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Esposito F, Nappi F, Urraro F, Vitillo P, Rotondi F. Unconventional diagnosis of bradyarrhythmic syncope in Brugada syndrome: a case report. Eur Heart J Case Rep 2024; 8:ytae201. [PMID: 38711682 PMCID: PMC11071446 DOI: 10.1093/ehjcr/ytae201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 04/03/2024] [Accepted: 04/16/2024] [Indexed: 05/08/2024]
Abstract
Background The Brugada syndrome (BrS) is an inherited disorder associated with the risk of ventricular fibrillation and sudden cardiac death (SCD). The current main therapy is an implantable cardioverter-defibrillator (ICD). However, the risk stratification and management of patients remain challenging. Here, we present a case of BrS representative of the pitfalls that clinicians may encounter in the management of Brugada patients in routine clinical practice. Case summary A 39-year-old man with BrS and recurring syncope was implanted with a subcutaneous ICD (S-ICD) (EMBLEM MRI S-ICD, Boston Scientific). Syncope recurred some months later. Subcutaneous ICD interrogation showed no arrhythmic events, but SMART Pass (high-pass filter) deactivation was noted. A query was sent to Boston Scientific clinical service, unveiling an extremely long asystolic pause as syncope determinant. Subcutaneous ICD was explanted and replaced by conventional single chamber ICD in the pre-pectoral region. Discussion Brugada syndrome patients with high-risk features are candidates for ICD implantation to prevent SCD. Recent evidence highlighted that symptomatic patients carry a substantially higher risk compared with asymptomatic ones. Syncope may represent a pivotal symptom in BrS patients, but young patients with Type 1 Brugada pattern may experience syncope other than from tachyarrhythmias. Subcutaneous ICD is an advisable option in young ICD recipients to avoid lifetime complication related to standard transvenous systems. However, S-ICD lacks pacing capabilities and, therefore, is not indicated when an anti-bradycardia system is needed. The diagnostic workup of syncope in Brugada patients may be ineffective in elucidating the underlying aetiology whose understanding is essential to offer a personalized therapeutic approach.
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Affiliation(s)
- Francesca Esposito
- Department of Cardiology, AORN ‘San Giuseppe Moscati’, Contrada Amoretta, Avellino 83100, Italy
| | - Felice Nappi
- Department of Cardiology, AORN ‘San Giuseppe Moscati’, Contrada Amoretta, Avellino 83100, Italy
| | - Francesco Urraro
- Department of Cardiology, AORN ‘San Giuseppe Moscati’, Contrada Amoretta, Avellino 83100, Italy
| | - Paolo Vitillo
- Department of Cardiology, AORN ‘San Giuseppe Moscati’, Contrada Amoretta, Avellino 83100, Italy
| | - Francesco Rotondi
- Department of Cardiology, AORN ‘San Giuseppe Moscati’, Contrada Amoretta, Avellino 83100, Italy
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2
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Lazzeri M, Ziacchi M, Angeletti A, Carecci A, Bertelli M, Locchi F, Oppimitti J, Biffi M. Unanticipated subcutaneous ICD end-of-service due to premature battery depletion and occurrence of lead fracture: A single centre experience. Int J Cardiol 2024; 400:131687. [PMID: 38151163 DOI: 10.1016/j.ijcard.2023.131687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 12/29/2023]
Abstract
The use of subcutaneous ICDs (S-ICD) is growing over years despite increasing alerts on premature battery depletion (PBD) and lead fractures leading to unanticipated device replacements. In our single-centre study including 192 patients, per year analysis demonstrated that incidence of PBD is higher than previously reported with overall greatest battery replacement requirements around the fifth year of follow-up. The underlying issue appears to be limited to old series devices, but only a longer follow-up will clarify the real impact of this phenomenon on patient outcomes. PBD is an underestimated S-ICDs issue and if the hereby demonstrated trend were to be confirmed in latest device series, this would bring significant concerns to patient safety and huge economic expense to health system.
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Affiliation(s)
- Mirco Lazzeri
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy.
| | - Matteo Ziacchi
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
| | - Andrea Angeletti
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
| | - Alessandro Carecci
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
| | - Michele Bertelli
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
| | - Federica Locchi
- Pharmacy Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
| | - Jennifer Oppimitti
- Pharmacy Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
| | - Mauro Biffi
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
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3
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Sink J, Peigh G, Speakman B, Banno J, Sanders D, Nso N, Waits G, Lohrmann G, Elsayed M, Carneiro H, Baman J, Pfenniger A, Patil KD, Arora R, Kim SS, Chicos AB, Lin AC, Passman RS, Knight BP, Dandamudi S, Kaplan RM, Huang H, Wasserlauf J, Verma N. Correlation between high- and low-voltage impedance measurements following subcutaneous implantable cardioverter-defibrillator implantation. Heart Rhythm 2024; 21:492-494. [PMID: 38159788 DOI: 10.1016/j.hrthm.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/19/2023] [Accepted: 12/23/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Joshua Sink
- Department of Internal Medicine, Northwestern University, Chicago, Illinois
| | - Graham Peigh
- Division of Cardiology, Northwestern University, Chicago, Illinois
| | | | - Joseph Banno
- Division of Cardiology, Corewell Health, Grand Rapids, Michigan
| | - David Sanders
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Nso Nso
- Division of Cardiology, Northshore University Health System, Evanston, Illinois
| | - George Waits
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Graham Lohrmann
- Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Mahmoud Elsayed
- Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Herman Carneiro
- Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Jayson Baman
- Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Anna Pfenniger
- Division of Cardiology, Northwestern University, Chicago, Illinois
| | | | - Rishi Arora
- Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Susan S Kim
- Division of Cardiology, Northwestern University, Chicago, Illinois
| | | | - Albert C Lin
- Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Rod S Passman
- Division of Cardiology, Northwestern University, Chicago, Illinois
| | - Bradley P Knight
- Division of Cardiology, Northwestern University, Chicago, Illinois
| | | | - Rachel M Kaplan
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Henry Huang
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Jeremiah Wasserlauf
- Division of Cardiology, Northshore University Health System, Evanston, Illinois
| | - Nishant Verma
- Division of Cardiology, Northwestern University, Chicago, Illinois.
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4
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Doldi F, Frommeyer G, Löher A, Ellermann C, Wolfes J, Güner F, Zerbst M, Engelke H, Korthals D, Reinke F, Eckardt L, Willy K. Validation of the PRAETORIAN score in a large subcutaneous implantable cardioverter-defibrillator collective: Usefulness in clinical routine. Heart Rhythm 2024:S1547-5271(24)00204-2. [PMID: 38382685 DOI: 10.1016/j.hrthm.2024.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/20/2024] [Accepted: 02/12/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND To assess the risk of unsuccessful conversion of ventricular fibrillation during defibrillation testing (DFT) with the subcutaneous implantable cardioverter-defibrillator (S-ICD), the PRAETORIAN score has been proposed. OBJECTIVE The purpose of this study was to validate the PRAETORIAN score in a large S-ICD collective. METHODS A retrospective single-center analysis of S-ICD patients receiving intraoperative DFT was performed. DFT was performed using a stepwise protocol with 65-J standard polarity, change of polarity, increase to 80 J, and repositioning if necessary. If all DFTs failed, we switched to a transvenous ICD. RESULTS Overall, 398 patients were analyzed (268 male [67.3%]; mean age 42.4 ± 15.9 years; mean body mass index [BMI] 25.9 ± 4.8 kg/m2). Successful DFT with the first ICD shock was observed in 264 patients (66.3%). One hundred fourteen patients were defibrillated with the second (n = 104) or third (n = 10) DFT after changing shock polarity and/or shock energy. Overall, 20 patients needed at least 3 DFT (ie, 80 J and/or re-positioning). The majority (n = 88 [65.7%]) of DFT failures occurred before 2015 with the first-generation S-ICD. PRAETORIAN score was an independent predictor of DFT failure (odds ratio [OR] 1.007; 95% confidence interval [CI] 1.003-1.011 P ≤.001), while whereas BMI alone was not (P = .31). Presence of hypertrophic cardiomyopathy (HCM) (OR 2.6; 95% CI 1.3-4.4; P = .004) was predictive for at least 1 unsuccessful DFT in our multivariate regression analysis. CONCLUSION PRAETORIAN score proved to be a useful and valid predictive tool for successful DFT, whereas BMI only had a limited role. Patients with HCM were at increased risk for DFT failure or needed higher DFT energy.
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Affiliation(s)
- Florian Doldi
- Department for Cardiology II, Electrophysiology, University Hospital Münster, Münster, Germany.
| | - Gerrit Frommeyer
- Department for Cardiology II, Electrophysiology, University Hospital Münster, Münster, Germany
| | - Andreas Löher
- Department for Cardio-Thoracic Surgery, University Hospital Münster, Münster, Germany
| | - Christian Ellermann
- Department for Cardiology II, Electrophysiology, University Hospital Münster, Münster, Germany
| | - Julian Wolfes
- Department for Cardiology II, Electrophysiology, University Hospital Münster, Münster, Germany
| | - Fatih Güner
- Department for Cardiology II, Electrophysiology, University Hospital Münster, Münster, Germany
| | - Mathis Zerbst
- Department for Cardiology II, Electrophysiology, University Hospital Münster, Münster, Germany
| | - Hauke Engelke
- Department for Cardiology II, Electrophysiology, University Hospital Münster, Münster, Germany
| | - Dennis Korthals
- Department for Cardiology II, Electrophysiology, University Hospital Münster, Münster, Germany
| | - Florian Reinke
- Department for Cardiology II, Electrophysiology, University Hospital Münster, Münster, Germany
| | - Lars Eckardt
- Department for Cardiology II, Electrophysiology, University Hospital Münster, Münster, Germany
| | - Kevin Willy
- Department for Cardiology II, Electrophysiology, University Hospital Münster, Münster, Germany
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5
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Kasagawa A, Nakajima I, Nakayama Y, Togashi D, Sasaki K, Matsuda H, Harada T, Akashi YJ. Preoperative Prediction of Shock Impedance for Subcutaneous Implantable Cardioverter Defibrillator Using Chest Computed Tomography. Circ J 2024:CJ-23-0229. [PMID: 38311419 DOI: 10.1253/circj.cj-23-0229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
BACKGROUND High shock impedance is associated with conversion failure among patients with subcutaneous implantable cardioverter defibrillators (S-ICD). Currently, there is no preoperative assessment method for predicting high shock impedance. This study examined the efficacy of chest computed tomography (CT) as a preoperative evaluation tool to assess the shock impedance of S-ICDs.Methods and Results: The amount of adipose tissue adjacent to the device and anteroposterior diameter at the basal heart region were measured preoperatively using chest CT. We examined the correlation between these measurements and shock impedance at the conversion test. We enrolled 43 patients with S-ICDs (mean [±SD] age 54±15 years; body mass index 23±4 kg/m2; PRAETORIAN score 30-270 points; amount of adipose tissue 1,250±716 cm3), who underwent intraoperative conversion tests by inducing ventricular fibrillation, which was terminated with a 65-J shock. A sufficient concordance correlation coefficient was observed between the shock impedance and the amount of adipose tissue (r=0.616, P<0.01) and anteroposterior diameter (r=0.645, P<0.01). In multiple regression analysis, the amount of adipose tissue (β=0.439, P=0.009) and anteroposterior diameter (β=0.344, P=0.038) were identified as independent predictive factors of shock impedance. CONCLUSIONS The preoperative CT-measured amount of adipose tissue and basal heart anteroposterior diameter are independent predictors of shock impedance. These parameters may be more accurate in identifying higher shock impedance in patients with S-ICDs.
