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Crozier I, Haqqani H, Kotschet E, Shaw D, Prabhu A, Roubos J, Alison J, Melton I, Denman R, Lin T, Almeida A, Thompson A, Lande J, Liang S, O’donnell D. Three-year chronic follow-up from the pilot study of a substernal extravascular implantable cardioverter defibrillator. Europace 2022. [DOI: 10.1093/europace/euac053.467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Medtronic
Background
The investigational Extravascular Implantable Cardioverter-Defibrillator (EV ICD) uses a substernal lead and delivers defibrillation and pacing therapies, including antitachycardia pacing (ATP).
Objective
To characterize EV ICD system performance through 3 years.
Methods
The prospective, first-in-human EV ICD Pilot study was conducted at 4 sites in Australia and New Zealand. ICD-indicated patients were enrolled July-December of 2018. Defibrillation testing was conducted for all patients at implant, and chronically per physician discretion. Electrical testing was conducted at pre-hospital discharge, 2 weeks, 4-6 weeks and 3 months post-implant, and every 6 months thereafter. Posture effects on pacing and sensing were evaluated through 3 months.
Results
Of 26 patients enrolled, 21 underwent the EV ICD implant procedure. There were no intraprocedural complications. After successful implantation and testing, 17 of 21 patients entered chronic follow-up. 14 patients continue follow up, representing 523 patient-months. Eight elective chronic defibrillation tests converted 7 of 7 patients with ≤ 40 J (maximum energy). Five episodes of spontaneous ventricular tachycardia (VT) were detected in 1 patient and either self-terminated or successfully defibrillated with appropriate shock.
Over the total course of follow-up, 3 patients received an inappropriate shock due to; lead tip displacement with subsequent P-wave oversensing; Electromagnetic interference (EMI) in a ungrounded hot-tub; and EMI while doing plumbing work on unearthed electrical pipes, resulting in an annualized inappropriate shock rate of 6.9%.
Pacing capture thresholds remained stable across time (5.1 ± 2.0 V at implant and 5.5 ± 2.7 V at 3 years); similarly, R-wave amplitudes were stable across time (3.4 ±2.0 mV at implant and 4.2 ± 2.7 mV at 3 years). Pacing thresholds tended to be lowest with the patient lying on the right side and pacing threshold often increased relative to supine position for left-side, prone or bending postures. R-wave amplitude tended to be greater when bending forward.
There were 10 system or procedure-related adverse events in 8 patients through 3 years, including 3 elective system removals for: a single inappropriate shock (1), chronic defibrillation testing showing no safety margin in a patient with arrhythmogenic right ventricular dysplasia (1), intolerance to ATP (1 - high pacing threshold and frequent VT). Other than the lead tip displacement within the first 3 months, no additional clinically significant lead displacements have been observed through 3 years.
Conclusion
The EV ICD is a novel platform for delivering high-voltage therapy. There were no procedure and system related complications observed after the first year post-implant. Lead position and chronic system performance have generally remained stable through 3 years with a low rate of adverse events.
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Affiliation(s)
- I Crozier
- Christchurch Hospital, cardiology, Christchurch, New Zealand
| | - H Haqqani
- The Prince Charles Hospital, Department of Cardiology, Brisbane, Australia
| | - E Kotschet
- Monash Medical Center, Department of Cardiac Rhythm Services, Clayton, Australia
| | - D Shaw
- Christchurch Hospital, cardiology, Christchurch, New Zealand
| | - A Prabhu
- The Prince Charles Hospital, Department of Cardiology, Brisbane, Australia
| | - J Roubos
- Austin Health, Department of Cardiology, Heidelberg, Australia
| | - J Alison
- Monash Medical Center, Department of Cardiac Rhythm Services, Clayton, Australia
| | - I Melton
- Christchurch Hospital, cardiology, Christchurch, New Zealand
| | - R Denman
- The Prince Charles Hospital, Department of Cardiology, Brisbane, Australia
| | - T Lin
- Austin Health, Department of Cardiology, Heidelberg, Australia
| | - A Almeida
- Monash Medical Center, Department of Cardiac Rhythm Services, Clayton, Australia
| | - A Thompson
- Medtronic, Inc., Minneapolis, United States of America
| | - J Lande
- Medtronic, Inc., Minneapolis, United States of America
| | - S Liang
- Medtronic, Inc., Minneapolis, United States of America
| | - D O’donnell
- Austin Health, Department of Cardiology, Heidelberg, Australia
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Roubos J, Maliko N, van der Wilden GM. [A man with swollen abdomen, abdominal pain and nausea]. Ned Tijdschr Geneeskd 2020; 164:D5119. [PMID: 33201639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A 45-year-old man presented with acute intestinal obstruction, due to congenital peritoneal encapsulation. This rare malformation leads to an accessory peritoneal sac around all or part of the small bowel. Torsion of this sac can lead to acute bowel obstruction and therefore ischaemia. In this case, detorsion and adhesiolysis resulted in a positive outcome.
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Affiliation(s)
- J Roubos
- Alrijne Ziekenhuis, afd. Heelkunde, Leiderdorp
- Contact: J. Roubos
| | - N Maliko
- Alrijne Ziekenhuis, afd. Heelkunde, Leiderdorp
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