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A survey study of the use of a subcutaneous implantable cardioverter-defibrillator in various clinical scenarios by expert electrophysiologists in Poland
, 1
Affiliations- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Poland
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Abstract
Background: A subcutaneous implantable cardioverter-defibrillator (S-ICD) has become a recognized
alternative to a traditional transvenous implantable cardioverter-defibrillator (T-ICD). Despite the
growing evidence of non-inferiority of S-ICD, there are no clear clinical guidelines for selection of either
of the two available systems. The aim of the study was to analyze the decisions made in predefined typical
clinical scenarios by Polish cardiologists experienced in the use of both S-ICDs and T-ICDs.
Methods: A group of 30 experts of cardiac electrotherapy experienced in the use of S-ICDs was recruited
and invited to participate in a web-based anonymous survey. The survey questions regarded the proposed
therapy in various but typical clinical scenarios.
Results: From the invited 30 experts representing 18 clinical centers, 25 completed the survey. 72%
of them declared that the number of S-ICDs implanted at their center during the preceding 12 months
exceeded 10, and 40% — that it was over 20. Rates of responders preferring S-ICD or T-ICD in various
clinical scenarios are reported and discussed in detail.
Conclusions: Significant divergence of opinion exists among Polish experts regarding the use of
a subcutaneous cardioverter-defibrillator. It is especially pronounced on the issue of the use of the system
in middle-age patients, in case of complications of the hitherto ICD therapy, or the need of upgrading the
existing cardiac implantable electronic device.
Abstract
Background: A subcutaneous implantable cardioverter-defibrillator (S-ICD) has become a recognized
alternative to a traditional transvenous implantable cardioverter-defibrillator (T-ICD). Despite the
growing evidence of non-inferiority of S-ICD, there are no clear clinical guidelines for selection of either
of the two available systems. The aim of the study was to analyze the decisions made in predefined typical
clinical scenarios by Polish cardiologists experienced in the use of both S-ICDs and T-ICDs.
Methods: A group of 30 experts of cardiac electrotherapy experienced in the use of S-ICDs was recruited
and invited to participate in a web-based anonymous survey. The survey questions regarded the proposed
therapy in various but typical clinical scenarios.
Results: From the invited 30 experts representing 18 clinical centers, 25 completed the survey. 72%
of them declared that the number of S-ICDs implanted at their center during the preceding 12 months
exceeded 10, and 40% — that it was over 20. Rates of responders preferring S-ICD or T-ICD in various
clinical scenarios are reported and discussed in detail.
Conclusions: Significant divergence of opinion exists among Polish experts regarding the use of
a subcutaneous cardioverter-defibrillator. It is especially pronounced on the issue of the use of the system
in middle-age patients, in case of complications of the hitherto ICD therapy, or the need of upgrading the
existing cardiac implantable electronic device.
Keywords
implantable cardioverter-defibrillator, subcutaneous implantable cardioverter-defibrillator, sudden cardiac death, ventricular fibrillation, ventricular tachycardia
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About this articleTitle
A survey study of the use of a subcutaneous implantable cardioverter-defibrillator in various clinical scenarios by expert electrophysiologists in Poland
Journal
Issue
Article type
Original Article
Pages
214-220
Published online
2022-08-11
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2189
Article views/downloads
386
DOI
Pubmed
Bibliographic record
Cardiol J 2023;30(2):214-220.
Keywords
implantable cardioverter-defibrillator
subcutaneous implantable cardioverter-defibrillator
sudden cardiac death
ventricular fibrillation
ventricular tachycardia
Authors
Maciej Kempa
Barbara Opielowska-Nowak
Szymon Budrejko
Grzegorz Raczak
References (32)- 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.
- Priori SG, Blomström-Lundqvist C, Mazzanti A, et al. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J. 2015; 36(41): 2793–2867.
- Knops R, Nordkamp LO, Delnoy PP, et al. Subcutaneous or transvenous defibrillator therapy. N Engl J Med. 2020; 383(6): 526–536.
- Gold MR, Lambiase PD, El-Chami MF, et al. Primary Results From the Understanding Outcomes With the S-ICD in Primary Prevention Patients With Low Ejection Fraction (UNTOUCHED) Trial. Circulation. 2021; 143(1): 7–17.
- Kaczmarek K, Zwoliński R, Bartczak K, et al. A subcutaneous implantable cardioverter-defibrillator — the first implantation in Poland. Kardiol Pol. 2015; 73(1): 62.
- Kempa M, Budrejko S, Raczak G. Subcutaneous implantable cardioverter-defibrillator (S-ICD) for secondary prevention of sudden cardiac death. Arch Med Sci. 2016; 12(5): 1179–1180.
- Kempa M, Przybylski A, Budrejko S, et al. Evolution of implantation technique and indications for a subcutaneous cardioverter-defibrillator: over 7 years of experience in Poland. Kardiol Pol. 2021; 79(9): 1016–1018.
- Rozporządzenie Ministra Zdrowia z dnia 9 stycznia 2019 r. zmieniające rozporządzenie w sprawie świadczeń gwarantowanych z zakresu leczenia szpitalnego. Dziennik Ustaw Rzeczypospolitej Polskiej: poz. 77. http://isap.sejm.gov.pl/isap.nsf/download.xsp/WDU20190000077/O/D20190077.pdf.
- Boveda S, Lenarczyk R, Haugaa K, et al. Implantation of subcutaneous implantable cardioverter defibrillators in Europe: results of the European Heart Rhythm Association survey. Europace. 2016; 18(9): 1434–1439.