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Affiliation(s)
- Akira Kasagawa
- Division of Cardiology, St. Marianna University School of Medicine
| | - Ikutaro Nakajima
- Division of Cardiology, St. Marianna University School of Medicine
| | - Yui Nakayama
- Division of Cardiology, St. Marianna University School of Medicine
| | - Daisuke Togashi
- Division of Cardiology, St. Marianna University School of Medicine
| | - Kenichi Sasaki
- Division of Cardiology, St. Marianna University School of Medicine
| | - Hisao Matsuda
- Division of Cardiology, St. Marianna University School of Medicine, Yokohama City Seibu Hospital
| | - Tomoo Harada
- Division of Cardiology, St. Marianna University School of Medicine
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Schaller RD, Hyman M, Supple GE, Santangeli P, Riley MP, Nazarian S, Arkles J, Garcia F, Lin D, Guandalini G, Kumareswaran R, Deo R, Bode W, Markman T, Epstein A, Callans DJ, Dixit S, Brozoski J, Marchlinski FE, Frankel DS. Defibrillation testing of the subcutaneous implantable cardioverter-defibrillator at the time of generator replacement. Heart Rhythm 2024; 21:117-118. [PMID: 37838309 DOI: 10.1016/j.hrthm.2023.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 10/01/2023] [Accepted: 10/03/2023] [Indexed: 10/16/2023]
Affiliation(s)
- Robert D Schaller
- Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Matthew Hyman
- Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gregory E Supple
- Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Michael P Riley
- Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Saman Nazarian
- Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeffrey Arkles
- Lancaster General Hospital, Section of Cardiac Electrophysiology, University of Pennsylvania Health System, Lancaster, Pennsylvania
| | - Fermin Garcia
- Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Lin
- Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gustavo Guandalini
- Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ramanan Kumareswaran
- Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rajat Deo
- Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Weeranun Bode
- Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Timothy Markman
- Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrew Epstein
- Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David J Callans
- Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sanjay Dixit
- Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Francis E Marchlinski
- Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David S Frankel
- Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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7
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Ezzeddine FM, Killu AM, Deshmukh AJ, Munoz FDC. Inappropriate shocks due to P-wave oversensing in a patient with a subcutaneous implantable cardioverter-defibrillator. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01625-6. [PMID: 37670065 DOI: 10.1007/s10840-023-01625-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 08/14/2023] [Indexed: 09/07/2023]
Affiliation(s)
- Fatima M Ezzeddine
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First S.W., Rochester, MN, 55905, USA.
| | - Ammar M Killu
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First S.W., Rochester, MN, 55905, USA
| | - Abhishek J Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First S.W., Rochester, MN, 55905, USA
| | - Freddy Del-Carpio Munoz
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First S.W., Rochester, MN, 55905, USA
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8
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Francia P, Ziacchi M, Adduci C, Ammendola E, Pieragnoli P, De Filippo P, Rapacciuolo A, Rella V, Migliore F, Viani S, Musumeci MB, Biagini E, Lovecchio M, Baldini R, Falasconi G, Autore C, Biffi M, Cecchi F. Clinical course of hypertrophic cardiomyopathy patients implanted with a transvenous or subcutaneous defibrillator. Europace 2023; 25:euad270. [PMID: 37724686 PMCID: PMC10507661 DOI: 10.1093/europace/euad270] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/09/2023] [Indexed: 09/21/2023] Open
Abstract
AIMS The implantable cardioverter-defibrillator (ICD) is a life-saving therapy in patients with hypertrophic cardiomyopathy (HCM) at risk of sudden cardiac death. Implantable cardioverter-defibrillator complications are of concern. The subcutaneous ICD (S-ICD) does not use transvenous leads and is expected to reduce complications. However, it does not provide bradycardia and anti-tachycardia pacing (ATP). The aim of this study was to compare appropriate and inappropriate ICD interventions, complications, disease-related adverse events and mortality between HCM patients implanted with a S- or transvenous (TV)-ICD. METHODS AND RESULTS Consecutive HCM patients implanted with a S- (n = 216) or TV-ICD (n = 211) were enrolled. Propensity-adjusted cumulative Kaplan-Meier curves and multivariate Cox proportional hazard ratios were used to compare 5-year event-free survival and the risk of events. The S-ICD patients had lower 5-year risk of appropriate (HR: 0.32; 95%CI: 0.15-0.65; P = 0.002) and inappropriate (HR: 0.44; 95%CI: 0.20-0.95; P = 0.038) ICD interventions, driven by a high incidence of ATP therapy in the TV-ICD group. The S- and TV-ICD patients experienced similar 5-year rate of device-related complications, albeit the risk of major lead-related complications was lower in S-ICD patients (HR: 0.17; 95%CI: 0.038-0.79; P = 0.023). The TV- and S-ICD patients displayed similar risk of disease-related complications (HR: 0.64; 95%CI: 0.27-1.52; P = 0.309) and mortality (HR: 0.74; 95%CI: 0.29-1.87; P = 0.521). CONCLUSION Hypertrophic cardiomyopathy patients implanted with a S-ICD had lower 5-year risk of appropriate and inappropriate ICD therapies as well as of major lead-related complications as compared to those implanted with a TV-ICD. Long-term comparative follow-up studies will clarify whether the lower incidence of major lead-related complications will translate into a morbidity or survival benefit.
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Affiliation(s)
- Pietro Francia
- Cardiology, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, University Sapienza, Rome, Italy
| | - Matteo Ziacchi
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - Carmen Adduci
- Cardiology, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, University Sapienza, Rome, Italy
| | - Ernesto Ammendola
- Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, Monaldi Hospital, Naples, Italy
| | - Paolo Pieragnoli
- Careggi University Hospital, University of Florence, Florence, Italy
| | | | - Antonio Rapacciuolo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Valeria Rella
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS, Istituto Auxologico Italiano, San Luca Hospital, Milan, Italy
| | - Federico Migliore
- Department of Cardiac, Thoracic Vascular Sciences and Public Health University of Padova, Padova, Italy
| | - Stefano Viani
- Second Cardiology Division, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Maria Beatrice Musumeci
- Cardiology, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, University Sapienza, Rome, Italy
| | - Elena Biagini
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | | | - Rossella Baldini
- Cardiology, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, University Sapienza, Rome, Italy
| | - Giulio Falasconi
- Campus Clínic, University of Barcelona, Barcelona, Spain
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - Camillo Autore
- Cardiology, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, University Sapienza, Rome, Italy
| | - Mauro Biffi
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - Franco Cecchi
- Careggi University Hospital, University of Florence, Florence, Italy
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS, Istituto Auxologico Italiano, San Luca Hospital, Milan, Italy
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9
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Rubinstein M, Zhu A, Mariani JA, Patel HC. Subcutaneous defibrillator use with unipolar pacemakers: Cautiously possible. Indian Pacing Electrophysiol J 2023; 23:126-129. [PMID: 37196770 PMCID: PMC10323176 DOI: 10.1016/j.ipej.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/05/2023] [Accepted: 05/14/2023] [Indexed: 05/19/2023] Open
Abstract
Implantation of subcutaneous implantable cardioverter-defibrillator in a patient with existing unipolar pacemaker is against manufacturer recommendations. We report the case of a successful subcutaneous implantable cardioverter-defibrillator implantation in a patient with Fontan circulation and concomitant active unipolar pacing and present a summary of recommendations when considering subcutaneous implantable cardioverter-defibrillator implantation with unipolar pacing. Recommendations included: pre-procedure screening, rescreening during implantation and ventricular fibrillation induction, pacemaker programming, and post-procedure investigations.
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Affiliation(s)
| | - Angela Zhu
- Department of Cardiology, Heart Centre, Alfred Health, Melbourne, Australia
| | - Justin A Mariani
- Department of Cardiology, Heart Centre, Alfred Health, Melbourne, Australia; Heart Failure Research Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia
| | - Hitesh C Patel
- Department of Cardiology, Heart Centre, Alfred Health, Melbourne, Australia; Heart Failure Research Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia.
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10
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Heist EK, Knops RE, Yap SC, Boersma LVA, Friedman DJ, Poole JE, Stahl W, Belalcazar A. Reduction in defibrillation threshold by modifications to the subcutaneous implantable-cardioverter defibrillator coil. Heart Rhythm 2023; 20:783-785. [PMID: 36773794 DOI: 10.1016/j.hrthm.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/20/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023]
Affiliation(s)
- E Kevin Heist
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, Massachusetts.
| | - Reinoud E Knops
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Sing-Chien Yap
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Daniel J Friedman
- Department of Cardiology, Electrophysiology Section, Duke University Hospital, Durham, North Carolina
| | - Jeanne E Poole
- Department of Cardiology, University of Washington, Seattle, Washington
| | - Wyatt Stahl
- Boston Scientific, St. Paul, Minneapolis, Minnesota
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11
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Russo V, Ciabatti M, Brunacci M, Dendramis G, Santobuono V, Tola G, Picciolo G, Teresa LM, D'Andrea A, Nesti M. Opportunities and drawbacks of the subcutaneous defibrillator across different clinical settings. Expert Rev Cardiovasc Ther 2023; 21:151-164. [PMID: 36847583 DOI: 10.1080/14779072.2023.2184350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
INTRODUCTION The subcutaneous implantable cardioverter-defibrillator (S-ICD) is an established therapy for the prevention of sudden cardiac death (SCD) and an alternative to a transvenous implantable cardioverter-defibrillator system in selected patients. Beyond randomized clinical trials, many observational studies have described the clinical performance of S-ICD across different subgroups of patients. AREAS COVERED Our review aimed to describe the opportunities and drawbacks of the S-ICD, focusing on their use in special populations and across different clinical settings. EXPERT OPINION The choice to implant S-ICD should be based on the patient's tailored approach, which takes into account the adequate S-ICD screening at rest or during stress, the infective risk, the ventricular arrhythmia susceptibility, the progressive nature of the underlying disease, the work or sports activity, and the risk of lead-related complications.
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Affiliation(s)
- Vincenzo Russo
- Cardiology Unit, University of Campania 'Luigi Vanvitelli' - Monaldi Hospital, Naples, Italy
| | | | | | | | | | | | | | | | | | - Martina Nesti
- Cardiology Unit, San Donato Hospital, Arezzo (FI), Italy
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12
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Tjong FVY, Breeman KTN, Boersma LVA, Yap SC, van Erven L, van der Stoel MD, van Dijk VF, Maass AH, Knops RE; NL-EVDR Working Group and NHR Device Registration Committee. NL-EVDR: Netherlands-ExtraVascular Device Registry. Neth Heart J 2023. [PMID: 36862338 DOI: 10.1007/s12471-023-01768-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 03/03/2023] Open
Abstract
Cardiac implantable electronic device (CIED) therapy is an essential element in treating cardiac arrhythmias. Despite their benefits, conventional transvenous CIEDs are associated with a significant risk of mainly pocket- and lead-related complications. To overcome these complications, extravascular devices (EVDs), such as the subcutaneous implantable cardioverter-defibrillator and intracardiac leadless pacemaker, have been developed. In the near future, several other innovative EVDs will become available. However, it is difficult to evaluate EVDs in large studies because of high costs, lack of long-term follow-up, imprecise data or selected patient populations. To improve evaluation of these technologies, real-world, large-scale, long-term data are of utmost importance. A Dutch registry-based study seems to be a unique possibility for this goal due to early involvement of Dutch hospitals in novel CIEDs and an existing quality control infrastructure, the Netherlands Heart Registration (NHR). Therefore, we will soon start the Netherlands-ExtraVascular Device Registry (NL-EVDR), a Dutch nationwide registry with long-term follow-up of EVDs. The NL-EVDR will be incorporated in NHR's device registry. Additional EVD-specific variables will be collected both retrospectively and prospectively. Hence, combining Dutch EVD data will provide highly relevant information on safety and efficacy. As a first step, a pilot project has started in selected centres in October 2022 to optimise data collection.
