐ICD. A total of 5 studies (2387 patients) were retrieved. S‐ICD had a similar rate of device‐related complications compared with TV‐ICD (RR, 0.59 [95% CI, 0.33–1.04]; P=0.070), but a significantly lower lead‐related complication rate (RR, 0.14 [95% CI, 0.07–0.29]; P<0.0001). The individual patient data–based 1‐stage stratified Cox model for device‐related complications across 4 studies yielded no significant difference (shared‐frailty HR, 0.82 [95% CI, 0.61–1.09]; P=0.167), but visual inspection of pooled Kaplan–Meier curves suggested a divergence favoring S‐ICD. Secondary outcomes did not differ significantly between both modalities. Conclusions S‐ICD is clinically superior to TV‐ICD in terms of lead‐related complications while demonstrating comparable efficacy and safety. For device‐related complications, S‐ICD may be beneficial over TV‐ICD in the long term. These indicate that S‐ICD is likely a suitable substitute for TV‐ICD in patients requiring implantable cardioverter‐defibrillator implantation without a pacing indication.
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Affiliation(s)
- Khi Yung Fong
- Yong Loo Lin School of MedicineNational University of Singapore Singapore
| | | | - Yue Wang
- Department of Cardiology Changi General Hospital Singapore
| | - Colin Yeo
- Department of Cardiology Changi General Hospital Singapore
| | - Vern Hsen Tan
- Department of Cardiology Changi General Hospital Singapore
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16
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Dhawan R, Ahmad M, Jhand A, Kanwal S, Jamil A, Khan F. Two Limitations of Subcutaneous Implantable Cardioverter Defibrillator in the Same Patient Warranting Its Explant. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e928983. [PMID: 33911064 PMCID: PMC8097742 DOI: 10.12659/ajcr.928983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND A subcutaneous implantable cardioverter defibrillator (S-ICD) is preferred over a transvenous implantable cardioverter defibrillator (TV-ICD) in selected cases owing to a lower rate of lead-related complications such as infections and venous thrombosis. However, the S-ICD has its own limitations, including inappropriate shocks due to oversensed events, and the inability to treat ventricular tachycardia (VT) below a heart rate of 170 beats per minutes (bpm). We present a patient case which showed manifestations of both of these limitations, warranting explant of the device. CASE REPORT A 50-year-old man with a history of nonischemic cardiomyopathy and VT had a S-ICD placed at an outside facility. However, he continued to have VT despite on anti-arrhythmic drugs and required recurrent S-ICD shocks. Device interrogation showed that he was intermittently receiving appropriate shocks for slower VT (with a heart rate ranging from 150 bpm to 160 bpm) due to oversensing of T waves. However, treatment was delayed for other VT episodes owing to appropriate sensing and the patient's heart rate being below the lowest detection zone for S-ICD. Due to slower VT cycle length and frequent oversensed events, the S-ICD was ultimately replaced by a TV-ICD system. CONCLUSIONS This case report emphasizes the importance of S-ICD pre-implant vector screening and the need for paying attention to VT cycle length to prevent inappropriate device shocks and/or delayed therapies.
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Affiliation(s)
- Rahul Dhawan
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Mansoor Ahmad
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Aravdeep Jhand
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sumera Kanwal
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Adeel Jamil
- Department of Medicine, OSF Healthcare St. Francis Medical Center, Peoria, IL, USA
| | - Faris Khan
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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17
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Jing R, Jin H, Hua W, Yang S, Hu Y, Zhang S. Association Between Subcutaneous Implantable Cardioverter Defibrillator Preimplantation Screening and the Response to Cardiac Resynchronization Therapy. Korean Circ J 2020; 50:1062-1073. [PMID: 33150752 PMCID: PMC7707981 DOI: 10.4070/kcj.2019.0420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 07/26/2020] [Accepted: 08/25/2020] [Indexed: 11/12/2022] Open
Abstract
Background and Objectives Preimplantation QRS-T morphology screening (TMS) is a composite tool for selecting subcutaneous implantable cardioverter defibrillator (S-ICD) candidates. However, its role in predicting the patient's response to cardiac resynchronization therapy (CRT) is uncertain. Methods A total of 55 consecutive de novo CRT candidates were enrolled between January 2016 and March 2017. Electrocardiogram (ECG) and TMS were performed before and soon after implantation. The ECG parameters were recorded, including QRS duration and morphology (such as ΔQRS_Index, QTc during biventricular pacing mode [BiV pacing QTc], and QRS/T ratio during biventricular pacing mode [BiV pacing QRS/T ratio]). TMS monitored three sensory vectors of the S-ICD. Six months after implantation, the responses to CRT were evaluated. Results Thirty-nine patients (70.9%) passed the TMS during biventricular pacing mode. At the six-month follow-up, the number of responders and super-responders was significantly higher in the passing group than in the non-passing group (responders: 31/39 [79.5%] vs. 5/16 [31.3%], p<0.001; super-responders: 9/39 [23.1%] vs. 1/16 [6.3%], p=0.020). The super-response rate was higher among patients who passed all three vectors than among those who passed 1 or 2 vectors (3 vs. 2 vectors, p=0.018; 3 vs. 1 vector, p=0.003). A smaller left atrial diameter, vectors that passed TMS during biventricular pacing mode, and larger ΔQRS_Index values were independently associated with good CRT response. Conclusions Our study demonstrated that patients on CRT who pass the TMS during biventricular pacing mode are more likely to respond and super-respond to CRT.
