Acute shock efficacy of the subcutaneous implantable cardioverter‐defibrillator according to the implantation technique

Francia, Pietro; Adduci, Carmen; Angeletti, Andrea; Ottaviano, Luca; Perrotta, Laura; Vivo, Stefano De; Bongiorni, Maria Grazia; Migliore, Federico; Russo, Antonio Dello; Filippo, Paolo De; Caravati, Fabrizio; Nigro, Gerardo; Palmisano, Pietro; Viani, Stefano; D’Onofrio, Antonio; Lovecchio, Mariolina; Valsecchi, Sergio; Ziacchi, Matteo

doi:10.1111/jce.15081

Cited by 8 publications

(5 citation statements)

References 27 publications

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“…Indeed inter/submuscular implantation with posterior generator positioning plus ensuring minimal subcutaneous fat under the sternal coil to achieve a low PRAETORIAN score maximise the chances of optimal DFT [68][69][70] .Taken together, these studies support the concept that all contemporary ICDs are safe and effective in HCM patients, and that there are no disease-specific or left ventricular massrelated concerns regarding S-ICD defibrillation efficacy.…”

Section: Defibrillation Threshold In Hcm Patientsmentioning

confidence: 55%

Implantable cardioverter-defibrillators for hypertrophic cardiomyopathy: The Times They Are a-Changin’

et al. 2021

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The implantable cardioverter-defibrillator (ICD) is a life-saving therapy in patients with hypertrophic cardiomyopathy (HCM) at high risk of sudden cardiac death. The heterogeneity of clinical scenarios in HCM and the availability of ICDs with distinct characteristics emphasizes the need for selecting the right device for the right patient. There is growing awareness that unnecessarily complex devices can lead to short- and long-term complications without adding significant clinical benefits. Young patients have the greatest potential years of life gained from the ICD but are also most exposed to device-related complications. This increases the complexity of decision-making of ICD prescription in these often otherwise well patients in whom device selection should be tailored to preserve survival benefit without introducing morbidity. In the light of the multiple clinical phenotypes characterizing HCM, the present article offers evidence-based perspectives helpful in predicting the individual impact of the ICD and choosing the most appropriate device.

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Section: Defibrillation Threshold In Hcm Patientsmentioning

confidence: 55%

Implantable cardioverter-defibrillators for hypertrophic cardiomyopathy: The Times They Are a-Changin’

et al. 2021

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“…The above considerations also have to be commented on from the clinical perspective. According to available reports [ 21 , 22 ], the widely adopted intermuscular technique of implantation results in a consistently dorsal position of the device and its proximity to the costal plane (the DFT-increasing layer of subcutaneous fat tissue is left above the device by definition). Tunneling of the lead, and hence its final position in relation to the sternum and ribs, remains the most variable yet crucial part of the procedure in terms of the final position of the system and its DFT [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Real-Life Inter-Rater Variability of the PRAETORIAN Score Values

Budrejko

Kempa

Krupa

et al. 2022

IJERPH

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(1) Background: The PRAETORIAN score is a tool developed for postoperative evaluation of the position of subcutaneous implantable cardioverter-defibrillator systems. The aim of our study was to evaluate the real-life inter-rater variability of the PRAETORIAN score, based on chest radiographs of S-ICD patients reviewed by independent clinical raters. (2) Methods: Postoperative chest X-rays of patients that underwent S-ICD implantation were evaluated by five clinical raters who gave values of the PRAETORIAN score. Ratings were then compared in a fully crossed manner to determine the inter-rater variability of the attributed scores. (3) Results: In total, 87 patients were included in the study. In the case of the most important final risk category of the PRAETORIAN score, the mean Light’s kappa was 0.804, the Fleiss’ kappa was 0.249, and the intraclass correlation was 0.38. The final risk category was identically determined by all five raters in 75.86% of patients, by four raters in 14.94%, and by three raters in 9.20% of patients. (4) Conclusions: The overall inter-rater variability of the PRAETORIAN score in a group of electrophysiologists experienced in S-ICD implantation, yet previously naive to the PRAETORIAN score, and self-trained in its utilization, was only modest in our study. Appropriate use of the score might require training of clinical raters.

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“… 19–21 Subcutaneous ICD lead tunnelling was performed according to the two- or three-incision technique, and the pulse generator was positioned in a subcutaneous or intermuscular pocket. 22–24 Post-implant defibrillation testing was conducted according to the centre’s standard practice. 25 , 26 …”

Section: Methodsmentioning

confidence: 99%

Clinical course of hypertrophic cardiomyopathy patients implanted with a transvenous or subcutaneous defibrillator

Francia,

Ziacchi,

Adduci

et al. 2023

Europace

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Aims The implantable cardioverter-defibrillator (ICD) is a life-saving therapy in patients with hypertrophic cardiomyopathy (HCM) at risk of sudden cardiac death. Implantable cardioverter-defibrillator complications are of concern. The subcutaneous ICD (S-ICD) does not use transvenous leads and is expected to reduce complications. However, it does not provide bradycardia and anti-tachycardia pacing (ATP). The aim of this study was to compare appropriate and inappropriate ICD interventions, complications, disease-related adverse events and mortality between HCM patients implanted with a S- or transvenous (TV)-ICD. Methods and results Consecutive HCM patients implanted with a S- (n = 216) or TV-ICD (n = 211) were enrolled. Propensity-adjusted cumulative Kaplan–Meier curves and multivariate Cox proportional hazard ratios were used to compare 5-year event-free survival and the risk of events. The S-ICD patients had lower 5-year risk of appropriate (HR: 0.32; 95%CI: 0.15–0.65; P = 0.002) and inappropriate (HR: 0.44; 95%CI: 0.20–0.95; P = 0.038) ICD interventions, driven by a high incidence of ATP therapy in the TV-ICD group. The S- and TV-ICD patients experienced similar 5-year rate of device-related complications, albeit the risk of major lead-related complications was lower in S-ICD patients (HR: 0.17; 95%CI: 0.038–0.79; P = 0.023). The TV- and S-ICD patients displayed similar risk of disease-related complications (HR: 0.64; 95%CI: 0.27–1.52; P = 0.309) and mortality (HR: 0.74; 95%CI: 0.29–1.87; P = 0.521). Conclusion Hypertrophic cardiomyopathy patients implanted with a S-ICD had lower 5-year risk of appropriate and inappropriate ICD therapies as well as of major lead-related complications as compared to those implanted with a TV-ICD. Long-term comparative follow-up studies will clarify whether the lower incidence of major lead-related complications will translate into a morbidity or survival benefit.

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Acute shock efficacy of the subcutaneous implantable cardioverter‐defibrillator according to the implantation technique

Cited by 8 publications

References 27 publications

Implantable cardioverter-defibrillators for hypertrophic cardiomyopathy: The Times They Are a-Changin’

Implantable cardioverter-defibrillators for hypertrophic cardiomyopathy: The Times They Are a-Changin’

Real-Life Inter-Rater Variability of the PRAETORIAN Score Values

Clinical course of hypertrophic cardiomyopathy patients implanted with a transvenous or subcutaneous defibrillator

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