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Tanawuttiwat T, Das MK, Miller JM, Guglin ME. Device-device interaction between cardiac implantable electronic devices and continuous-flow left ventricular assist devices. Heart Rhythm 2023; 20:918-926. [PMID: 36863637 DOI: 10.1016/j.hrthm.2023.02.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/11/2023] [Accepted: 02/17/2023] [Indexed: 03/04/2023]
Abstract
The current design of an innovative left ventricular assist device (LVAD) makes use of magnetic levitation technology, which enables the rotors of the device to be completely suspended by magnetic force, reducing friction and blood or plasma damage. However, this electromagnetic field can result in electromagnetic interference (EMI), which can interfere with proper functioning of another cardiac implantable electronic device (CIED) in its direct proximity. Approximately 80% of patients with an LVAD have a CIED, most frequently an implantable cardioverter-defibrillator (ICD). Several device-device interactions have been reported, including EMI-induced inappropriate shocks, inability to establish telemetry connection, EMI-induced premature battery depletion, undersensing by the device, and other CIED malfunctions. Unfortunately, additional procedures, including generator exchange, lead adjustment, and system extraction, are frequently required because of these interactions. In some circumstances, the additional procedure might be preventable or avoidable with appropriate solutions. In this article, we describe how EMI from the LVAD impacts the functionality of the CIED and provide possible management options, including manufacturer-specific information, for the current CIEDs (eg, transvenous and leadless pacemakers, transvenous and subcutaneous ICDs, and transvenous cardiac resynchronization therapy pacemakers and ICDs).
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Affiliation(s)
| | - Mithilesh K Das
- Division of Cardiovascular Medicine, Indiana University, Indianapolis, Indiana
| | - John M Miller
- Division of Cardiovascular Medicine, Indiana University, Indianapolis, Indiana
| | - Maya E Guglin
- Division of Cardiovascular Medicine, Indiana University, Indianapolis, Indiana
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14
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Dendramis G, Brugada P. Lights and shadows of subcutaneous implantable cardioverter-defibrillator in Brugada syndrome. Heart Rhythm 2023; 20:274-81. [PMID: 36162769 DOI: 10.1016/j.hrthm.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/18/2022] [Accepted: 09/20/2022] [Indexed: 02/04/2023]
Abstract
Currently the cornerstone of therapy for ventricular arrhythmic complications and sudden cardiac death prevention in Brugada syndrome (BrS) is an implantable cardioverter-defibrillator (ICD). BrS patient population differs from the majority of patients with an ICD implanted for structural heart disease, and as widely known, transvenous ICD (TV-ICD) systems have been associated with high complication rates in patients with BrS. Technological evolution of these devices has certainly reduced complications due to the device itself, but a careful preimplant screening of these patients is still essential. To date, criteria for an adequate screening process to select suitable candidates for a subcutaneous implantable cardioverter-defibrillator (S-ICD) from patients with BrS are sometimes nonstandardized and often lack important precautions that are instead fundamental to select the most suitable type of ICD for these patients. To better select suitable candidates for an S-ICD from patients with BrS, a full screening process should include screening during or immediately after an exercise test and after a drug provocation challenge test. We report an analysis of the "lights and shadows" of S-ICD for a correct use of this device in patients with BrS.
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Romero J, Rodriguez-Taveras J, Diaz JC, Lorente-Ros M, Braunstein ED, Alviz I, Parides M, Haroun MW, Papa L, Dave K, Rodriguez D, Krishnan S, Toquica C, Velasco A, Gabr M, Natale A, Di Biase L. Tumescent local anesthesia versus general anesthesia for subcutaneous implantable cardioverter-defibrillator implantation: A cost-effectiveness analysis. Heart Rhythm 2022; 20:522-529. [PMID: 36563830 DOI: 10.1016/j.hrthm.2022.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 12/05/2022] [Accepted: 12/09/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND General anesthesia (GA) is the standard anesthetic approach for subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation. Nonetheless, GA is expensive and can be associated with adverse events. Tumescent local anesthesia (TLA) has been shown to reduce in-room and procedural times and to decrease post-procedural pain, all of which could result in a reduction in procedure-related costs. OBJECTIVE The purpose of this study is to compare the cost-effectiveness of GA and TLA in patients undergoing S-ICD implantation. METHODS The present study is a prospective, nonrandomized, controlled study of patients who underwent S-ICD implantation between 2019 and 2022. Patients were allocated to either the TLA or the GA group. We performed a cost analysis for each intervention. As an effectiveness measure, the 0-10 point Numeric Pain Rating Scale at 1, 12, and 24 hours post-implantation was analyzed and compared between the groups. A score of 0 was considered no pain; 1-5, mild pain; 6-7, moderate pain; and 8-10, severe pain. Cost-effectiveness was calculated using incremental cost-effectiveness ratios. RESULTS Seventy patients underwent successful S-ICD implantation. The total cost of the electrophysiology laboratory was higher in the GA group than in the TLA group (median ± interquartile range US$55,824 ± US$29,411 vs US$37,222 ± US$24,293; P < .001), with a net saving of $20,821 when compared with GA for each S-ICD implantation. There was a significant decrease in post-procedural pain scores in the TLA group when compared with the GA group (repeated measures analysis of variance, P = .009; median ± interquartile range 0 ± 3 vs 0 ± 5 at 1 hour, P = .058; 3 ± 4 vs 6 ± 8 at 12 hours, P = .030; 0 ± 4 vs 2 ± 6 at 24 hours, P = .040). CONCLUSION TLA is a more cost-effective alternative to GA for S-ICD implantation, with both direct and indirect cost reductions. Importantly, these reduced costs are associated with reduced postprocedural pain.
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Affiliation(s)
- Jorge Romero
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, New York
| | - Joan Rodriguez-Taveras
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, New York
| | - Juan Carlos Diaz
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, New York
| | - Marta Lorente-Ros
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, New York
| | - Eric D Braunstein
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, New York
| | - Isabella Alviz
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, New York
| | - Michael Parides
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, New York
| | - Magued W Haroun
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, New York
| | - Lauren Papa
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, New York
| | - Kartikeya Dave
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, New York
| | - Daniel Rodriguez
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, New York
| | - Suraj Krishnan
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, New York
| | - Christian Toquica
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, New York
| | - Alejandro Velasco
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, New York
| | - Mohamed Gabr
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, New York
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas
| | - Luigi Di Biase
- Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, New York.
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Gasperetti A, Schiavone M, Vogler J, Laredo M, Fastenrath F, Palmisano P, Ziacchi M, Angeletti A, Mitacchione G, Kaiser L, Compagnucci P, Breitenstein A, Arosio R, Vitali F, De Bonis S, Picarelli F, Casella M, Santini L, Pignalberi C, Lavalle C, Pisanò E, Ricciardi D, Calò L, Curnis A, Bertini M, Gulletta S, Dello Russo A, Badenco N, Tondo C, Kuschyk J, Tilz R, Forleo GB, Biffi M. The need for a subsequent transvenous system in patients implanted with subcutaneous implantable cardioverter-defibrillator. Heart Rhythm 2022; 19:1958-1964. [PMID: 35781042 DOI: 10.1016/j.hrthm.2022.06.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The absence of pacing capabilities may reduce the appeal of subcutaneous implantable cardioverter-defibrillator (S-ICD) devices for patients at risk for conduction disorders or with antitachycardia pacing (ATP)/cardiac resynchronization (CRT) requirements. Reports of rates of S-ICD to transvenous implantable cardioverter-defibrillator (TV-ICD) system switch in real-world scenarios are limited. OBJECTIVE The purpose of this study was to investigate the need for a subsequent transvenous (TV) device in patients implanted with an S-ICD and its predictors. METHODS All patients implanted with an S-ICD were enrolled from the multicenter, real-world iSUSI (International SUbcutaneouS Implantable cardioverter defibrillator) Registry. The need for a TV device and its clinical reason, and appropriate and inappropriate device therapies were assessed. Logistic regression with Firth penalization was used to assess the association between baseline and procedural characteristics and the overall need for a subsequent TV device. RESULTS A total of 1509 patients were enrolled (age 50.8 ± 15.8 years; 76.9% male; 32.0% ischemic; left ventricular ejection fraction 38% [30%-60%]). Over 26.5 [13.4-42.9] months, 155 (10.3%) and 144 (9.3%) patients experienced appropriate and inappropriate device therapies, respectively. Forty-one patients (2.7%) required a TV device (13 bradycardia; 10 need for CRT; 10 inappropriate shocks). Body mass index (BMI) >30 kg/m2 and chronic kidney disease (CKD) were associated with need for a TV device (odds ratio [OR] 2.57 [1.37-4.81], P = .003; and OR 2.67 [1.29-5.54], P = .008, respectively). CONCLUSION A low rate (2.7%) of conversion from S-ICD to a TV device was observed at follow-up, with need for antibradycardia pacing, ATP, or CRT being the main reasons. BMI >30 kg/m2 and CKD predicted all-cause need for a TV device.
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Affiliation(s)
- Alessio Gasperetti
- Cardiology Unit, Luigi Sacco University Hospital, Milan, Italy; Università degli Studi di Milano, Milan, Italy; Johns Hopkins University, Baltimore, Maryland; Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy.
| | | | - Julia Vogler
- Department of Rhythmology, Herzzentrum Lubeck, Lubeck, Germany
| | | | - Fabian Fastenrath
- Cardiology Unit, University Medical Centre Mannheim, Manheim, Germany
| | | | - Matteo Ziacchi
- Cardiology Unit, IRCCS, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Andrea Angeletti
- Cardiology Unit, IRCCS, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Gianfranco Mitacchione
- Cardiology Unit, Luigi Sacco University Hospital, Milan, Italy; Cardiology Unit, Spedali Civili Brescia, Brescia, Italy
| | | | - Paolo Compagnucci
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy; Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti, Ancona, Italy
| | | | | | - Francesco Vitali
- Cardiological Center, S. Anna University Hospital, Ferrara, Italy
| | - Silvana De Bonis
- Department of Cardiology, Castrovillari Hospital, Cosenza, Italy
| | | | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti, Ancona, Italy
| | - Luca Santini
- Cardiology Unit, Ospedale G.B. Grassi, Ostia, Italy
| | | | | | - Ennio Pisanò
- Cardiac Electrophysiology Unit, Vito Fazzi Hospital, Lecce, Italy
| | | | | | | | - Matteo Bertini
- Cardiological Center, S. Anna University Hospital, Ferrara, Italy
| | - Simone Gulletta
- Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Antonio Dello Russo
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy; Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti, Ancona, Italy
| | | | - Claudio Tondo
- Heart Rhythm Center, Monzino Cardiology Center, IRCCS, Milan, Italy
| | - Jürgen Kuschyk
- Cardiology Unit, University Medical Centre Mannheim, Manheim, Germany
| | - Roland Tilz
- Department of Rhythmology, Herzzentrum Lubeck, Lubeck, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | | | - Mauro Biffi
- Cardiology Unit, IRCCS, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
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Sugawara M, Takatsugu K, Kondo Y, Watanabe M, Matsumiya G, Kobayashi Y. Subcutaneous implantable cardioverter-defibrillator implantation in a patient with an axillary bifemoral bypass and past sternectomy. HeartRhythm Case Rep 2022; 9:80-83. [PMID: 36860744 PMCID: PMC9968905 DOI: 10.1016/j.hrcr.2022.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Masafumi Sugawara
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan,Address reprint requests and correspondence: Dr Masafumi Sugawara, Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Kajiyama Takatsugu
- Department of Advanced Cardiorhythm Therapeutics, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yusuke Kondo
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Michiko Watanabe
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Goro Matsumiya
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
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18
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Yang Y, Birgersdotter-Green U. The subcutaneous implantable cardioverter-defibrillator should be reserved for niche indications. Heart Rhythm O2 2022; 3:597-601. [PMID: 36340490 PMCID: PMC9626898 DOI: 10.1016/j.hroo.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Ulrika Birgersdotter-Green
- Address reprint requests and correspondence: Dr Ulrika Birgersdotter-Green, 9452 Medical Center Dr, MC 7411, La Jolla, CA 92037.