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Affiliation(s)
- Ran Jing
- The Cardiac Arrhythmia Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Han Jin
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Wei Hua
- The Cardiac Arrhythmia Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Shengwen Yang
- The Cardiac Arrhythmia Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yiran Hu
- The Cardiac Arrhythmia Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu Zhang
- The Cardiac Arrhythmia Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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18
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Zormpas C, Eiringhaus J, Hillmann HAK, Hohmann S, Müller-Leisse J, Schmitto JD, Veltmann C, Duncker D. A novel screening tool to unmask potential interference between S-ICD and left ventricular assist device. J Cardiovasc Electrophysiol 2020; 31:3286-3292. [PMID: 33017069 DOI: 10.1111/jce.14769] [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] [Received: 08/31/2020] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In patients with a left ventricular assist device (LVAD), the subcutaneous implantable cardioverter-defibrillator (S-ICD) can be an alternative to transvenous ICD systems due to reduced risk of systemic infection, which could lead to extraction of the ICD as well as the LVAD. S-ICD eligibility is lower in patients with LVAD than in patients with end-stage heart failure without LVAD. Several reports have shown inappropriate S-ICD therapy in the coexistence of LVAD and S-ICD. The aim of the present study was to evaluate S-ICD eligibility in patients with LVAD using the established electrocardiogram (ECG)-based screening test as well as a novel device-based screening test to identify potentially inappropriate S-ICD sensing in this specific patient cohort. METHODS AND RESULTS The present study included 115 patients implanted with an LVAD. The standard ECG-based screening test and a novel device-based screening test were performed in all patients. Eighty patients (70%) were eligible for S-ICD therapy with the standard ECG-based screening test. Performance of the novel device-based screening test identified device-device interference in 14 of these 80 patients (12%). CONCLUSION Using a novel extended device-based S-ICD screening method, a small number of patients with LVAD deemed eligible for S-ICD with the standard ECG-based screening test exhibit device-device interference. Careful S-ICD screening should be performed in patients with LVAD, who are candidates for S-ICD therapy, to prevent inappropriate sensing or ICD therapy.
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Affiliation(s)
- Christos Zormpas
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Jörg Eiringhaus
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Henrike A K Hillmann
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Stephan Hohmann
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Johanna Müller-Leisse
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Jan D Schmitto
- Department of Cardiac, Thoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Christian Veltmann
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
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19
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Tsutsui K, Kato R, Asano S, Ikeda Y, Mori H, Tawara M, Tanaka S, Hasegawa S, Nakano S, Iwanaga S, Muramatsu T, Matsumoto K. Myopotential Oversensing Is a Major Cause of Inappropriate Shock in Subcutaneous Implantable Defibrillator in Japan. Int Heart J 2020; 61:913-921. [PMID: 32921668 DOI: 10.1536/ihj.20-129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Previous study has identified marked differences in patient characteristics and causes of inappropriate shock (IAS) between Japan and the Western societies in terms of subcutaneous implantable cardioverter-defibrillator (S-ICD). However, evidence of IAS in Asian populations including Japan has been limited to one observational study.Thus, we conducted a single-center registry study that tracks the postoperative course of 61 consecutive patients who received S-ICD from February 2016 to January 2020. Our findings showed that IAS occurred in 9.8% of the study population (6/61), which is comparable to the previously reported incidence. Remarkably, T-wave oversensing did not result in an IAS (0/6). Instead, myopotential oversensing was determined to have caused the most IAS events (4/6), while atrial fibrillation ranked second (2/6). A provocation maneuver (e.g., abdominal clench, push-ups, lifting a heavy item) reproduced myopotential noise disguised as R-waves, which should potentially trigger an IAS if uninterrupted. R-wave amplitude of the IAS group appeared relatively low compared to that of the non-IAS group although this finding was not tested significant. Furthermore, no temporal changes were noted in R-wave amplitude between the time of implantation and IAS events, suggesting that it is neither constantly low nor acutely dropped R-wave amplitude but a relatively high noise level that drives IAS. All the myopotential-IAS patients were found to be male. Right-sided lead implantation was associated with a higher incidence of IAS.This study highlights the fact that IAS continues to occur due to myopotential noise oversensing instead of T-wave oversensing. To minimize the risk of IAS, it is desirable to search and secure high R-wave voltage.
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Affiliation(s)
- Kenta Tsutsui
- Department of Cardiovascular Medicine, Saitama International Medical Center, Faculty of Medicine, Saitama Medical University
| | - Ritsushi Kato
- Department of Cardiovascular Medicine, Saitama International Medical Center, Faculty of Medicine, Saitama Medical University
| | - Sou Asano
- Department of Cardiovascular Medicine, Saitama International Medical Center, Faculty of Medicine, Saitama Medical University
| | - Yoshifumi Ikeda
- Department of Cardiovascular Medicine, Saitama International Medical Center, Faculty of Medicine, Saitama Medical University
| | - Hitoshi Mori
- Department of Cardiovascular Medicine, Saitama International Medical Center, Faculty of Medicine, Saitama Medical University
| | - Mai Tawara
- Department of Cardiovascular Medicine, Saitama International Medical Center, Faculty of Medicine, Saitama Medical University
| | - Sayaka Tanaka
- Department of Cardiovascular Medicine, Saitama International Medical Center, Faculty of Medicine, Saitama Medical University
| | - Saki Hasegawa
- Department of Cardiovascular Medicine, Saitama International Medical Center, Faculty of Medicine, Saitama Medical University
| | - Shintaro Nakano
- Department of Cardiovascular Medicine, Saitama International Medical Center, Faculty of Medicine, Saitama Medical University
| | - Siro Iwanaga
- Department of Cardiovascular Medicine, Saitama International Medical Center, Faculty of Medicine, Saitama Medical University
| | - Toshihiro Muramatsu
- Department of Cardiovascular Medicine, Saitama International Medical Center, Faculty of Medicine, Saitama Medical University
| | - Kazuo Matsumoto
- Department of Cardiovascular Medicine, Saitama International Medical Center, Faculty of Medicine, Saitama Medical University
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20
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van Dijk VF, Boersma LVA. The subcutaneous implantable cardioverter defibrillator in 2019 and beyond. Trends Cardiovasc Med 2020; 30:378-384. [DOI: 10.1016/j.tcm.2019.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 11/16/2022]
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21
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Zormpas C, Eiringhaus J, Hillmann HAK, Hohmann S, Müller-Leisse J, Schmitto JD, Veltmann C, Duncker D. Eligibility for subcutaneous implantable cardioverter-defibrillator in patients with left ventricular assist device. J Interv Card Electrophysiol 2020; 60:303-311. [PMID: 32613315 PMCID: PMC7925469 DOI: 10.1007/s10840-020-00810-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/22/2020] [Indexed: 11/07/2022]
Abstract
Purpose The subcutaneous implantable cardioverter-defibrillator (S-ICD) could be a promising alternative to the conventional transvenous ICD in patients with LVAD due to its reduced risk of infection. However, surface ECG is altered following LVAD implantation and, since S-ICD detection is based on surface ECG, S-ICD could be potentially affected. The aim of the present study was to analyze S-ICD eligibility in patients with LVAD. Methods Seventy-five patients implanted with an LVAD were included in this prospective single-center study. The ECG-based screening test and the automated screening test were performed in all patients. Results Fifty-five (73.3%) patients had either a positive ECG-based or automated screening test. Out of these, 28 (37.3%) patients were found eligible for S-ICD implantation with both screening tests performed. ECG-based screening test was positive in 50 (66.6%) patients; automated screening test was positive in 33 (44.0%) patients. Three ECG-based screening tests could not be evaluated due to artifacts. With the automated screening test, in 9 (12.0%) patients, the test yielded no result. Conclusions Patients implanted with an LVAD showed lower S-ICD eligibility rates compared with patients without LVAD. With an S-ICD eligibility rate of maximal 73.3%, S-ICD therapy may be a feasible option in these patients. Nevertheless, S-ICD implantation should be carefully weighed against potential device-device interference. Prospective studies regarding S-ICD eligibility before and after LVAD implantation are required to further elucidate the role of S-ICD therapy in this population.
