Left ventricular non-compaction (LVNC) is described as the persistence of trabeculated myocardium in the left ventricle (LV) and is optimally assessed by cardiac magnetic resonance (CMR). Right ventricular (RV) involvement in LVNC remains poorly studied. Consecutive patients (N = 14) diagnosed with LVNC by CMR were studied. Their clinical data were analyzed. In addition, CMR assessment included quantification of LV and RV volumes, mass, ejection fraction (EF), LV wall motion score, LV non-compacted segments and non-compacted to compacted myocardium ratios. Average age of presentation was 33.1 ± 17.6 years old, with 9 males (64%). Of these patients, 7 (50%) presented with acute heart failure and 3 (21%) with syncope, including 1 documented ventricular tachycardia. RV EF < 35% was identified in 7 (50%) of these patients. Patients with RV EF < 35% presented at a higher median New York Heart Association class (1 [IQR 1-2] vs. 3 [IQR 2-4], P = 0.021) and had significantly lower LV EF (50.7% ± 15.4 vs. 21.8% ± 19.9, P = 0.029), higher LV end diastolic (100.9 ml/m(2) ± 22.3 vs. 159.1 ml/m(2) ± 36.0, P = 0.002) and systolic volume indices (52.0 ml/m(2) ± 25.8 vs. 129.1 ml/m(2) ± 48.4, P = 0.002), higher LV wall motion score index (1.3 ± 0.5 vs. 2.2 ± 0.6, P = 0.004) and higher ratio of LV non-compacted to compacted myocardium (3.3 ± 0.6 vs. 4.1 ± 0.8, P = 0.026). All 4 patients that had ventricular tachycardia also had RV dysfunction. RV dysfunction was present in half of patients with LVNC. Significant RV dysfunction seems to be a marker of advanced LVNC and may carry a worse prognosis. Further studies in a larger sample of patients are needed to confirm those observations.
Background Subcutaneous implantable cardioverter defibrillators (S‐ICDs) have gained increasing popularity because of certain advantages over transvenous ICDs. However, while conventional ICDs require a single surgical incision to implant, S‐ICDS need two or three incisions, making them less appealing. Objective This study sought out to investigate the feasibility of using a single‐incision technique to implant S‐ICDs. Methods Patients qualifying for S‐ICDs were considered for a single incision. A single incision is performed by making a left inframammary incision and then the subcutaneous tissue is dissected medially toward the lower sternum. Two sutures are placed in the fascia in the xiphoid area to anchor the lead and a tunneling tool is used to dissect the tissue to place the lead parallel to the sternum. Then subcutaneous tissues are dissected down the lateral chest wall over the muscle fascia to create the pulse generator pocket in the vicinity of the fifth and sixth intercostal spaces and near the mid‐axillary line. Results Eleven patients (six males and five females) successfully underwent S‐ICD implantation with a single incision without acute complications (64% for primary prevention). The mean age is 47.4 ± 15.8 years. There were no lead dislodgements, inappropriate shocks, or any other issues during a median follow‐up of 10 months (interquartile range 5–17). One patient had a successful appropriate shock for ventricular fibrillation about one year after device implant. Conclusions A single incision for subcutaneous ICDs is feasible and safe in our early experience.
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