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Perel N, Tovia-Brodie O, Rav Acha M, Accinelli S, Levy EE, Glikson M, Michowitz Y. Lack of magnet use during chest compressions leads to multiple inappropriate shocks by a subcutaneous implantable cardioverter-defibrillator. HeartRhythm Case Rep 2022; 8:815-819. [PMID: 36620368 PMCID: PMC9811013 DOI: 10.1016/j.hrcr.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Nimrod Perel
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, Jerusalem, Israel
| | - Oholi Tovia-Brodie
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, Jerusalem, Israel
| | - Moshe Rav Acha
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, Jerusalem, Israel
| | | | | | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, Jerusalem, Israel
| | - Yoav Michowitz
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, Jerusalem, Israel,Address reprint requests and correspondence: Dr Yoav Michowitz, Department of Cardiology, Shaare Zedek Hospital, 12 Shmuel Beit St, Jerusalem 9103102, Israel.
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20
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Yamazaki K, Ishida Y, Sasaki S, Toyama Y, Nishizaki K, Kinjo T, Itoh T, Kimura M, Sakai S, Shikanai S, Sorimachi Y, Hamaura S, Tomita H. Characterization of the PRAETORIAN score in Japanese patients undergoing subcutaneous implantable cardioverter-defibrillator implantation. J Cardiol 2022; 80:482-486. [PMID: 35902323 DOI: 10.1016/j.jjcc.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/15/2022] [Accepted: 06/23/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND The PRAETORIAN score was developed to evaluate the implant position and predict defibrillation success in patients implanted with a subcutaneous implantable cardioverter-defibrillator (S-ICD). However, usefulness of the PRAETORIAN score for Japanese patients is unknown. METHODS We evaluated usefulness of this score, which was determined by width of sub-coil fat, sub-generator fat, and anterior positioning of the S-ICD generator by post-operative chest X-ray, in consecutive 100 Japanese S-ICD implanted patients [78 men, median age 59 (IQR 46.5-67.0) years, median body mass index (BMI) 24.2 (21.3-27.2) kg/m2]. RESULTS The median PRAETORIAN score was 30 (30-45) and 93 patients were classified as a low risk of conversion failure. The remaining seven were at an intermediate risk. Almost all patients were classified as an optimal pulse-generator position in the second and third steps of the PRAETORIAN score. The only difference observed was in the width of sub-coil fat in the first step. To further evaluate its significance, patients were divided into the Thicker group (sub-coil fat >1 coil width, n = 19) and the Thinner group (sub-coil fat ≤1 coil width, n = 81). BMI and post-shock impedance were both higher in the Thicker group than in the Thinner group [27.1 (25.6-31.6) versus 23.1 (20.9-25.7) kg/m2, p < 0.001, and 75 (68-88) versus 63 (55-74) Ω, p = 0.003, respectively]. During the median follow-up periods of 888 (523-1418) days, 7 patients experienced appropriate shock therapy for spontaneous ventricular tachyarrhythmias, who were all at a low risk. No conversion failure was observed. Inappropriate shock (IAS) occurred in 11 patients, and there was no difference in IAS rate between the Thicker group (n = 2) and the Thinner group (n = 9) (p = 0.747 by log-rank test). CONCLUSIONS Most Japanese patients were classified as at low risk of conversion failure. The PRAETORIAN score may be useful for the evaluation of conversion failure in Japanese S-ICD implanted patients.
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Affiliation(s)
- Ken Yamazaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuji Ishida
- Department of Cardiac Remote Management System, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shingo Sasaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
| | - Yuichi Toyama
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kimitaka Nishizaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takahiko Kinjo
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Taihei Itoh
- Department of Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Masaomi Kimura
- Department of Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shuntaro Sakai
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shun Shikanai
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuya Sorimachi
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shogo Hamaura
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hirofumi Tomita
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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21
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Conte G, Cattaneo F, de Asmundis C, Berne P, Vicentini A, Namdar M, Scalone A, Klersy C, Caputo ML, Demarchi A, Özkartal T, Salghetti F, Casu G, Passarelli I, Mameli S, Shah D, Burri H, De Ferrari G, Brugada P, Auricchio A. Impact of SMART Pass filter in patients with ajmaline-induced Brugada syndrome and subcutaneous implantable cardioverter-defibrillator eligibility failure: results from a prospective multicentre study. Europace 2022; 24:845-854. [PMID: 34499723 PMCID: PMC9071063 DOI: 10.1093/europace/euab230] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 08/11/2021] [Indexed: 12/03/2022] Open
Abstract
AIMS Ajmaline challenge can unmask subcutaneous implantable cardioverter-defibrillator (S-ICD) screening failure in patients with Brugada syndrome (BrS) and non-diagnostic baseline electrocardiogram (ECG). The efficacy of the SMART Pass (SP) filter, a high-pass filter designed to reduce cardiac oversensing (while maintaining an appropriate sensing margin), has not yet been assessed in patients with BrS. The aim of this prospective multicentre study was to investigate the effect of the SP filter on dynamic Brugada ECG changes evoked by ajmaline and to assess its value in reducing S-ICD screening failure in patients with drug-induced Brugada ECGs. METHODS AND RESULTS The S-ICD screening with conventional automated screening tool (AST) was performed during ajmaline challenge in subjects with suspected BrS. The S-ICD recordings were obtained before, during and after ajmaline administration and evaluated by the means of a simulation model that emulates the AST behaviour with and without SP filter. A patient was considered suitable for S-ICD if at least one sensing vector was acceptable in all tested postures. A sensing vector was considered acceptable in the presence of QRS amplitude >0.5 mV, QRS/T-wave ratio >3.5, and sense vector score >100. Of the 126 subjects (mean age: 42 ± 14 years, males: 61%, sensing vectors: 6786), 46 (36%) presented with an ajmaline-induced Brugada type 1 ECG. Up to 30% of subjects and 40% of vectors failed the screening during the appearance of Brugada type 1 ECG evoked by ajmaline. The S-ICD screening failure rate was not significantly reduced in patients with Brugada ECGs when SP filter was enabled (30% vs. 24%). Similarly, there was only a trend in reduction of vector-failure rate attributable to the SP filter (from 40% to 36%). The most frequent reason for screening failure was low QRS amplitude or low QRS/T-wave ratio. None of these patients was implanted with an S-ICD. CONCLUSION Patients who pass the sensing screening during ajmaline can be considered good candidates for S-ICD implantation, while those who fail might be susceptible to sensing issues. Although there was a trend towards reduction of vector sensing failure rate when SP filter was enabled, the reduction in S-ICD screening failure in patients with Brugada ECGs did not reach statistical significance. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov Unique Identifier NCT04504591.
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Affiliation(s)
- Giulio Conte
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
- Centre for Computational Medicine in Cardiology, Faculty of Informatics, Università della Svizzera Italiana, Lugano, Switzerland
- Faculty of Biomedical Sciences, USI, Lugano, Switzerland
| | - Fabio Cattaneo
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel—Postgraduate program Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
| | - Paola Berne
- Cardiology Department, Ospedale San Francesco, Nuoro, Italy
| | - Alessandro Vicentini
- Elettrofisiologia ed Elettrostimolazione, Divisione di Cardiologia, IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Mehdi Namdar
- Cardiology Department, University Hospital of Geneva, Switzerland
| | | | - Catherine Klersy
- Service of Biometry and Clinical Epidemiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Andrea Demarchi
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Tardu Özkartal
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Francesca Salghetti
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel—Postgraduate program Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
| | - Gavino Casu
- Cardiology Department, Ospedale San Francesco, Nuoro, Italy
| | - Ilaria Passarelli
- Elettrofisiologia ed Elettrostimolazione, Divisione di Cardiologia, IRCCS Policlinico S. Matteo, Pavia, Italy
| | | | - Dipen Shah
- Cardiology Department, University Hospital of Geneva, Switzerland
| | - Haran Burri
- Cardiology Department, University Hospital of Geneva, Switzerland
| | - Gaetano De Ferrari
- Elettrofisiologia ed Elettrostimolazione, Divisione di Cardiologia, IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Pedro Brugada
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel—Postgraduate program Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
| | - Angelo Auricchio
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
- Centre for Computational Medicine in Cardiology, Faculty of Informatics, Università della Svizzera Italiana, Lugano, Switzerland
- Faculty of Biomedical Sciences, USI, Lugano, Switzerland
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22
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Ishida Y, Itoh T, Sasaki S, Washima S, Toyama Y, Tomita H. Substernal and subcutaneous electrocardiograms during subcutaneous implantable cardioverter-defibrillator implantation. J Interv Card Electrophysiol 2022; 64:235-236. [PMID: 35149966 DOI: 10.1007/s10840-022-01155-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/07/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Yuji Ishida
- Department of Cardiac Remote Management System, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Taihei Itoh
- Department of Advanced Management of Cardiac Arrhytmia, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
| | - Shingo Sasaki
- Department of Cardiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Shota Washima
- Department of Cardiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Yuichi Toyama
- Department of Cardiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Hirofumi Tomita
- Department of Cardiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
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23
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Elders J, AlHashimi H, Gomes M, Panhuizen I, van Kuijk S, Vernooy K. Subcutaneous ICD implantation under ultrasound-guided serratus anterior plane block: Single-center experience in the Netherlands. Int J Cardiol Heart Vasc 2022; 38:100949. [PMID: 35028411 PMCID: PMC8739453 DOI: 10.1016/j.ijcha.2021.100949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/19/2021] [Accepted: 12/28/2021] [Indexed: 11/28/2022]
Abstract
Introduction To avoid general anesthesia (GA) and improve postoperative pain management for subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation there is a growing interest for alternative methods. We describe the first experience in the Netherlands of S-ICD implantation under Ultrasound-guided Serratus Anterior Plane Block (US-SAPB). Methods US-SAPB was performed 1 hour before S-ICD implantation. The two-incision technique was used and a pocket beneath the latissimus dorsi muscle was surgically created. Lidocaine was used to provide anesthesia of the skin. Sedation during defibrillation testing (DFT) was induced by intravenous Propofol. Periprocedural pain experience was monitored using the Numerical Rating Scale for Pain (NRS-Pain). The results were compared with a control group of patients undergoing S-ICD implantation under GA. Results Forty consecutive patients (29 Male/11 Female, median age 59 years (range 34–84 years), median body mass index 26 (range 17–41) underwent S-ICD implantation; Twenty patients under US-SAPB and twenty under GA. Median procedure time was 42 min. (range 28–60 min.) with no differences between both groups. In both groups implantations went successful and defibrillation was accomplished using 65 J. US-SAPB was successful in 19 of the 20 patients and GA was successful in all cases. Median NRS-Pain in the US-SAPB group was 2 (range 2–6) and in the GA group 4 (range 2–6). In the US-SAPB group 5 patients required additional opioids postoperatively compared to 10 patients in the GA group. Conclusions S-ICD implantation under US-SAPB is feasible, safe and reduces the need for postoperative opioids significantly. S-ICD implantation under US-SAPB seems a good alternative for GA.