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Affiliation(s)
- Christos Zormpas
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Jörg Eiringhaus
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Henrike A K Hillmann
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Stephan Hohmann
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Johanna Müller-Leisse
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - Jan D Schmitto
- Department of Cardiac, Thoracic, Transplant and Vascular Surgery, Hannover Medical School, Hanover, Germany
| | - Christian Veltmann
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany
| | - David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hanover, Germany.
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22
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Rella V, Parati G, Crotti L. Sudden Cardiac Death in Children Affected by Cardiomyopathies: An Update on Risk Factors and Indications at Transvenous or Subcutaneous Implantable Defibrillators. Front Pediatr 2020; 8:139. [PMID: 32318526 PMCID: PMC7146705 DOI: 10.3389/fped.2020.00139] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 03/11/2020] [Indexed: 12/19/2022] Open
Abstract
In the present paper, we will discuss the main cardiomyopathies affecting children with a specific focus on risk stratification and prevention of sudden cardiac death (SCD). We will discuss the main clinical features of hypertrophic cardiomyopathy (HCM), dilated and restrictive cardiomyopathies, left ventricular non-compaction (LVNC) and arrhythmogenic cardiomyopathy (AC), always highlighting their peculiarities in the pediatric age. Since sudden cardiac death may be the first manifestation of the disease, even in children, the identification of the specific underlying condition and of risk factors are pivotal to carry out the appropriate preventing strategies. ICD recommendations in children are similar to adults, but supporting evidences are not so solid, being based on registries or single center studies. Furthermore, children and young patients are most likely to manifest long term complications related to an implanted ICD, and this should be taken into account when evaluating the risk benefit ratio. In this perspective, subcutaneous ICDs (S-ICDs) could carry an advantage; however, they cannot be considered in small children for technical reasons. Data on effectiveness and safety of S-ICDs in a pediatric population is still lacking, although some limited experiences are reported and will be discussed in the current review.
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Affiliation(s)
- Valeria Rella
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Lia Crotti
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Milan, Italy.,Istituto Auxologico Italiano, IRCCS, Laboratory of Cardiovascular Genetics, Milan, Italy
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23
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Arias MA, Pachón M, Sánchez-Iglesias I, Loughlin G, Martín-Sierra C, Puchol A, Sabatel F, Rodríguez-Padial L. Impact of routine right parasternal electrocardiographic screening in assessing eligibility for subcutaneous implantable cardioverter-defibrillator. J Cardiovasc Electrophysiol 2019; 31:103-111. [PMID: 31724763 DOI: 10.1111/jce.14275] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 10/21/2019] [Accepted: 11/06/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Between 7% and 15% of patients with an indication for an implantable cardioverter-defibrillator (ICD) are not eligible for implantation of a subcutaneous implantable cardioverter-defibrillator (S-ICD) on the basis of the result of the conventional left parasternal electrocardiographic screening (LPES). Our objective was to determine the impact of systematically performing right parasternal electrocardiographic screening (RPES) in addition to conventional LPES, in terms of increasing both the total percentage of potentially eligible patients for S-ICD implantation and the number of suitable vectors per patient. METHODS AND RESULTS Consecutive patients from the outpatient device clinic who already had an implanted ICD, and no requirement for pacing were enrolled. Conventional left parasternal electrode position and right parasternal electrode positions were used. The automatic screening tool was used to analyze the recordings. Screenings were performed in the supine and standing positions. Overall, 209 patients were included. The mean age was 63.4 ± 13 years, 59.8% had ischemic heart disease, mean QRS duration was 100 ± 31 ms, and 69.9% had a primary prevention ICD indication. Based on conventional isolated LPES, 12.9% of patients were not eligible for S-ICD compared with 11.5% based on RPES alone (P = .664). Considering LPES and RPES together, only 7.2% of patients were not eligible for S-ICD (P < .001). Moreover, the number of patients with more than one suitable vector increased from 66.5% with isolated LPES to 82.3% (23.7% absolute increase [P < .001]). CONCLUSION Adding an automated RPES to the conventional automated LPES increased patient eligibility for the S-ICD significantly. Moreover, combined screening increased the number of suitable vectors per eligible patient.
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Affiliation(s)
- Miguel A Arias
- Arrhythmia Unit, Department of Cardiology, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - Marta Pachón
- Arrhythmia Unit, Department of Cardiology, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - Iván Sánchez-Iglesias
- Department of Psychobiology and Behavioral Sciences Methods, Complutense University of Madrid, Madrid, Spain
| | - Gerard Loughlin
- Arrhythmia Unit, Department of Cardiology, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - Cristina Martín-Sierra
- Arrhythmia Unit, Department of Cardiology, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - Alberto Puchol
- Arrhythmia Unit, Department of Cardiology, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - Fernando Sabatel
- Arrhythmia Unit, Department of Cardiology, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - Luis Rodríguez-Padial
- Arrhythmia Unit, Department of Cardiology, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
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24
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Diagnostic and Therapeutic Approach to Arrhythmias in Adult Congenital Heart Disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:44. [PMID: 31342289 DOI: 10.1007/s11936-019-0749-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW Adult survivors of congenital heart disease (CHD) are at increased risk of arrhythmia. The goal of this review is to outline diagnostic and therapeutic approaches to arrhythmia in adult CHD patients. RECENT FINDINGS Macro-reentrant atrial tachyarrhythmia is the most common arrhythmia encountered in adults with CHD. Approximately 25% of hospitalizations associated with arrhythmia. The risk of ventricular arrhythmia is estimated as high as 25-100 times that for the general population and increased after two decades. Routine ambulatory monitoring is important for arrhythmia risk assessment in adults with CHD. There are limitations, potential adverse effects, and risk of recurrence with antiarrhythmic drugs, catheter ablation, and surgical approaches. Adults with CHD suffer various forms of arrhythmia, are at increased risk of sudden death, and require special consideration for medical and interventional therapy.
