IntroductionThe implantable cardioverter defibrillator had been increasing the survival
of patients at high risk for sudden cardiac death. The subcutaneous
implantable cardioverter defibrillator was developed to mitigate the
complications inherent to lead placement into cardiovascular system.ObjectiveTo report the initial experience of 18 consecutive cases of subcutaneous
implantable cardioverter defibrillator implantation showing the indications,
potential pitfalls and perioperative complications.MethodsBetween September 2016 and March 2017, 18 patients with indication for
primary and secondary prevention of sudden cardiac death, with no
concomitant indication for artificial cardiac pacing, were included.ResultsThe implantation of the subcutaneous implantable cardioverter defibrillator
successfully performed in 18 patients. It was difficult to place the
subcutaneous lead at the parasternal line in two patients. One patient
returned a week after the procedure complaining about an increase in pain
intensity at pulse generator pocket site, which was associated with edema,
temperature rising and hyperemia. Two patients took antialgic medication for
five days after surgery. A reintervention was necessary in one patient to
replace the lead in order to correct inappropriate shocks caused by
myopotential oversensing.ConclusionIn our initial experience, although the subcutaneous implantable cardioverter
defibrillator implantation is a less-invasive, simple-accomplishment
procedure, it resulted in a bloodier surgery perhaps requiring an operative
care different from the conventional. Inappropriate shock by oversensing is
a reality in this system, which should be overcame in order not to become a
limiting issue for its indication.
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