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Affiliation(s)
- Jan Elders
- Department of Cardiology. Canisius Wilhelminahospital, Nijmegen, The Netherlands
| | - Hisham AlHashimi
- Department of Cardiology. Canisius Wilhelminahospital, Nijmegen, The Netherlands
| | - Marc Gomes
- Department of Cardiology. Canisius Wilhelminahospital, Nijmegen, The Netherlands
| | - Ivo Panhuizen
- Department of Anesthesiology, Canisius Wilhelminahospital, Nijmegen, The Netherlands
| | - Sander van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
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24
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Wiles BM, Roberts PR, Allavatam V, Acharyya A, Vemishetty N, ElRefai M, Wilson DG, Maharatna K, Chen H, Morgan JM. Personalized subcutaneous implantable cardioverter-defibrillator sensing vectors generated by mathematical rotation increase device eligibility whilst preserving device performance. Europace 2022; 24:1267-1275. [PMID: 35022725 DOI: 10.1093/europace/euab310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/30/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS Approximately 5.7% of potential subcutaneous implantable cardioverter-defibrillator (S-ICD) recipients are ineligible by virtue of their vector morphology, with higher rates of ineligibility observed in some at-risk groups. Mathematical vector rotation is a novel technique that can generate a personalized sensing vector, one with maximal R:T ratio, using electrocardiogram (ECG) signal recorded from the present S-ICD location. METHODS AND RESULTS A cohort of S-ICD ineligible patients were identified through ECG screening of ICD patients with no ventricular pacing requirement and their personalized vectors were generated using ECG signal from a Holter monitor. Subcutaneous ICD eligibility in this cohort was then recalculated. In a separate cohort, episodes of arrhythmia were recorded in patients undergoing arrhythmia induction, and arrhythmia detection in standard S-ICD vectors was compared to rotated vectors using an S-ICD simulator. Ninety-two participants (mean age 64.9 ± 2.7 years) underwent screening and 5.4% were found to be S-ICD ineligible. Personalized vector generation increased the R:T ratio in these vectors from 2.21 to 7.21 (4.54-9.88, P < 0.001) increasing the cohort eligibility from 94.6% to 100%. Rotated S-ICD vectors also showed high ventricular fibrillation (VF) detection sensitivity (97.8%), low time to VF detection (6.1 s), and excellent tachycardia discrimination (sensitivity 96%, specificity 88%), with no significant differences between rotated and standard vectors. CONCLUSION In S-ICD ineligible patients, mathematical vector rotation can generate a personalized vector that is associated with a significant increase in R:T ratio, resulting in universal device eligibility in our cohort. Ventricular fibrillation detection efficacy, time to VF detection, and tachycardia discrimination were not affected by vector rotation.
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Affiliation(s)
- Benedict M Wiles
- Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK.,Faculty of Medicine, University of Southampton, Southampton, UK
| | - Paul R Roberts
- Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK.,Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Amit Acharyya
- Department of Electrical Engineering, Indian Institute of Technology, Hyderabad, India
| | - Naresh Vemishetty
- Department of Electrical Engineering, Indian Institute of Technology, Hyderabad, India
| | - Mohamed ElRefai
- Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK.,Faculty of Medicine, University of Southampton, Southampton, UK
| | - David G Wilson
- Cardiology Department, Worcestershire Acute Hospitals NHS Foundation Trust, Worcester, UK
| | - Koushik Maharatna
- School of Electronics and Computer Science, University of Southampton, Southampton, UK
| | - Hanjie Chen
- School of Electronics and Computer Science, University of Southampton, Southampton, UK
| | | | - John M Morgan
- Faculty of Medicine, University of Southampton, Southampton, UK.,Cardiac Rhythm Management, Boston Scientific, Marlborough, MA, USA
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25
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Tonko JB, Rinaldi CA. Non-traditional implantable cardioverter-defibrillator configurations and insertion techniques: a review of contemporary options. Europace 2021; 24:181-192. [PMID: 34453529 PMCID: PMC8824518 DOI: 10.1093/europace/euab178] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/01/2021] [Indexed: 11/14/2022] Open
Abstract
Implantable cardioverter-defibrillators (ICDs) have revolutionized the treatment of acquired or inherited cardiac diseases associated with a high risk of sudden cardiac death due to ventricular tachyarrhythmias. Contemporary ICD devices offer reliable arrhythmia detection and discrimination algorithms and deliver highly efficient tachytherapies. Percutaneously inserted transvenous defibrillator coils with pectoral generator placement are the first-line approach in the majority of adults due to their extensively documented clinical benefit and efficiency with comparably low periprocedural implantation risks as well as the option of providing pain-free tachycardia treatment via anti-tachycardia pacing (ATP), concomitant bradycardiaprotection, and incorporation in a cardiac resynchronization therapy if indicated. Yet, expanding ICD indications particularly among younger and more complex patient groups as well as the increasingly evident long-term consequences and complications associated with intravascular lead placements promoted the development of alternative ICD configurations. Most established in daily clinical practice is the subcutaneous ICD but other innovative extravascular approaches like epicardial, pericardial, extra-pleural, and most recently substernal defibrillator coil placements have been introduced as well to overcome shortcomings associated with traditional devices and allow for individualized treatment strategies tailored to the patients characteristics and needs. The review aims to provide practical solutions for common complications encountered with transvenous ICD systems including restricted venous access, high defibrillation/fibrillation thresholds (DFTs), and recurrent device infections. We summarize the contemporary options for non-traditional extravascular ICD configurations outlining indications, advantages, and disadvantages.
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Affiliation(s)
- Johanna B Tonko
- Department of Cardiology, St. Thomas' Hospital, Westminster Bridge Rd, London SE1 7EH, UK.,Department of Cardiovascular Imaging, Arrhythmia Research Group, King's College London, School of Biomedical Engineering & Imaging Sciences, London, UK
| | - Christopher A Rinaldi
- Department of Cardiology, St. Thomas' Hospital, Westminster Bridge Rd, London SE1 7EH, UK.,Department of Cardiovascular Imaging, Arrhythmia Research Group, King's College London, School of Biomedical Engineering & Imaging Sciences, London, UK
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26
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Markman TM, Smietana J, Epstein AE. A novel cause of inappropriate subcutaneous implantable cardioverter-defibrillator therapies after a generator change. HeartRhythm Case Rep 2021; 7:562-5. [PMID: 34434709 DOI: 10.1016/j.hrcr.2021.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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27
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van der Stuijt W, Quast AFBE, Baalman SWE, de Wilde KC, Brouwer TF, Wilde AAM, Knops RE. Complications related to elective generator replacement of the subcutaneous implantable defibrillator. Europace 2021; 23:395-399. [PMID: 33197266 PMCID: PMC7947576 DOI: 10.1093/europace/euaa263] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 08/07/2020] [Indexed: 11/27/2022] Open
Abstract
Aims To guarantee uninterrupted function of the subcutaneous implantable cardioverter-defibrillator (S-ICD), the pulse generator needs to be surgically replaced before the battery is depleted. The risks related to this replacement substantially impact long-term outcome for S-ICD recipients, as the majority will undergo one or several of these procedures in their lifetime. We aim to describe the procedural characteristics of the replacement procedure and to provide an insight in the complications associated with these replacements. Methods and results In this retrospective analysis, data from replacement procedures and follow-up visits were collected from all patients who underwent elective S-ICD generator replacement in our tertiary centre from June 2014 until November 2019. Original device position was assessed using the PRAETORIAN score. Complications were defined as those requiring surgical intervention, systemic antibiotic treatment, or device extraction. Seventy-two patients were included, with a median follow-up of 1.9 years (IQR 0.6–3.3 years) after replacement. Battery depletion occurred after 5.9 ± 0.7 years. The pulse generator was repositioned in patients with a PRAETORIAN score ≥90 to minimize the defibrillation threshold. Although there was an increase in impedance compared to the implant procedure, first shock conversion rate during defibrillation testing was 91.4% with a success rate of 100% after multiple attempts. Two patients developed a complication after, respectively, 9 and 21 months, resulting in a complication rate of 1.4% per year. Conclusion With a median follow-up of 1.9 years, this study shows a low complication rate after S-ICD replacement, with a first shock conversion rate of 91.4%.
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Affiliation(s)
- Willeke van der Stuijt
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, AMC, PO Box 22700, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Anne-Floor B E Quast
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, AMC, PO Box 22700, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Sarah W E Baalman
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, AMC, PO Box 22700, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Koen C de Wilde
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, AMC, PO Box 22700, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Tom F Brouwer
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, AMC, PO Box 22700, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Arthur A M Wilde
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, AMC, PO Box 22700, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Reinoud E Knops
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, AMC, PO Box 22700, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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28
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Gasperetti A, Schiavone M, Ziacchi M, Vogler J, Breitenstein A, Laredo M, Palmisano P, Ricciardi D, Mitacchione G, Compagnucci P, Bisignani A, Angeletti A, Casella M, Picarelli F, Fink T, Kaiser L, Hakmi S, Calò L, Pignalberi C, Santini L, Lavalle C, Pisanò E, Olivotto I, Tondo C, Curnis A, Dello Russo A, Badenco N, Steffel J, Love CJ, Tilz R, Forleo G, Biffi M. Long-term complications in patients implanted with subcutaneous implantable cardioverter-defibrillators: Real-world data from the extended ELISIR experience. Heart Rhythm 2021:S1547-5271(21)01866-X. [PMID: 34271173 DOI: 10.1016/j.hrthm.2021.07.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/21/2021] [Accepted: 07/07/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Recently, the Food and Drug Administration issued a recall for the subcutaneous implantable cardioverter-defibrillator (S-ICD) because of the possibility of lead ruptures and accelerated battery depletion. OBJECTIVE The aim of this study was to evaluate device-related complications over time in a large real-world multicenter S-ICD cohort. METHODS Patients implanted with an S-ICD from January 2015 to June 2020 were enrolled from a 19-institution European registry (Experience from the Long-term Italian S-ICD registry [ELISIR]; ClinicalTrials.gov identifier NCT0473876). Device-related complication rates over follow-up were collected. Last follow-up of patients was performed after the Boston Scientific recall issue. RESULTS A total of 1254 patients (median age 52.0 [interquartile range 41.0-62.2] years; 973 (77.6%) men; 387 (30.9%) ischemic) was enrolled. Over a follow-up of 23.2 (12.8-37.8) months, complications were observed in 117 patients (9.3%) for a total of 127 device-related complications (23.6% managed conservatively and 76.4% required reintervention). Twenty-seven patients (2.2%) had unanticipated generator replacement after 3.6 (3.3-3.9) years, while 4 (0.3%) had lead rupture. Body mass index (hazard ratio [HR] 1.063 [95% confidence interval 1.028-1.100]; P < .001), chronic kidney disease (HR 1.960 [1.191-3.225]; P = .008), and oral anticoagulation (HR 1.437 [1.010-2.045]; P = .043) were associated with an increase in overall complications, whereas older age (HR 0.980 [0.967-0.994]; P = .007) and procedure performed in high-volume centers (HR 0.463 [0.300-0.715]; P = .001) were protective factors. CONCLUSION The overall complication rate over 23.2 months of follow-up in a multicenter S-ICD cohort was 9.3%. Early unanticipated device battery depletions occurred in 2.2% of patients, while lead fracture was observed in 0.3%, which is in line with the expected rates reported by Boston Scientific.