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25
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Sakhi R, Theuns DA, Cosgun D, Michels M, Schinkel AF, Kauling RM, Roos-Hesselink JW, Yap SC. Usefulness of a standard 12-lead electrocardiogram to predict the eligibility for a subcutaneous defibrillator. J Electrocardiol 2019; 55:123-127. [DOI: 10.1016/j.jelectrocard.2019.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 05/06/2019] [Accepted: 05/21/2019] [Indexed: 10/26/2022]
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26
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Pfenniger A, Knight BP. Evolution of extravascular implantable defibrillator technologies. Prog Cardiovasc Dis 2019; 62:249-255. [PMID: 31004606 DOI: 10.1016/j.pcad.2019.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 04/15/2019] [Indexed: 11/30/2022]
Abstract
The implantable cardioverter-defibrillator (ICD) has been successfully treating patients with lethal ventricular arrhythmias for decades. The main acute and chronic complications of this therapy modality are related to the use of a transvenous lead. An entirely extravascular ICD concept was developed over the last 20 years, with emergence of the subcutaneous ICD (S-ICD). This device was approved for clinical use seven years ago, and accumulating real-life experience confirms its safety and efficacy. The main limitations related to this system include the lack of pacing capabilities for bradycardia, tachycardia or resynchronization therapy, a large size, and relatively high energy requirements for effective defibrillation. This review article summarizes current knowledge and potential future developments of the extravascular ICD technologies.
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Affiliation(s)
- Anna Pfenniger
- Division of Cardiology, Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States of America
| | - Bradley P Knight
- Division of Cardiology, Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States of America.
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27
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Bögeholz N, Willy K, Niehues P, Rath B, Dechering DG, Frommeyer G, Kochhäuser S, Löher A, Köbe J, Reinke F, Eckardt L. Spotlight on S-ICD™ therapy: 10 years of clinical experience and innovation. Europace 2019; 21:1001-1012. [DOI: 10.1093/europace/euz029] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 02/09/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Subcutaneous ICD (S-ICD™) therapy has been established in initial clinical trials and current international guideline recommendations for patients without demand for pacing, cardiac resynchronization, or antitachycardia pacing. The promising experience in ‘ideal’ S-ICD™ candidates increasingly encourages physicians to provide the benefits of S-ICD™ therapy to patients in clinical constellations beyond ‘classical’ indications of S-ICD™ therapy, which has led to a broadening of S-ICD™ indications in many centres. However, the decision for S-ICD™ implantation is still not covered by controlled randomized trials but rather relies on patient series or observational studies. Thus, this review intends to give a contemporary update on available empirical evidence data and technical advancements of S-ICD™ technology and sheds a spotlight on S-ICD™ therapy in recently discovered fields of indication beyond ideal preconditions. We discuss the eligibility for S-ICD™ therapy in Brugada syndrome as an example for an adverse and dynamic electrocardiographic pattern that challenges the S-ICD™ sensing and detection algorithms. Besides, the S-ICD™ performance and defibrillation efficacy in conditions of adverse structural remodelling as exemplified for hypertrophic cardiomyopathy is discussed. In addition, we review recent data on potential device interactions between S-ICD™ systems and other implantable cardio-active systems (e.g. pacemakers) including specific recommendations, how these could be prevented. Finally, we evaluate limitations of S-ICD™ therapy in adverse patient constitutions, like distinct obesity, and present contemporary strategies to assure proper S-ICD™ performance in these patients. Overall, the S-ICD™ performance is promising even for many patients, who may not be ‘classical’ candidates for this technology.
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Affiliation(s)
- Nils Bögeholz
- Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany
| | - Kevin Willy
- Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany
| | - Philipp Niehues
- Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany
| | - Benjamin Rath
- Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany
| | - Dirk G Dechering
- Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany
| | - Gerrit Frommeyer
- Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany
| | - Simon Kochhäuser
- Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany
| | - Andreas Löher
- Department of Cardiothoracic Surgery, University Hospital of Muenster, Muenster, Germany
| | - Julia Köbe
- Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany
| | - Florian Reinke
- Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany
| | - Lars Eckardt
- Division of Electrophysiology, Department of Cardiology and Angiology, University Hospital of Muenster, Muenster, Germany
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28
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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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29
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Miwa N, Nagata Y, Yamaguchi T, Nagase M, Sasaki T, Nozato T, Ashikaga T, Goya M, Hirao K. Effect of diurnal variations in the QRS complex and T waves on the eligibility for subcutaneous implantable cardioverter-defibrillators. Heart Rhythm 2019; 16:913-920. [PMID: 30616021 DOI: 10.1016/j.hrthm.2019.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Subcutaneous implantable cardioverter-defibrillators (S-ICDs) are an established therapy for preventing sudden cardiac death. However, a considerable number of patients still undergo inappropriate shocks even after conventional preimplantation electrocardiographic (ECG) screening. OBJECTIVE This study aimed to elucidate the additional effect of diurnal variations in the QRS complex and T waves of 24-hour Holter screening on S-ICD eligibility. METHODS Patients with transvenous ICDs who did not need pacing were selected for the study. The ECG was recorded by placing the electrodes to simulate the 3 sensing vectors of the S-ICD, with the patient in the standing and supine positions (conventional), during exercise, and during 24-hour Holter screening. We investigated the additional discrimination of diurnal variations in patients ineligible for S-ICDs as well as characteristics of those patients. RESULTS Of the 86 patients (82% men; mean age 54±16 years) analyzed by all 3 screenings, 2 (2.3%) and 3 (3.4%) were considered ineligible by conventional and exercise screening, respectively. An additional 21 patients (24.4%) were found ineligible through Holter screening. A multivariate logistic regression analysis demonstrated that Brugada syndrome and an increased QRS duration per millisecond were associated with ineligibility (odds ratio 5.74; 95% confidence interval 1.74-20.2; P = .003 and odds ratio 1.04; 95% confidence interval 1.01-1.07; P = .007, respectively). T-wave oversensing was mostly observed during 0-6 AM, but no significant diurnal variations were observed in the incorrect QRS profiles. CONCLUSION The detection of diurnal variations through Holter monitoring in addition to conventional screening is expected to be useful for determining S-ICD eligibility.