- Kempa M, Przybylski A, Budrejko S, et al. Utilization of Subcutaneous Cardioverter-Defibrillator in Poland and Europe-Comparison of the Results of Multi-Center Registries. Int J Environ Res Public Health. 2021; 18(13): 71–78.
- Kutyifa V, Rosero SZ, McNitt S, et al. Need for pacing in patients who qualify for an implantable cardioverter-defibrillator: Clinical implications for the subcutaneous ICD. Ann Noninvasive Electrocardiol. 2020; 25(4): e12744.
- de Bie MK, Thijssen J, van Rees JB, et al. Suitability for subcutaneous defibrillator implantation: results based on data from routine clinical practice. Heart. 2013; 99(14): 1018–1023.
- Lambiase PD, Theuns DA, Murgatroyd F, et al. Subcutaneous implantable cardioverter-defibrillators: long-term results of the EFFORTLESS study. Eur Heart J. 2022; 43(21): 2037–2050.
- Kempa M, Budrejko S, Zienciuk-Krajka A, et al. Subcutaneous implantable cardioverter-defibrillators for the prevention of sudden cardiac death: five‑year single-center experience. Kardiol Pol. 2020; 78(5): 447–450.
- Giammaria M, Lucciola MT, Amellone C, et al. Eligibility of cardiac resynchronization therapy patients for subcutaneous implantable cardioverter defibrillators. J Interv Card Electrophysiol. 2019; 54(1): 49–54.
- Probst V, Boveda S, Sadoul N, et al. Subcutaneous implantable cardioverter defibrillator indication in prevention of sudden cardiac death in difficult clinical situations: A French expert position paper. Arch Cardiovasc Dis. 2020; 113(5): 359–366.
- Porterfield C, DiMarco JP, Mason PK. Effectiveness of implantation of a subcutaneous implantable cardioverter-defibrillator in a patient with complete heart block and a pacemaker. Am J Cardiol. 2015; 115(2): 276–278.
- Gemein C, Haj M, Schmitt J. Combining an subcutaneous ICD and a pacemaker with abdominal device location and bipolar epicardial left ventricular lead: first-in-man approach. Europace. 2016; 18(8): 1279.
- Kaczmarek K, Czarniak B, Jakubowski P, et al. Leadless pacemaker and subcutaneous implantable cardioverter-defibrillator therapy: the first use of a novel treatment option in Poland. Kardiol Pol. 2018; 76(6): 1026.
- Boveda S, Lenarczyk R, Fumagalli S, et al. Factors influencing the use of subcutaneous or transvenous implantable cardioverter-defibrillators: results of the European Heart Rhythm Association prospective survey. EP Europace. 2018; 20(5): 887–892.
- Conte G, Kawabata M, de Asmundis C, et al. High rate of subcutaneous implantable cardioverter-defibrillator sensing screening failure in patients with Brugada syndrome: a comparison with other inherited primary arrhythmia syndromes. Europace. 2018; 20(7): 1188–1193.
- Tachibana M, Nishii N, Morita H, et al. Exercise stress test reveals ineligibility for subcutaneous implantable cardioverter defibrillator in patients with Brugada syndrome. J Cardiovasc Electrophysiol. 2017; 28(12): 1454–1459.
- Lambiase PD, Eckardt L, Theuns DA, et al. Evaluation of subcutaneous implantable cardioverter-defibrillator performance in patients with ion channelopathies from the EFFORTLESS cohort and comparison with a meta-analysis of transvenous ICD outcomes. Heart Rhythm O2. 2020; 1(5): 326–335.
- Silvetti MS, Pazzano V, Verticelli L, et al. Subcutaneous implantable cardioverter-defibrillator: is it ready for use in children and young adults? A single-centre study. Europace. 2018; 20(12): 1966–1973.
- Silvetti MS. Cardioverter-defibrillator in children and young patients with congenital heart disease. Time to define ICD selection. Kardiol Pol. 2020; 78(9): 839–841.
- Kwok SY, Yam N, Lun KS, et al. Abdominal submuscular implant of subcutaneous implantable cardioverter-defibrillator in a young child. Europace. 2018; 20(FI2): f248.
- von Alvensleben JC, White C, Brateng C, et al. Subcutaneous implantable cardioverter defibrillator placement in a 5-year-old patient: Modifications for the smallest patients. HeartRhythm Case Rep. 2019; 5(8): 440–444.
- von Alvensleben JC, Dechert B, Bradley DJ, et al. Subcutaneous implantable cardioverter-defibrillators in pediatrics and congenital heart disease: a Pediatric and Congenital Electrophysiology Society Multicenter Review. JACC Clin Electrophysiol. 2020; 6(14): 1752–1761.
- Bogush N, Espinosa RE, Cannon BC, et al. Selecting the right defibrillator in the younger patient: Transvenous, epicardial or subcutaneous? Int J Cardiol. 2018; 250: 133–138.
- Pitak MJ, Jastrzębski M, Rudek-Budzyńska A, et al. Subcutaneous implantable cardioverter-defibrillator and the two-incision intermuscular technique in pediatric patients - a single center experience. Kardiol Pol. 2021; 79(9): 1025–1027.
- Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a Report of the American College of Cardiology/ American Heart Association Task Force on Clinical Practice Guidelines and the Society. Heart Rhythm. 2018; 15: e73–e189.
- Ptaszyński P, Grabowski M, Kowalski O, et al. [Subcutaneous implantable cardioverter-defibrillator in prevention of sudden cardiac death in Poland - opinion paper endorsed by the Polish Cardiac Society Working Group on Heart Rhythm]. Kardiol Pol. 2017; 75(10): 1057–1060.