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29
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Yoshizawa R, Kunugita F, Sawa Y, Komatsu T. Implantation of a subcutaneous implantable cardioverter-defibrillator in a patient with epicardial defibrillation patches. HeartRhythm Case Rep 2021; 7:429-431. [PMID: 34194996 PMCID: PMC8226319 DOI: 10.1016/j.hrcr.2021.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Reisuke Yoshizawa
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University School of Medicine, Shiwa, Japan
| | - Fusanori Kunugita
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University School of Medicine, Shiwa, Japan
| | - Yohei Sawa
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University School of Medicine, Shiwa, Japan
| | - Takashi Komatsu
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University School of Medicine, Shiwa, Japan
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30
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Forleo GB, Gasperetti A, Breitenstein A, Laredo M, Schiavone M, Ziacchi M, Vogler J, Ricciardi D, Palmisano P, Piro A, Compagnucci P, Waintraub X, Mitacchione G, Carrassa G, Russo G, De Bonis S, Angeletti A, Bisignani A, Picarelli F, Casella M, Bressi E, Rovaris G, Calò L, Santini L, Pignalberi C, Lavalle C, Viecca M, Pisanò E, Olivotto I, Curnis A, Dello Russo A, Tondo C, Love CJ, Di Biase L, Steffel J, Tilz R, Badenco N, Biffi M. Subcutaneous implantable cardioverter-defibrillator and defibrillation testing: A propensity-matched pilot study. Heart Rhythm 2021; 18:2072-2079. [PMID: 34214647 DOI: 10.1016/j.hrthm.2021.06.1201] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/22/2021] [Accepted: 06/27/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND To date, only a few comparisons between subcutaneous implantable cardioverter-defibrillator (S-ICD) patients undergoing and those not undergoing defibrillation testing (DT) at implantation (DT+ vs DT-) have been reported. OBJECTIVE The purpose of this study was to compare long-term clinical outcomes of 2 propensity-matched cohorts of DT+ and DT- patients. METHODS Among consecutive S-ICD patients implanted across 17 centers from January 2015 to October 2020, DT- patients were 1:1 propensity-matched for baseline characteristics with DT+ patients. The primary outcome was a composite of ineffective shocks and cardiovascular mortality. Appropriate and inappropriate shock rates were deemed secondary outcomes. RESULTS Among 1290 patients, a total of 566 propensity-matched patients (283 DT+; 283 DT-) served as study population. Over median follow-up of 25.3 months, no significant differences in primary outcome event rates were found (10 DT+ vs 14 DT-; P = .404) as well as for ineffective shocks (5 DT- vs 3 DT+; P = .725). At multivariable Cox regression analysis, DT performance was associated with a reduction of neither the primary combined outcome nor ineffective shocks at follow-up. A high PRAETORIAN score was positively associated with both the primary outcome (hazard ratio 3.976; confidence interval 1.339-11.802; P = .013) and ineffective shocks alone at follow-up (hazard ratio 19.030; confidence interval 4.752-76.203; P = .003). CONCLUSION In 2 cohorts of strictly propensity-matched patients, DT performance was not associated with significant differences in cardiovascular mortality and ineffective shocks. The PRAETORIAN score is capable of correctly identifying a large percentage of patients at risk for ineffective shock conversion in both cohorts.
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Affiliation(s)
| | - Alessio Gasperetti
- Cardiology Unit, Luigi Sacco University Hospital, Milan, Italy; Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Salesi-Lancisi", Ancona, Italy; Division of Cardiology, Johns Hopkins University, Baltimore, Maryland
| | | | | | - Marco Schiavone
- Cardiology Unit, Luigi Sacco University Hospital, Milan, Italy.
| | - Matteo Ziacchi
- Cardiology Unit, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Julia Vogler
- Cardiology Department, University Hospital of Lubeck, Lubeck, Germany
| | | | | | - Agostino Piro
- Cardiology Department, Policlinico Umberto I, Rome, Italy
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Salesi-Lancisi", Ancona, Italy
| | | | | | | | - Giulia Russo
- Cardiology Department, Vito Fazzi Hospital, Lecce, Italy
| | - Silvana De Bonis
- Cardiology Department, Ferrari Hospital, Castrovillari, Cosenza, Italy
| | - Andrea Angeletti
- Cardiology Unit, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Antonio Bisignani
- Cardiology Department, Ferrari Hospital, Castrovillari, Cosenza, Italy
| | | | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Salesi-Lancisi", Ancona, Italy
| | - Edoardo Bressi
- Cardiology Department, Policlinico Casilino, Rome, Italy
| | | | - Leonardo Calò
- Cardiology Department, Policlinico Casilino, Rome, Italy
| | - Luca Santini
- Cardiology Department, Ospedale G.B. Grassi, Ostia, Italy
| | | | - Carlo Lavalle
- Cardiology Department, Policlinico Umberto I, Rome, Italy
| | - Maurizio Viecca
- Cardiology Unit, Luigi Sacco University Hospital, Milan, Italy
| | - Ennio Pisanò
- Cardiology Department, Vito Fazzi Hospital, Lecce, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Antonio Curnis
- Cardiology Department, Spedali Civili Brescia, Brescia, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital "Umberto I-Salesi-Lancisi", Ancona, Italy
| | - Claudio Tondo
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy; Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Charles J Love
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Jan Steffel
- Cardiology Department, Zurich University Hospital, Zurich, Switzerland
| | - Roland Tilz
- Cardiology Department, University Hospital of Lubeck, Lubeck, Germany
| | | | - Mauro Biffi
- Cardiology Unit, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
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Wang L, Javadekar N, Rajagopalan A, Rogovoy NM, Haq KT, Broberg CS, Tereshchenko LG. Eligibility for subcutaneous implantable cardioverter-defibrillator in congenital heart disease. Heart Rhythm 2021; 17:860-869. [PMID: 32354451 DOI: 10.1016/j.hrthm.2020.01.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/08/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Adult congenital heart disease (ACHD) patients can benefit from a subcutaneous implantable cardioverter-defibrillator (S-ICD). OBJECTIVE The purpose of this study was to assess left- and right-sided S-ICD eligibility in ACHD patients, use machine learning to predict S-ICD eligibility in ACHD patients, and transform 12-lead electrocardiogram (ECG) to S-ICD 3-lead ECG, and vice versa. METHODS ACHD outpatients (n = 101; age 42 ± 14 years; 52% female; 85% white; left ventricular ejection fraction [LVEF] 56% ± 9%) were enrolled in a prospective study. Supine and standing 12-lead ECG were recorded simultaneously with a right- and left-sided S-ICD 3-lead ECG. Peak-to-peak QRS and T amplitudes; RR, PR, QT, QTc, and QRS intervals; Tmax, and R/Tmax (31 predictor variables) were tested. Model selection, training, and testing were performed using supine ECG datasets. Validation was performed using standing ECG datasets and an out-of-sample non-ACHD population (n = 68; age 54 ± 16 years; 54% female; 94% white; LVEF 61% ± 8%). RESULTS Forty percent of participants were ineligible for S-ICD. Tetralogy of Fallot patients passed right-sided screening (57%) more often than left-sided screening (21%; McNemar χ2P = .025). Female participants had greater odds of eligibility (adjusted odds ratio [OR] 5.9; 95% confidence interval [CI] 1.6-21.7; P = .008). Validation of the ridge models was satisfactory for standing left-sided (receiver operating characteristic area under the curve [ROC AUC] 0.687; 95% CI 0.582-0.791) and right-sided (ROC AUC 0.655; 95% CI 0.549-0.762) S-ICD eligibility prediction. Validation of transformation matrices showed satisfactory agreement (<0.1 mV difference). CONCLUSION Nearly half of the contemporary ACHD population is ineligible for S-ICD. The odds of S-ICD eligibility are greater for female than for male ACHD patients. Machine learning prediction of S-ICD eligibility can be used for screening of S-ICD candidates.
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Affiliation(s)
- Linda Wang
- Oregon Health & Science University, Knight Cardiovascular Institute, Portland, Oregon
| | - Neeraj Javadekar
- Oregon Health & Science University, Knight Cardiovascular Institute, Portland, Oregon
| | - Ananya Rajagopalan
- Oregon Health & Science University, Knight Cardiovascular Institute, Portland, Oregon
| | - Nichole M Rogovoy
- Oregon Health & Science University, Knight Cardiovascular Institute, Portland, Oregon
| | - Kazi T Haq
- Oregon Health & Science University, Knight Cardiovascular Institute, Portland, Oregon
| | - Craig S Broberg
- Oregon Health & Science University, Knight Cardiovascular Institute, Portland, Oregon
| | - Larisa G Tereshchenko
- Oregon Health & Science University, Knight Cardiovascular Institute, Portland, Oregon.
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Smietana J, Frankel DS, Serletti JM, Arkles J, Pothineni NVK, Marchlinski FE, Schaller RD. Subserratus implantation of the subcutaneous implantable cardioverter-defibrillator. Heart Rhythm 2021; 18:1799-1804. [PMID: 34119694 DOI: 10.1016/j.hrthm.2021.06.1169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/02/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Jeffrey Smietana
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David S Frankel
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph M Serletti
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeffrey Arkles
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Naga Venkata K Pothineni
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Francis E Marchlinski
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert D Schaller
- Electrophysiology Section, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
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Romero J, Diaz JC, Alviz I, Briceno D, Zhang X, Palma E, Vue E, Bello J, Natale A, Di Biase L. Tumescent local anesthesia for subcutaneous implantable cardioverter-defibrillator implantation: An alternative for general anesthesia. HeartRhythm Case Rep 2021; 7:286-291. [PMID: 34026517 PMCID: PMC8134752 DOI: 10.1016/j.hrcr.2021.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Jorge Romero
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Juan Carlos Diaz
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Isabella Alviz
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - David Briceno
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Xiaodong Zhang
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Eugen Palma
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Elizabeth Vue
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Juan Bello
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Andrea Natale
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Luigi Di Biase
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
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35
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Romero J, Bello J, Díaz JC, Grushko M, Velasco A, Zhang X, Briceno D, Gabr M, Purkayastha S, Alviz I, Polanco D, Della Rocca D, Krumerman A, Palma E, Lakkireddy D, Natale A, Di Biase L. Tumescent local anesthesia versus general anesthesia for subcutaneous implantable cardioverter-defibrillator implantation. Heart Rhythm 2021; 18:1326-1335. [PMID: 33684548 DOI: 10.1016/j.hrthm.2021.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/20/2021] [Accepted: 03/01/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Subcutaneous implantable cardioverter-defibrillator (S-ICD) is an effective alternative to transvenous implantable cardioverter-defibrillator. General anesthesia (GA) is considered the standard sedation approach because of the pain caused by the manipulation of subcutaneous tissue with S-ICD implantation. However, GA carries several limitations, including additional risk of adverse events, prolonged in-room times, and increased costs. OBJECTIVE The purpose of this study was to define the effectiveness and safety of tumescent local anesthesia (TLA) in comparison to GA in patients undergoing S-ICD implantation. METHODS We performed a prospective, nonrandomized, controlled, multicenter study of patients referred for S-ICD implantation between 2019 and 2020. Patients were allocated to either TLA or GA on the basis of patient's preferences and/or anesthesia service availability. TLA was prepared using lidocaine, epinephrine, sodium bicarbonate, and sodium chloride. All patients provided written informed consent, and the institutional review board at each site provided approval for the study. RESULTS Sixty patients underwent successful S-ICD implantation from July 2019 to November 2020. Thirty patients (50%) received TLA, and the rest GA. There were no differences between groups with regard to baseline characteristics. In-room and procedural times were significantly shorter with TLA (107.6 minutes vs 186 minutes; P < .0001 and 53.2 minutes vs 153.7 minutes; P < .0001, respectively). Pain was reported less frequently by patients who received TLA. The use of opioids was significantly reduced in patients who received TLA (23% vs 62%; P = .002). CONCLUSION TLA is an effective and safe alternative to GA in S-ICD implantation. The use of TLA is associated with shorter in-room and procedural times, less postprocedural pain, and reduced usage of opioids and acetaminophen for analgesia.
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Affiliation(s)
- Jorge Romero
- Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | - Juan Bello
- Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | | | - Michael Grushko
- Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | - Alejandro Velasco
- Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | - Xiaodong Zhang
- Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | - David Briceno
- Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | - Mohamed Gabr
- Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | - Sutopa Purkayastha
- Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | - Isabella Alviz
- Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | - Dalvert Polanco
- Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | | | - Andrew Krumerman
- Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | - Eugen Palma
- Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | | | - Andrea Natale
- Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, New York, New York; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas
| | - Luigi Di Biase
- Cardiac Arrhythmia Center, Montefiore-Einstein Center for Heart and Vascular Care, Division of Cardiology, Department of Medicine, Albert Einstein College of Medicine, New York, New York; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas.