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Affiliation(s)
- Naoyuki Miwa
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Yasutoshi Nagata
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Tetsuo Yamaguchi
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan.
| | - Masashi Nagase
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Takeshi Sasaki
- Department of Cardiovascular Medicine, Disaster Medical Center, Tokyo, Japan
| | - Toshihiro Nozato
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Takashi Ashikaga
- Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Masahiko Goya
- Heart Rhythm Center, Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kenzo Hirao
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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30
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Garside H, Leyva F, Hudsmith L, Marshall H, de Bono J. Eligibility for subcutaneous implantable cardioverter defibrillators in the adult congenital heart disease population. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 42:65-70. [DOI: 10.1111/pace.13537] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/03/2018] [Accepted: 10/03/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Hannah Garside
- Department of Cardiology; Queen Elizabeth Hospital; Birmingham United Kingdom
| | - Francisco Leyva
- Department of Cardiology; Queen Elizabeth Hospital; Birmingham United Kingdom
- Aston Medical Research Institute, Aston Medical School; Aston University; Birmingham United Kingdom
| | - Lucy Hudsmith
- Department of Cardiology; Queen Elizabeth Hospital; Birmingham United Kingdom
| | - Howard Marshall
- Department of Cardiology; Queen Elizabeth Hospital; Birmingham United Kingdom
| | - Joseph de Bono
- Department of Cardiology; Queen Elizabeth Hospital; Birmingham United Kingdom
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31
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Zormpas C, Mueller-Leisse J, Koenig T, Schmitto JD, Veltmann C, Duncker D. Electrocardiographic changes after implantation of a left ventricular assist device - Potential implications for subcutaneous defibrillator therapy. J Electrocardiol 2018; 52:29-34. [PMID: 30476635 DOI: 10.1016/j.jelectrocard.2018.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 11/01/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Implantation of a left ventricular assist device (LVAD) leads to a diverse spectrum of changes on the twelve-lead surface electrocardiogram (ECG). We aimed to elucidate the changes of the surface ECG in patients after LVAD implantation potentially impacting ECG based screening tests of subcutaneous implantable cardioverter-defibrillators (S-ICD). METHODS Patients from 2005 until 2017 with a documented twelve-lead ECG before and after LVAD implantation were included. Baseline parameters were obtained through hospital records. The twelve-lead ECGs registered before and after LVAD implantation were analyzed. RESULTS From 415 patients undergoing an LVAD implantation, complete datasets were available for 253 patients. 216 patients (85%) were male. Mean age at time of LVAD implantation was 54.7 ± 12.4 years. The underlying etiology was ischemic cardiomyopathy in 119 (47%), dilated cardiomyopathy in 112 (44%), myocarditis in 8 (3%) and other in 14 (6%). We observed a reduction in the amplitude of the R wave in lead I (p < 0.0001), lead II (p < 0.0001), lead III (p < 0.004), lead aVL (p < 0.001) and lead aVF (p < 0.0001) as well as of the S wave in lead III (p < 0.001) and lead aVR (p < 0.0001) after LVAD implantation. We also noticed a reduction of the R:T ratio in lead I (p < 0.0001) as well as in lead II (p = 0.100) and lead aVF (p = 0.292) although statistically non-significant. CONCLUSION LVAD implantation leads to significant alterations of the surface ECG, especially the R:T ratio in leads I, II and aVF. These leads correlate with the vectors of the ECG based S-ICD screening test. Thus, these ECG changes may impact the continuous eligibility for subcutaneous ICD therapy in patients after LVAD implantation.
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Affiliation(s)
- Christos Zormpas
- Rhythmology and Electrophysiology, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Johanna Mueller-Leisse
- Rhythmology and Electrophysiology, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Thorben Koenig
- Rhythmology and Electrophysiology, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Jan D Schmitto
- Department of Cardiac, Thoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Christian Veltmann
- Rhythmology and Electrophysiology, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - David Duncker
- Rhythmology and Electrophysiology, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
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32
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Migliore F, Pelliccia F, Autore C, Bertaglia E, Cecchi F, Curcio A, Bontempi L, Curnis A, De Filippo P, D’Onofrio A, Francia P, Maurizi N, Musumeci B, Proclemer A, Zorzi A, Corrado D. Subcutaneous implantable cardioverter defibrillator in cardiomyopathies and channelopathies. J Cardiovasc Med (Hagerstown) 2018; 19:633-642. [DOI: 10.2459/jcm.0000000000000712] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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33
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2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Heart Rhythm 2018; 15:e73-e189. [DOI: 10.1016/j.hrthm.2017.10.036] [Citation(s) in RCA: 177] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Indexed: 02/07/2023]
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34
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Kawabata M, Goya M, Takahashi Y, Maeda S, Yagishita A, Shirai Y, Kaneko M, Shiohira S, Hirao K. Candidacy for a Subcutaneous Implantable Cardioverter Defibrillator in Patients with Cardiac Resynchronization Therapy. Int Heart J 2018; 59:951-958. [PMID: 30101850 DOI: 10.1536/ihj.17-550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In patients requiring an implantable cardioverter defibrillator (ICD), the combined use of a prior pacemaker and a subcutaneous ICD (S-ICD) could be an alternative treatment option to implantation of new leads or upgrading of pacemakers to an ICD if vascular access is limited. Here, we assessed the prevalence of S-ICD's eligibility according to surface electrogram screening in those receiving cardiac resynchronization therapy (CRT). S-ICD's eligibility was assessed in patients with a CRT pacemaker or a CRT defibrillator using the S-ICD template screening tool. Eligibility was defined as fulfillment of the template in both supine and upright positions in one or more leads during biventricular pacing. Among 44 patients (34 men, age: 67 ± 12), 36 (82%) were found to be eligible. The T/QRS amplitude ratio in lead II was significantly lower in those who were eligible (0.31 ± 0.16 versus 0.44 ± 0.18 in the ineligible group, P = 0.04). The lead position, underlying disease, and other electrocardiographic findings were not different between those who were eligible and those who were not. The majority of patients with biventricular pacing were eligible for S-ICD based on current screening tests and may benefit from this treatment. Further study is required.
