The subcutaneous implantable cardioverter-defibrillator: A tertiary center experience
Abstract
Background: The aim of the study was to evaluate subcutaneous implantable cardioverter-defibrillator (S-ICD) patients with regard to underlying etiology, peri-procedural outcome, appropriate/inappropriate shocks, and complications during follow-up. Methods: All patients who underwent S-ICD implantation from February 2013 to March 2017 at an academic hospital in Vienna were included. Medical records were examined and follow-up interrogations of devices were conducted. Results: A total of 79 S-ICD patients (58.2% males) with a mean age of 44.5 ± 17.2 years were followed for a mean duration of 12.8 ± 13.7 months. A majority of patients (58.2%) had S-ICD for primary prevention of sudden cardiac death. The most common of the 16 underlying etiologies were ischemic cardiomyopathy, non-ischemic cardiomyopathy, and idiopathic ventricular fibrillation. The lead was implanted to the left sternal border in 96.2% of cases, between muscular layers in 72.2%. Mean implant time was 45 min, 3 patients were induced, and all patients except one were programmed to two zones. Six (7.6%) patients experienced at least one appropriate therapy for ventricular arrhythmias and the time to first event ranged from 1 to 52 months. Seven patients experienced inappropriate shocks due to T-wave oversensing, atrial tachycardia with rapid atrioventricular conduction, external electromagnetic interference, and/or baseline oversensing due to lead movement. Four patients underwent revision for lead repositioning (n = 1), loose device suture (n = 1), and infection (n = 2). Conclusions: While S-ICDs are a feasible and effective treatment, issues remain with inappropriate shock and infection.
Keywords: arrhythmiacomplicationsubcutaneous implantable cardioverter-defibrillatorsudden cardiac death
References
- McLeod CJ, Boersma L, Okamura H, et al. The subcutaneous implantable cardioverter defibrillator: state-of-the-art review. Eur Heart J. 2017; 38(4): 247–257.
- Kleemann T, Becker T, Doenges K, et al. Annual rate of transvenous defibrillation lead defects in implantable cardioverter-defibrillators over a period of >10 years. Circulation. 2007; 115(19): 2474–2480.
- Burke MC, Gold MR, Knight BP, et al. Safety and Efficacy of the Totally Subcutaneous Implantable Defibrillator: 2-Year Results From a Pooled Analysis of the IDE Study and EFFORTLESS Registry. J Am Coll Cardiol. 2015; 65(16): 1605–1615.
- Bardy GH, Smith WM, Hood MA, et al. An entirely subcutaneous implantable cardioverter-defibrillator. N Engl J Med. 2010; 363(1): 36–44.
- Dabiri Abkenari L, Theuns DA, Valk SDA, et al. Clinical experience with a novel subcutaneous implantable defibrillator system in a single center. Clin Res Cardiol. 2011; 100(9): 737–744.
- Olde Nordkamp LRA, Dabiri Abkenari L, Boersma LVA, et al. The entirely subcutaneous implantable cardioverter-defibrillator: initial clinical experience in a large Dutch cohort. J Am Coll Cardiol. 2012; 60(19): 1933–1939.
- Aydin A, Hartel F, Schlüter M, et al. Shock efficacy of subcutaneous implantable cardioverter-defibrillator for prevention of sudden cardiac death: initial multicenter experience. Circ Arrhythm Electrophysiol. 2012; 5(5): 913–919.
- Jarman JWE, Todd DM. United Kingdom national experience of entirely subcutaneous implantable cardioverter-defibrillator technology: important lessons to learn. Europace. 2013; 15(8): 1158–1165.
- Köbe J, Reinke F, Meyer C, et al. Implantation and follow-up of totally subcutaneous versus conventional implantable cardioverter-defibrillators: a multicenter case-control study. Heart Rhythm. 2013; 10(1): 29–36.
- Frommeyer G, Dechering DG, Zumhagen S, et al. Long-term follow-up of subcutaneous ICD systems in patients with hypertrophic cardiomyopathy: a single-center experience. Clin Res Cardiol. 2016; 105(1): 89–93.
- Brouwer TF, Yilmaz D, Lindeboom R, et al. Long-Term clinical outcomes of subcutaneous versus transvenous implantable defibrillator therapy. J Am Coll Cardiol. 2016; 68(19): 2047–2055.
- Honarbakhsh S, Providencia R, Srinivasan N, et al. A propensity matched case-control study comparing efficacy, safety and costs of the subcutaneous vs. transvenous implantable cardioverter defibrillator. Int J Cardiol. 2017; 228: 280–285.
- Mesquita J, Cavaco D, Ferreira A, et al. Effectiveness of subcutaneous implantable cardioverter-defibrillators and determinants of inappropriate shock delivery. Int J Cardiol. 2017; 232: 176–180.
- Mithani AA, Kath H, Hunter K, et al. Characteristics and early clinical outcomes of patients undergoing totally subcutaneous vs. transvenous single chamber implantable cardioverter defibrillator placement. Europace. 2018; 20(2): 308–314.
- Moss AJ, Schuger C, Beck CA, et al. MADIT-RIT Trial Investigators. Reduction in inappropriate therapy and mortality through ICD programming. N Engl J Med. 2012; 367(24): 2275–2283.
- Olde Nordkamp LRA, Warnaars JLF, Kooiman KM, et al. Which patients are not suitable for a subcutaneous ICD: incidence and predictors of failed QRS-T-wave morphology screening. J Cardiovasc Electrophysiol. 2014; 25(5): 494–499.
- Weinstock J, Bader YH, Maron MS, et al. Subcutaneous implantable cardioverter defibrillator in patients with hypertrophic cardiomyopathy: an initial experience. J Am Heart Assoc. 2016; 5(2).
- Brisben AJ, Burke MC, Knight BP, et al. A new algorithm to reduce inappropriate therapy in the S-ICD system. J Cardiovasc Electrophysiol. 2015; 26(4): 417–423.
- Friedman DJ, Parzynski CS, Varosy PD, et al. Trends and in-hospital outcomes associated with adoption of the subcutaneous implantable cardioverter defibrillator in the united states. JAMA Cardiol. 2016; 1(8): 900–911.
- Winter J, Siekiera M, Shin DI, et al. Intermuscular technique for implantation of the subcutaneous implantable cardioverter defibrillator: long-term performance and complications. Europace. 2017; 19(12): 2036–2041.