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Cody J, Graul T, Holliday S, Streckenbach S, Hussain N, Dalia AA, Cronin B, Hargrave J, Augoustides JG, Essandoh M. Nontransvenous Cardiovascular Implantable Electronic Device Technology-A Review for the Anesthesiologist. J Cardiothorac Vasc Anesth 2021; 35:2784-2791. [PMID: 33707106 DOI: 10.1053/j.jvca.2021.02.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 11/11/2022]
Abstract
There has been a recent shift in bradycardia pacing and defibrillation therapy to leadless pacemakers and extrathoracic cardioverter-defibrillator technology due to complications associated with transvenous devices. These innovations have implications for anesthesia care, as these novel devices have design and functionality features different from transvenous devices. Current perioperative guidelines do not address management of leadless pacemakers and the subcutaneous implantable cardioverter-defibrillator, although implantation rates are increasing globally. This article addresses the features and capabilities of nontransvenous cardiac implantable electronic devices, such as the Micra and the subcutaneous implantable cardioverter-defibrillator, and provides guidance for perioperative management.
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Affiliation(s)
- Joseph Cody
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Thomas Graul
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Scott Holliday
- Department of Internal Medicine and Office of Graduate Medical Education, Ohio State University Wexner Medical Center, Columbus, OH
| | - Scott Streckenbach
- Department of Anesthesiology, Pain Medicine, and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Nasir Hussain
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Adam A Dalia
- Department of Anesthesiology, Pain Medicine, and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Brett Cronin
- Department of Anesthesiology, University of California, San Diego, San Diego, CA
| | - Jennifer Hargrave
- Department of Cardiothoracic Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH
| | - John G Augoustides
- Department of Anesthesiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Michael Essandoh
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH.
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Zormpas C, Silber-Peest AS, Eiringhaus J, Hillmann HAK, Hohmann S, Müller-Leisse J, Westhoff-Bleck M, Veltmann C, Duncker D. Eligibility for subcutaneous implantable cardioverter-defibrillator in adults with congenital heart disease. ESC Heart Fail 2021; 8:1502-1508. [PMID: 33538124 PMCID: PMC8006645 DOI: 10.1002/ehf2.13243] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/30/2020] [Accepted: 01/19/2021] [Indexed: 01/06/2023] Open
Abstract
Aims Patients with adult congenital heart disease (ACHD) carry an increased risk for sudden cardiac death. Implantable cardioverter‐defibrillator (ICD) therapy may be challenging in these patients due to anatomical barriers, repeated cardiac surgery, or complicated transvenous access. Thus, the subcutaneous ICD (S‐ICD) can be a promising alternative in this patient population. Patients with ACHD show significant electrocardiogram (ECG) abnormalities, which could affect S‐ICD sensing because it depends on surface ECG. Methods and results One hundred patients with ACHD were screened for S‐ICD eligibility. Standard ECG‐based screening test and automated S‐ICD screening test were performed in all patients. Sixty‐six patients (66%) were male. Underlying congenital heart disease (CHD) was mainly CHD of great complexity (71%) and moderate complexity (29%), including repaired tetralogy of Fallot (20%), which was the most common entity. Thirty‐seven patients (37%) already had a pacemaker (23%) or ICD (14%) implanted. Automated screening test identified 83 patients (83%) eligible for S‐ICD implantation in either left parasternal position (78%) or right parasternal position (75%). Absence of sinus rhythm, QRS duration, and a paced QRS complex were associated with S‐ICD screening failure in univariate analysis. Receiver operating characteristic curve and multivariate analysis revealed a QRS duration ≥148 ms as the only independent predictor for S‐ICD screening failure. Conclusions Patients with ACHD show satisfactory eligibility rates (83%) for S‐ICD implantation utilizing the automated screening test, including patients with CHD of high complexity. S‐ICD therapy should be considered with caution in ACHD patients with a QRS duration ≥148 ms and/or need for ventricular pacing.
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Affiliation(s)
- Christos Zormpas
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, D-30625, Germany.,Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | | | - Jörg Eiringhaus
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, D-30625, Germany.,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, Carl-Neuberg-Str. 1, Hannover, D-30625, Germany.,Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Stephan Hohmann
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, D-30625, Germany.,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, Carl-Neuberg-Str. 1, Hannover, D-30625, Germany.,Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | | | - Christian Veltmann
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, D-30625, Germany.,Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, D-30625, Germany.,Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
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von Hafe P, Faria B, Dias G, Cardoso F, Alves MJ, Alves A, Rodrigues B, Ribeiro S, Sanfins V, Lourenço A. Brugada syndrome: Eligibility for subcutaneous implantable cardioverter-defibrillator after exercise stress test. Rev Port Cardiol 2021; 40:33-8. [PMID: 33436324 DOI: 10.1016/j.repc.2020.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 03/25/2020] [Accepted: 05/05/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Brugada syndrome (BrS) is a channelopathy associated with ventricular arrhythmias and sudden cardiac death. In patients at high risk of sudden death, an implantable cardioverter-defibrillator is indicated. Subcutaneous implantable cardioverter-defibrillators (S-ICDs) are an alternative to transvenous systems, with reduced risk of infection and complications associated with system extraction or explantation. OBJECTIVE To test electrocardiographic eligibility for S-ICD placement after exercise stress testing (EST) in patients with BrS. METHODS The sample included 35 consecutive patients with BrS. Electrocardiographic eligibility was assessed using the Boston Scientific model 2889 EMBLEM™ S-ICD automated screening tool, in four phases: decubitus and orthostatism, and before and after EST. Those who had at least one acceptable vector in the four measurements were considered eligible. RESULTS In this study, 71.4% of patients were male and mean age was 53.86±12 years. In screening prior to EST, 14.3% of patients (n=5) were not eligible for an S-ICD. There was a statistically significant association between ineligibility and presence of complete right bundle branch block and history of syncope. After EST, 16.7% of initially eligible patients no longer had eligible vectors (n=5). CONCLUSION In this study, 16.7% of patients previously eligible for an S-ICD were no longer eligible after EST. This result demonstrates the importance of screening after EST in all patients with BrS and with indication for an S-ICD, and may influence decisions concerning which ICD to implant or whether to institute pharmacological measures that avoid inappropriate therapies.
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Sasaki S, Nishizaki K, Ishida Y, Toyama Y, Hamaura S, Tomita H. Usefulness of lead repositioning to improve subcutaneous electrocardiogram sensing in patients with arrhythmogenic right ventricular cardiomyopathy with subcutaneous implantable cardioverter-defibrillator. HeartRhythm Case Rep 2020; 6:786-790. [PMID: 33101956 PMCID: PMC7573477 DOI: 10.1016/j.hrcr.2020.07.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Shingo Sasaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kimitaka Nishizaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuji Ishida
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuichi Toyama
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shogo Hamaura
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hirofumi Tomita
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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40
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Weigand S, O'Connor M, Blažek P, Kantenwein V, Friedrich L, Grebmer C, Schaarschmidt C, von Olshausen G, Reents T, Deisenhofer I, Lennerz C, Kolb C. Release of high-sensitive TROPonin T by implantation of an entirely subcutaneous Implantable Cardioverter-defibrillator compared to a conventional transvenous approach: the TROPIC registry. J Interv Card Electrophysiol 2020; 62:75-81. [PMID: 32959177 DOI: 10.1007/s10840-020-00874-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/10/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Implantation of a subcutaneous implantable cardioverter-defibrillator (S-ICD) has become an alternative option when a conventional transvenous approach is not suitable. The myocardial damage caused by S-ICD implantation appears to be minimal despite mandatory defibrillation threshold (DFT) testing. However, there has not been a direct comparison with the traditional transvenous placement of a single-chamber ICD (VVI-ICD). The aim of this study was to determine the extent of myocardial damage by analysing the changes in serum levels of cardiac enzymes after S-ICD implantation in comparison with VVI-ICD. METHODS In 43 patients who received an S-ICD system, differences in serum levels of high-sensitive troponin T (ΔhsTnT) and creatine kinase total (ΔCK) and muscle brain fraction (ΔCK-MB) were acquired by blood sampling before and the day after implantation. The control group consisted of 43 patients from the TropShock study who had received a transvenous VVI-ICD without DFT. RESULTS After S-ICD implantation and testing procedure, ΔhsTnT (0.000 ng/ml, IQR - 0.003-0.002 ng/ml) was significantly lower than after conventional VVI-ICD implantation (0.018 ng/ml, IQR 0.004-0.032 ng/ml; p < 0.001). There was no significant difference in CK (ΔCKS-ICD 85.0 U/I, IQR 30.5-225.8 U/I vs ΔCKVVI-ICD 69.5 U/I, IQR 22.9-172.3 U/I; p = 0.357), but there was a significant difference in CK-MB (ΔCK-MBS-ICD of - 0.60, IQR - 2.60-1.0 vs ΔCK-MBVVI-ICD 1.0, IQR - 1.08-3.18; p = 0.030). CONCLUSION S-ICD implantation causes less myocardial damage than VVI-ICD implantation evidenced by ΔhsTnT and ΔCK-MB.
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Affiliation(s)
- Severin Weigand
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany. .,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
| | - Matthew O'Connor
- Department of Cardiology, Wellington Hospital, Wellington, New Zealand
| | - Patrick Blažek
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Verena Kantenwein
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Lena Friedrich
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Christian Grebmer
- Abteilung für Elektrophysiologie, Kantonsspital Luzern, Herzzentrum, Lucerne, Switzerland
| | - Claudia Schaarschmidt
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Gesa von Olshausen
- Medizinische Klinik I, Klinikum rechts der Isar, Faculty of Medicine, Technische Universität München, Munich, Germany
| | - Tilko Reents
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Isabel Deisenhofer
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Carsten Lennerz
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Christof Kolb
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
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Shinohara T, Abe I, Hirota K, Kondo H, Fukui A, Akioka H, Teshima Y, Yufu K, Nakagawa M, Takahashi N. Usefulness of subcutaneous implantable cardioverter-defibrillator therapy in patients with Brugada syndrome. Heart Vessels 2021; 36:260-6. [PMID: 32833119 DOI: 10.1007/s00380-020-01683-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/14/2020] [Indexed: 10/23/2022]
Abstract
Implantable cardioverter-defibrillators (ICDs) are the main therapy to prevent sudden cardiac death in patients with Brugada syndrome (BrS). The subcutaneous ICD (S-ICD) can eliminate lead-associated complications compared with transvenous ICD (TV-ICD). However, S-ICD is susceptible to T-wave oversensing (TWOS) and may result in more frequent inappropriate shocks in patients with BrS. This study aimed to compare inappropriate shocks between TV-ICD and S-ICD in patients with BrS. We enrolled 32 patients with BrS (including one woman; mean age 52 ± 18 years) who were implanted with ICD (23 TV-ICDs and 9 S-ICDs) between January 2002 and November 2018 in Oita University Hospital. We carried out a standard surface electrocardiogram (ECG) screening tests in both supine and standing positions prior to S-ICD implantation. The patients received routine clinical review every month and device monitoring every 4 months. The period of follow-up was 129 ± 51 months. Six patients with BrS and TV-ICDs experienced inappropriate shocks (26%) with their ICD therapy. In contrast, two patients with BrS and S-ICDs experienced inappropriate shocks (22%). There was no significant difference between the two groups (P = 0.82). Although one case in the S-ICD group experienced TWOS-induced inappropriate shock, SMART Pass (new high-pass filter) prevented the subsequent recurrence of inappropriate shocks during ICD therapy. Our results suggest that S-ICD is not inferior to TV-ICD in the incidence of inappropriate shocks. SMART Pass may be a useful tool to prevent inappropriate ICD shocks by TWOS in patients with BrS.