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Affiliation(s)
| | - Masahiko Goya
- Heart Rhythm Center, Tokyo Medical and Dental University
| | | | - Shingo Maeda
- Heart Rhythm Center, Tokyo Medical and Dental University
| | | | | | | | | | - Kenzo Hirao
- Heart Rhythm Center, Tokyo Medical and Dental University
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35
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Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2018; 138:e272-e391. [PMID: 29084731 DOI: 10.1161/cir.0000000000000549] [Citation(s) in RCA: 249] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | - William G Stevenson
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Michael J Ackerman
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - William J Bryant
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - David J Callans
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Anne B Curtis
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Barbara J Deal
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Timm Dickfeld
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Michael E Field
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Gregg C Fonarow
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Anne M Gillis
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Christopher B Granger
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Stephen C Hammill
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Mark A Hlatky
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - José A Joglar
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - G Neal Kay
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Daniel D Matlock
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Robert J Myerburg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Richard L Page
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
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Salgado BC, Coram R, Mandrola J, Gopinathannair R. Inappropriate shock from delayed T-wave oversensing by a subcutaneous implantable cardioverter-defibrillator after septal myectomy for hypertrophic cardiomyopathy. HeartRhythm Case Rep 2018; 4:408-411. [PMID: 30228966 PMCID: PMC6140424 DOI: 10.1016/j.hrcr.2018.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Benjamin C Salgado
- Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky
| | - Rita Coram
- Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky
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Eligibility of cardiac resynchronization therapy patients for subcutaneous implantable cardioverter defibrillators. J Interv Card Electrophysiol 2018; 54:49-54. [PMID: 30187250 DOI: 10.1007/s10840-018-0437-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 08/03/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Before subcutaneous implantable cardioverter defibrillator (S-ICD) implantation, the adequacy of sensing is required to be verified through surface ECG screening. Our objective was to determine whether S-ICD can be considered as a supplementary therapy in patients who are receiving biventricular (BIV) pacing. METHODS We evaluated 48 patients with BIV devices to determine S-ICD candidacy during BIV, left ventricular (LV), right ventricular (RV) pacing, and intrinsic conduction (left bundle branch block-LBBB) by using an automated screening tool. Eligibility was defined by the presence of at least one appropriate vector in the supine and standing positions. RESULTS Eligibility was verified during BIV pacing in 34 (71%) patients. In patients screened-out, QRS duration was longer (p = 0.035) and ischemic cardiomyopathy was more frequent (p = 0.027). LV-only pacing was associated with a lower passing rate (46%) (p < 0.001 versus BIV). The LBBB QRS morphology during inhibited ventricular pacing was acceptable in 51% of patients. The QRS generated by RV pacing was acceptable in 25% of patients. In patients who passed the screening test during BIV, the QRS was not acceptable in 76% during RV pacing (i.e., accidental loss of LV capture). The concomitant adequacy during inhibited ventricular pacing (i.e., possible intrinsic conduction) was not assessed in 40% of patients. CONCLUSIONS S-ICD may be a supplemental therapy in the majority of CRT patients. Standard BIV pacing should be preferred to the LV-only pacing mode, as it is more frequently associated with adequacy of S-ICD sensing. Spontaneous LBBB and RV-paced QRS morphologies are frequently inadequate. Therefore, in patients selected for concomitant S-ICD and CRT implantation, accidental loss of LV capture or possible intrinsic conduction must be prevented.
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Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2018; 72:e91-e220. [PMID: 29097296 DOI: 10.1016/j.jacc.2017.10.054] [Citation(s) in RCA: 676] [Impact Index Per Article: 112.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Bögeholz N, Pauls P, Güner F, Bode N, Fischer A, Dechering D, Frommeyer G, Köbe J, Wasmer K, Eckardt L, Reinke F. Direct comparison of the novel automated screening tool (AST) versus the manual screening tool (MST) in patients with already implanted subcutaneous ICD. Int J Cardiol 2018; 265:90-96. [DOI: 10.1016/j.ijcard.2018.02.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 02/03/2018] [Accepted: 02/08/2018] [Indexed: 12/01/2022]
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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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Bettin M, Rath B, Ellermann C, Leitz P, Bögeholz N, Reinke F, Köbe J, Eckardt L, Frommeyer G. Change of sensing vector in the subcutaneous ICD during follow-up and after device replacement. J Cardiovasc Electrophysiol 2018; 29:1241-1247. [PMID: 29873873 DOI: 10.1111/jce.13647] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 05/18/2018] [Accepted: 05/23/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The subcutaneous implantable cardioverter defibrillator (S-ICD) has been established as a valuable alternative to transvenous ICD for prevention of sudden cardiac death. The system automatically chooses the optimal sensing vector. However, during follow-up and especially after device replacement we observed a change of the suggested sensing vector in automatic setup. Therefore, we analyzed frequency and reasons of vector change and its impact on inappropriate shocks (IAS). MATERIAL AND METHODS Between June 2010 and December 2017, a total of 216 patients with S-ICD® were included in this analysis. In all patients sensing vectors at the time of implantation, during follow-up, and after device replacement were investigated. Median follow-up time was 27.3 ± 25.3 months. RESULTS A change of the initial vector was seen in 77 patients (35.7%). The most frequent reason for vector change was the postoperative setup in supine and erect position in 54 patients (70.1%). In 12 patients (15.5%), the vector was manually changed due to inappropriate sensing and/or therapies. Routine setup during follow-up led to automatic vector change in 10 cases (13.0%). In only 1 patient the vector was manually changed due to oversensing in an exercise treadmill test. In 27 patients, the device was replaced due to battery depletion and in 6 of these patients the sensing vector was changed by the automatic setup. Vector change did not have an impact for inappropriate therapies in the follow-up; only 1 patient received an IAS due to an inadvertent vector change after device replacement. CONCLUSION In the present study, a significant number of S-ICD® patients had a manual or automatic vector change during follow-up and after device replacement. The study underlines the importance of a thoroughly performed screening and at least two valuable sensing vectors preimplant. Further studies are needed to evaluate the necessity of a routine automatic setup during follow-up.
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Affiliation(s)
- Markus Bettin
- Department of Cardiology II - Electrophysiology, University Hospital Münster, Münster, Germany
| | - Benjamin Rath
- Department of Cardiology II - Electrophysiology, University Hospital Münster, Münster, Germany
| | - Christian Ellermann
- Department of Cardiology II - Electrophysiology, University Hospital Münster, Münster, Germany
| | - Patrick Leitz
- Department of Cardiology II - Electrophysiology, University Hospital Münster, Münster, Germany
| | - Nils Bögeholz
- Department of Cardiology II - Electrophysiology, University Hospital Münster, Münster, Germany
| | - Florian Reinke
- Department of Cardiology II - Electrophysiology, University Hospital Münster, Münster, Germany
| | - Julia Köbe
- Department of Cardiology II - Electrophysiology, University Hospital Münster, Münster, Germany
| | - Lars Eckardt
- Department of Cardiology II - Electrophysiology, University Hospital Münster, Münster, Germany
| | - Gerrit Frommeyer
- Department of Cardiology II - Electrophysiology, University Hospital Münster, Münster, Germany
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Thomas JA, Perez-Alday EA, Hamilton C, Kabir MM, Park EA, Tereshchenko LG. The utility of routine clinical 12-lead ECG in assessing eligibility for subcutaneous implantable cardioverter defibrillator. Comput Biol Med 2018; 102:242-250. [PMID: 29754992 DOI: 10.1016/j.compbiomed.2018.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/30/2018] [Accepted: 05/01/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The subcutaneous implantable cardioverter-defibrillator (S-ICD) is a life-saving device. Recording of a specialized 3-lead electrocardiogram (ECG) is required for S-ICD eligibility assessment. The goals of this study were: (1) evaluate the effect of ECG filtering on S-ICD eligibility, and (2) simplify S-ICD eligibility assessment by development of an S-ICD ineligibility prediction tool, which utilizes the widely available routine 12-lead ECG. METHODS AND RESULTS Prospective cross-sectional study participants [n = 68; 54% male; 94% white, with wide ranges of age (18-81 y), body mass index (19-53), QRS duration (66-150 ms), and left ventricular ejection fraction (37-77%)] underwent 12-lead supine, 3-lead supine and standing ECG recording. All 3-lead ECG recordings were assessed using the standard S-ICD pre-implantation ECG morphology screening. Backward, stepwise, logistic regression was used to build a model for 12-lead prediction of S-ICD eligibility. Select electrocardiogram waves and complexes: QRS, R-, S, and T-amplitudes on all 12 leads, averaged QT interval, QRS duration, and R/T ratio in the lead with the largest T wave (R/Tmax) were included as predictors. The effect of ECG filtering on ECG morphology was evaluated. A total of 9 participants (13%) failed S-ICD screening prior to filtering. Filtering at 3-40 Hz, similar to the S-ICD default, reduced S-ICD ineligibility to 4%. A regression model that included RII, SII-aVL, TI, II, aVL, aVF, V3-V6, and R/Tmax perfectly predicted S-ICD eligibility, with an Area Under the Receiver Operating Characteristic Curve of 1.0. CONCLUSION Routine clinical 12-lead ECG can be used to predict S-ICD eligibility. ECG filtering may improve S-ICD eligibility.
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Affiliation(s)
- Jason A Thomas
- Oregon Health & Science University, Knight Cardiovascular Institute, Portland, OR, USA
| | | | - Christopher Hamilton
- Oregon Health & Science University, Knight Cardiovascular Institute, Portland, OR, USA
| | - Muammar M Kabir
- Oregon Health & Science University, Knight Cardiovascular Institute, Portland, OR, USA
| | - Eugene A Park
- Oregon Health & Science University, Knight Cardiovascular Institute, Portland, OR, USA
| | - Larisa G Tereshchenko
- Oregon Health & Science University, Knight Cardiovascular Institute, Portland, OR, USA.
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le Polain de Waroux JB, Ploux S, Mondoly P, Eschalier R, Strik M, Houard L, Pierre B, Buliard S, Klotz N, Ritter P, Haissaguerre M, Mahfouz K, Bordachar P. Defibrillation testing is mandatory in patients with subcutaneous implantable cardioverter–defibrillator to confirm appropriate ventricular fibrillation detection. Heart Rhythm 2018; 15:642-650. [DOI: 10.1016/j.hrthm.2018.02.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Indexed: 11/26/2022]
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Chang SC, Patton KK, Robinson MR, Poole JE, Prutkin JM. Subcutaneous ICD screening with the Boston Scientific ZOOM programmer versus a 12-lead ECG machine. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:511-516. [PMID: 29476654 DOI: 10.1111/pace.13314] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 01/24/2018] [Accepted: 02/17/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND The subcutaneous implantable cardioverter-defibrillator (S-ICD) requires preimplant screening to ensure appropriate sensing and reduce risk of inappropriate shocks. Screening can be performed using either an ICD programmer or a 12-lead electrocardiogram (ECG) machine. It is unclear whether differences in signal filtering and digital sampling change the screening success rate. METHODS Subjects were recruited if they had a transvenous single-lead ICD without pacing requirements or were candidates for a new ICD. Screening was performed using both a Boston Scientific ZOOM programmer (Marlborough, MA, USA) and General Electric MAC 5000 ECG machine (Fairfield, CT, USA). A pass was defined as having at least one lead that fit within the screening template in both supine and sitting positions. RESULTS A total of 69 subjects were included and 27 sets of ECG leads had differing screening results between the two machines (7%). Of these sets, 22 (81%) passed using the ECG machine but failed using the programmer and five (19%) passed using the ECG machine but failed using the programmer (P < 0.001). Four subjects (6%) passed screening using the ECG machine but failed using the programmer. No subject passed screening with the programmer but failed with the ECG machine. CONCLUSION There can be occasional disagreement in S-ICD patient screening between an ICD programmer and ECG machine, all of whom passed with the ECG machine but failed using the programmer. On a per lead basis, the ECG machine passes more subjects. It is unknown what the inappropriate shock rate would be if an S-ICD was implanted. Clinical judgment should be used in borderline cases.
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Affiliation(s)
- Shu C Chang
- Division of Cardiology, University of Colorado, Aurora, Colorado, USA
| | - Kristen K Patton
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Melissa R Robinson
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Jeanne E Poole
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Jordan M Prutkin
- Division of Cardiology, University of Washington, Seattle, Washington, USA
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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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Dialytic interval and the timing of electrocardiographic screening for subcutaneous cardioverter-defibrillator placement in chronic hemodialysis patients. J Interv Card Electrophysiol 2018. [DOI: 10.1007/s10840-018-0343-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Subcutaneous implantable cardioverter defibrillator eligibility according to a novel automated screening tool and agreement with the standard manual electrocardiographic morphology tool. J Interv Card Electrophysiol 2018; 52:61-67. [PMID: 29502193 DOI: 10.1007/s10840-018-0326-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 02/06/2018] [Indexed: 11/26/2022]
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Boey E, Kojodjojo P. Optimal Strategies for Mitigating Sudden Cardiac Death Risk in At-risk Patients with Structural Heart Disease. J Innov Card Rhythm Manag 2018; 9:3025-3032. [PMID: 32494485 PMCID: PMC7252838 DOI: 10.19102/icrm.2018.090204] [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: 07/09/2017] [Accepted: 08/29/2017] [Indexed: 12/03/2022] Open
Abstract
This article reviews the strategies used to mitigate sudden death risks in at-risk patients with structural heart disease. The roles of implantable and non-implantable technologies to prevent arrhythmic death are discussed.