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Regeer MV, Bondarenko O, Zeppenfeld K, Egorova AD. Anomalous left coronary artery from the pulmonary artery: a rare cause of an out-of-hospital cardiac arrest in an adult-a case report. Eur Heart J Case Rep 2020; 4:1-5. [PMID: 32617493 PMCID: PMC7319838 DOI: 10.1093/ehjcr/ytaa061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/04/2019] [Accepted: 02/27/2020] [Indexed: 11/14/2022]
Abstract
Background Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital disorder resulting in ischaemia and myocardial infarction which can act as a potential substrate for life-threatening arrhythmias and sudden cardiac death. Case summary A 19-year-old man was admitted to the hospital after successful resuscitation from an out-of-hospital cardiac arrest (OHCA) due to ventricular fibrillation occurring during jogging. In the diagnostic work-up of the OHCA, computed tomography identified an ALCAPA. The patient was referred to our tertiary hospital for surgical correction. Direct reimplantation of the left coronary artery in the aorta was performed. During follow-up, 24-h electrocardiogram revealed short episodes of non-sustained ventricular tachycardia (VT). The magnetic resonance imaging at initial admission showed focal wall thinning and transmural late gadolinium enhancement consistent with a previous anterolateral myocardial infarction. Therefore, the aetiology of the OHCA could be due to a scar-related mechanism and not necessarily due to a reversible cause and an implantable cardioverter-defibrillator (ICD) was considered indicated. Given the young age and the lower complication rates, a subcutaneous device was preferred over a transvenous ICD. However, as a subcutaneous ICD (S-ICD) lacks the possibility of anti-tachycardia pacing, programmed electrical stimulation (PES) was performed to test for inducibility of monomorphic, re-entrant VT. After a negative PES, an S-ICD was implanted. Discussion ALCAPA is a potential cause of OHCA in young patients. Some of these patients keep an irreversible substrate for ventricular arrhythmias despite full surgical revascularization and might be candidates for (subcutaneous) ICD implantation.
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Affiliation(s)
- Madelien V Regeer
- Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Olga Bondarenko
- Department of Cardiology, Medical Centre Leeuwarden, Henri Dunantweg 2, 8934 AD Leeuwarden, the Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Anastasia D Egorova
- Department of Cardiology, Leiden Heart-Lung Center, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
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Baalman SW, Kooiman KM, Quast AFB, Postema PG, Donnelley S, Knops RE. Noise caused by involuntary muscle response may inhibit detection of ventricular fibrillation during defibrillation testing. HeartRhythm Case Rep 2020; 6:126-130. [PMID: 32181129 PMCID: PMC7064800 DOI: 10.1016/j.hrcr.2019.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Sarah W.E. Baalman
- Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Address reprint requests and correspondence: Dr Sarah W.E. Baalman, Amsterdam UMC, University of Amsterdam, Department of Cardiology, Room C0-333, PO Box 22700, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | | | | | | | | | - Reinoud E. Knops
- Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Nazer B, Dale Z, Carrassa G, Reza N, Ustunkaya T, Papoutsidakis N, Gray A, Howell SJ, Elman MR, Pieragnoli P, Ricciardi G, Jacoby D, Frankel DS, Owens A, Olivotto I, Heitner SB. Appropriate and inappropriate shocks in hypertrophic cardiomyopathy patients with subcutaneous implantable cardioverter-defibrillators: An international multicenter study. Heart Rhythm 2020; 17:1107-1114. [PMID: 32084597 DOI: 10.1016/j.hrthm.2020.02.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 02/06/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Subcutaneous implantable cardioverter-defibrillators (S-ICDs) are attractive for preventing sudden cardiac death in hypertrophic cardiomyopathy (HCM) as they mitigate risks of transvenous leads in young patients. However, S-ICDs may be associated with increased inappropriate shock (IAS) in HCM patients. OBJECTIVE The purpose of this study was to assess the incidence and predictors of appropriate shock and IAS in a contemporary HCM S-ICD cohort. METHODS We collected electrocardiographic and clinical data from HCM patients who underwent S-ICD implantation at 4 centers. Etiologies of all S-ICD shocks were adjudicated. We used Firth penalized logistic regression to derive adjusted odds ratios (aORs) for predictors of IAS. RESULTS Eighty-eight HCM patients received S-ICDs (81 for primary and 7 for secondary prevention) with a mean follow-up of 2.7 years. Five patients (5.7%) had 9 IAS episodes (3.8 IAS per 100 patient-years) most often because of sinus tachycardia and/or T-wave oversensing. Independent predictors of IAS were higher 12-lead electrocardiographic R-wave amplitude (aOR 2.55 per 1 mV; 95% confidence interval 1.15-6.38) and abnormal T-wave inversions (aOR 0.16; 95% confidence interval 0.02-0.97). There were 2 appropriate shocks in 7 secondary prevention patients and none in 81 primary prevention patients, despite 96% meeting Enhanced American College of Cardiology/American Heart Association criteria and the mean European HCM Risk-SCD score predicting 5.7% 5-year risk. No patients had sudden death or untreated sustained ventricular arrhythmias. CONCLUSION In this multicenter HCM S-ICD study, IAS were rare and appropriate shocks confined to secondary prevention patients. The R-wave amplitude increased IAS risk, whereas T-wave inversions were protective. HCM primary prevention implantable cardioverter-defibrillator guidelines overestimated the risk of appropriate shocks in our cohort.
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Affiliation(s)
- Babak Nazer
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon.
| | - Zack Dale
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | | | - Nosheen Reza
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tuna Ustunkaya
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Andrew Gray
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Stacey J Howell
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | - Miriam R Elman
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
| | | | | | - Daniel Jacoby
- Cardiology Division, Yale University, New Haven, Connecticut
| | - David S Frankel
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anjali Owens
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Stephen B Heitner
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon
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Scaglione M, Peyracchia M, Battaglia A, Di Donna P, Cerrato N, Lamanna A, Caponi D. Subcutaneous implantable cardioverter-defibrillator implantation assisted by hypnotic communication in a patient with Brugada syndrome. HeartRhythm Case Rep 2019; 6:198-201. [PMID: 32322496 PMCID: PMC7156977 DOI: 10.1016/j.hrcr.2019.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Marco Scaglione
- Division of Cardiology, Cardinal G. Massaia Hospital, Asti, Italy
| | | | | | - Paolo Di Donna
- Division of Cardiology, Cardinal G. Massaia Hospital, Asti, Italy
| | - Natascia Cerrato
- Division of Cardiology, Cardinal G. Massaia Hospital, Asti, Italy
| | - Andrea Lamanna
- Division of Cardiology, Cardinal G. Massaia Hospital, Asti, Italy
| | - Domenico Caponi
- Division of Cardiology, Cardinal G. Massaia Hospital, Asti, Italy
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46
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Do K, Lee CC, Kiankhooy A, Chang PM, Doshi RN. Substernal subcutaneous implantable cardioverter-defibrillator lead placement for the management of inappropriate shocks. HeartRhythm Case Rep 2019; 5:407-410. [PMID: 31453090 PMCID: PMC6701193 DOI: 10.1016/j.hrcr.2019.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
| | | | | | | | - Rahul N. Doshi
- Keck School of Medicine of the University of Southern California, Los Angeles, California
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47
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Xiang K, Levine JD, Elayi SC, Su J, Hsu S, Kim R, Catanzaro JN. A novel bio envelope and suture orientation for stabilization of the subcutaneous implantable cardioverter-defibrillator generator to the chest wall. HeartRhythm Case Rep 2019; 5:430-432. [PMID: 31453096 PMCID: PMC6700997 DOI: 10.1016/j.hrcr.2019.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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48
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van den Bruck JH, Sultan A, Plenge T, Seuthe K, Mödder T, Iliadis C, Stern D, Blankenheim T, Steven D, Lüker J. Incidence of myopotential induction in subcutaneous implantable cardioverter-defibrillator patients: Is the oversensing issue really solved? Heart Rhythm 2019; 16:1523-1530. [PMID: 31048064 DOI: 10.1016/j.hrthm.2019.04.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND The subcutaneous implantable cardioverter-defibrillator (S-ICD) has established its role in the prevention of sudden cardiac death in a defined population. Inappropriate shocks and device malfunction in S-ICD therapy may be caused by myopotential (MP) oversensing. OBJECTIVE The purpose of this study was to systematically evaluate a cohort of consecutive S-ICD patients for MP inducibility. METHODS After S-ICD implantation, all vectors (primary [PrimV], secondary [SecV], alternative [AltV]) were analyzed during isometric chest press (ICP), lifting and holding a 20-kg weight, and side plank exercise (SPE), supporting the body weight on the left arm. When MPs were induced, signal classification was assessed: adequate noise detection, induced undersensing (R waves classified as noise), and oversensing (noise annotated as R waves). In case of noise induction in the current vector, device reprogramming to a noise-free vector was done. RESULTS We systematically assessed 41 patients. In nearly all patients (90.2%), MPs were inducible. ICP was the most potent inductor of MPs. Whereas SecV (70.7%) and AltV (75.6%) were most vulnerable during ICP, PrimV was most affected during SPE (51.2%). In only a few cases did the S-ICD software distinguish correctly between MPs and QRS. MPs predominantly led to undersensing (up to 65.9%), but in up to 22% of patients MP-induced oversensing occurred but did not lead to tachycardia detection. No relation was seen between S-ICD lead and generator position and MP inducibility. CONCLUSION Induction of MPs during physical exercise was observed frequently. Although in most cases MP noise led to undersensing, oversensing events were commonly observed.
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Affiliation(s)
- Jan-Hendrik van den Bruck
- University of Cologne, Department of Electrophysiology, University Hospital Cologne, Cologne, Germany.
| | - Arian Sultan
- University of Cologne, Department of Electrophysiology, University Hospital Cologne, Cologne, Germany
| | - Tobias Plenge
- University of Cologne, Department of Electrophysiology, University Hospital Cologne, Cologne, Germany
| | - Katharina Seuthe
- University of Cologne, Department of Electrophysiology, University Hospital Cologne, Cologne, Germany
| | - Tim Mödder
- University of Cologne, Department of Electrophysiology, University Hospital Cologne, Cologne, Germany
| | - Christos Iliadis
- University of Cologne, Department of Electrophysiology, University Hospital Cologne, Cologne, Germany
| | - Daniel Stern
- University of Cologne, Department of Electrophysiology, University Hospital Cologne, Cologne, Germany
| | - Tatjana Blankenheim
- University of Cologne, Department of Electrophysiology, University Hospital Cologne, Cologne, Germany
| | - Daniel Steven
- University of Cologne, Department of Electrophysiology, University Hospital Cologne, Cologne, Germany
| | - Jakob Lüker
- University of Cologne, Department of Electrophysiology, University Hospital Cologne, Cologne, Germany
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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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50
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Sharma S, Nand NP, Hematpour K, Reddy SK, Salas de Armas IA, Patel MK. Implantation of left atrial-ventricular epicardial pacemaker system and subcutaneous implantable cardioverter-defibrillator in a single setting: The "extravascular" cardiac resynchronization therapy. HeartRhythm Case Rep 2019; 5:354-358. [PMID: 31341775 PMCID: PMC6630148 DOI: 10.1016/j.hrcr.2019.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Saumya Sharma
- Department of Advanced Cardiopulmonary Therapies and Transplantation (ACTAT), The University of Texas Health Science Center at Houston, Houston, Texas
| | - Nikita P Nand
- Department of Advanced Cardiopulmonary Therapies and Transplantation (ACTAT), The University of Texas Health Science Center at Houston, Houston, Texas
| | - Khashayar Hematpour
- Department of Advanced Cardiopulmonary Therapies and Transplantation (ACTAT), The University of Texas Health Science Center at Houston, Houston, Texas
| | - Sunil K Reddy
- Department of Advanced Cardiopulmonary Therapies and Transplantation (ACTAT), The University of Texas Health Science Center at Houston, Houston, Texas
| | - Ismael A Salas de Armas
- Department of Advanced Cardiopulmonary Therapies and Transplantation (ACTAT), The University of Texas Health Science Center at Houston, Houston, Texas
| | - Manish K Patel
- Department of Advanced Cardiopulmonary Therapies and Transplantation (ACTAT), The University of Texas Health Science Center at Houston, Houston, Texas
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