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Affiliation(s)
- Elaine Boey
- Division of Cardiology, Ng Teng Fong General Hospital, National University Health System, Singapore
| | - Pipin Kojodjojo
- Division of Cardiology, Ng Teng Fong General Hospital, National University Health System, Singapore,Address correspondence to: Pipin Kojodjojo, PhD, National University Heart Centre, 1E Kent Ridge Road, National University Health System Tower Block, Level 9, Singapore 119228.
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Campbell M, Moore JP, Sreeram N, von Alvensleben JC, Shah A, Batra A, Law I, Sanatani S, Thomas V, Nik-Ahd F, Williams S, Nosavan N, Maldonado J, Hart A, Nguyen T, Balaji S. Predictors of electrocardiographic screening failure for the subcutaneous implantable cardioverter-defibrillator in children: A prospective multicenter study. Heart Rhythm 2018; 15:703-707. [PMID: 29309839 DOI: 10.1016/j.hrthm.2018.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Subcutaneous implantable cardioverter-defibrillator (SICD) shows promise for select patients at risk of sudden cardiac death. However, patients need to pass an electrocardiographic (ECG) screening (ECG-S) test before they can receive an SICD. Predictors of ECG-S failure in children are unclear. OBJECTIVE The purpose of this study was to identify the incidence and predictive factors for failure of ECG-S in children. METHODS Patients 18 years and younger with a preexisting ICD underwent ECG-S for SICD. ECG and demographic data were analyzed for factors predictive of failure. RESULTS Seventy-three patients (mean age 14.2 ± 3.3 years; range 5-18 years) with hypertrophic cardiomyopathy (n = 24, 33%), long QT syndrome (n =18, 25%), other inherited arrhythmia syndromes (n = 20, 27%), congenital heart disease (n = 9, 12%), and miscellaneous conditions (n = 2) with an existing transvenous ICD underwent prospective ECG-S. Nineteen (26%) failed ECG-S. Failed patients had a longer corrected QT (QTc) interval (457 ms vs 425 ms; P = .03), a longer QRS duration (120 ms vs 98 ms; P = .04), and a lower ratio of R-wave to T-wave amplitudes (R:T ratio) in lead aVF (4 vs 5; P = .001). Multivariable logistic regression identified QTc interval (odds ratio [OR] 4.31; P = .04), QRS duration (OR 4.93; P = .03), R:T ratio in lead aVF (OR 3.13; P = .08) as predictors of failure. A risk score with 1 point each for QTc interval >440 ms, QRS duration >120 ms, and R:T ratio <6.5 in lead aVF was associated with probability of failure of 15.4% (1 point), 47.4% (2 points), and 88.6% (3 points), respectively. CONCLUSION ECG-S failure for SICD occurred in 26% of children, which is higher than the reported incidence in adults. Factors predicting ECG-S failure included longer QTc interval, longer QRS duration, and lower R:T ratio in lead aVF.
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Affiliation(s)
| | - Jeremy P Moore
- University of California, Los Angeles, Los Angeles, California
| | | | | | - Anjan Shah
- University of Oklahoma, Oklahoma City, Oklahoma
| | - Anjan Batra
- University of California, Irvine, Orange, California
| | - Ian Law
- University of Iowa, Iowa City, Iowa
| | | | | | | | | | - Nina Nosavan
- University of California, Irvine, Orange, California
| | | | - Amelia Hart
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Thuan Nguyen
- Oregon Health and Science University, Portland, Oregon
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Bettin M, Dechering D, Frommeyer G, Larbig R, Löher A, Reinke F, Köbe J, Eckardt L. Right versus left parasternal electrode position in the entirely subcutaneous ICD. Clin Res Cardiol 2017; 107:389-394. [PMID: 29285623 DOI: 10.1007/s00392-017-1194-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 12/19/2017] [Indexed: 01/20/2023]
Abstract
OBJECTIVES The subcutaneous implantable cardioverter defibrillator (S-ICD®) has been established as an alternative to conventional transvenous ICD for the prevention of sudden cardiac death. Initial studies have shown safety and efficacy of the system with a left parasternal (LP) electrode. However, several case studies reported a right parasternal (RP) position. The purpose of this study was to analyze shock efficacy and safety of an RP electrode position. METHODS Between June 2010 and May 2016, 120 S-ICD® were implanted at our institution. On the basis of the heart location on preoperative chest radiography (CXR), the investigators decided on an RP (n = 52) or LP electrode position (n = 68). All perioperative induced VF episodes, and spontaneous appropriate and inappropriate episodes during follow-up were analyzed. RESULTS Patients with an RP electrode did not differ in terms of age, sex, or ejection fraction. A statistically significant difference in underlying cardiac disease was observed between the RP and LP electrode group, with more patients with channelopathies in the RP electrode group and more patients with non-ischemic cardiomyopathy in the LP electrode group. During a mean follow-up of 24.3 ± 19.5 months, 27 appropriate (19 in the LP group and 8 in the RP group) and 28 inappropriate (18 LP and 10 RP) ICD shocks occurred (p value = NS). CONCLUSIONS In the present study, an RP electrode position was chosen on the basis of chest radiographic characteristics and was efficient in terms of sensing and shock efficacy. Thus, a right-sided electrode implant might be an alternative if a left-sided electrode implant is inadequate. It might also be favorable for young patients with narrow heart silhouettes in the midsagittal position.
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Affiliation(s)
- Markus Bettin
- Division of Clinical and Experimental Electrophysiology, Department of Cardiology and Angiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany.
| | - Dirk Dechering
- Division of Clinical and Experimental Electrophysiology, Department of Cardiology and Angiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
| | - Gerrit Frommeyer
- Division of Clinical and Experimental Electrophysiology, Department of Cardiology and Angiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
| | - Robert Larbig
- Division of Clinical and Experimental Electrophysiology, Department of Cardiology and Angiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
| | - Andreas Löher
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University Hospital Münster, Münster, Germany
| | - Florian Reinke
- Division of Clinical and Experimental Electrophysiology, Department of Cardiology and Angiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
| | - Julia Köbe
- Division of Clinical and Experimental Electrophysiology, Department of Cardiology and Angiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
| | - Lars Eckardt
- Division of Clinical and Experimental Electrophysiology, Department of Cardiology and Angiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
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