Clinical parameters to optimize patient selection for subcutaneous and transvenous implantable defibrillator therapy

Quast, Anne‐Floor B.E.; Brouwer, Tom F.; Tjong, Fleur V.Y.; Wilde, Arthur A.M.; Knops, Reinoud E.

doi:10.1111/pace.13411

Cited by 5 publications

(3 citation statements)

References 15 publications

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“…The occurrence of episodes of NSVT in subjects with left ventricular dysfunction is associated with an increase risk in arrhythmic events. This is true both for NSVTs observed during continuous ambulatory ECG monitoring [ 10 ] and for their documentation during ICDs interrogation [ 3 ]. Although there are few updated data on myocardial tissue characterization, it has classically been assumed that, in subjects with ischemic heart disease, the electrophysiological substrate of subjects with only episodes of NSVT, sustained MVT or VF is different.…”

Section: Discussionmentioning

confidence: 99%

Cycle length of nonsustanied ventricular tachycardias among ICD patients: implications on subsequent appropriate therapies

Jiménez‐Candil

Duran

Oterino

et al. 2021

BMC Cardiovasc Disord

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Background ICD patients with episodes of nonsustained ventricular tachycardias (NSVT) are at risk of appropriate therapies. However, the relationship between the cycle length (CL) of such NSVTs and the subsequent incidence of appropriate interventions is unknown. Methods 416 ICD patients with LVEF < 45% were studied. ICD programming was standardized. NSVT was defined as any VT of 5 or more beats at ≥ 150 bpm occurred in the first 6 months after implantation that terminated spontaneously and was not preceded by any appropriate therapy. The mean follow-up was 41 ± 27 months. Results We analyzed 2201 NSVTs (mean CL = 323 ms) that occurred in 250 patients; 111 of such episodes were fast (CL ≤ 300 ms). Secondary prevention (HR = 1.7; p < 0.001), number of NSVT episodes (HR = 1.05; 95% CI 1.04–1.07; p < 0.001) and beta-blocker treatment (HR = 0.7; p = 0.04) were independent predictors of appropriate interventions; however, the mean CL of NSVTs was not (p = 0.6). There was a correlation between the mean CL of NSVTs and the CL of the first monomorphic VT: r = 0.88; p < 0.001. This correlation was especially robust in individuals with > 5 NSVTs (r = 0.97; p < 0.001), with an agreement between both values greater than 95%. Patients with any fast NSVT experienced a higher incidence of VF episodes (26%) compared to those without NVSTs (3%) or with only slow NSVTs (7%); p < 0.001. Conclusions Unlike the burden, the CL of NSVTs is not a predictor of subsequent appropriate interventions. However, there is a close relationship between the CL of NSVTs and that of arrhythmias that will later lead to appropriate therapies.

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Section: Discussionmentioning

confidence: 99%

Cycle length of nonsustanied ventricular tachycardias among ICD patients: implications on subsequent appropriate therapies

Jiménez‐Candil

Duran

Oterino

et al. 2021

BMC Cardiovasc Disord

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“…However, the inability of S-ICD to deliver ATP therapy is another non-negligible concern. Indeed, the history of monomorphic VT or non-sustained ventricular tachycardia (NSVT) increases the chance of appropriate ATP therapy in 1 out of 10 patients and 1 out of 3 patients, respectively [ 62 ]. This condition may be considered among all discriminant factors in the choice between S-ICD and TV-ICD.…”

Section: Indications For S-icd Implantmentioning

confidence: 99%

Subcutaneous Implantable Cardioverter Defibrillator: A Contemporary Overview

Guarracini,

Preda,

Bonvicini

et al. 2023

Life

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The difference between subcutaneous implantable cardioverter defibrillators (S-ICDs) and transvenous ICDs (TV-ICDs) concerns a whole extra thoracic implantation, including a defibrillator coil and pulse generator, without endovascular components. The improved safety profile has allowed the S-ICD to be rapidly taken up, especially among younger patients. Reports of its role in different cardiac diseases at high risk of SCD such as hypertrophic and arrhythmic cardiomyopathies, as well as channelopathies, is increasing. S-ICDs show comparable efficacy, reliability, and safety outcomes compared to TV-ICD. However, some technical issues (i.e., the inability to perform anti-bradycardia pacing) strongly limit the employment of S-ICDs. Therefore, it still remains only an alternative to the traditional ICD thus far. This review aims to provide a contemporary overview of the role of S-ICDs compared to TV-ICDs in clinical practice, including technical aspects regarding device manufacture and implantation techniques. Newer outlooks and future perspectives of S-ICDs are also brought up to date.

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“…Quast et al identified a prior history of monomorphic ventricular tachycardia or non-sustained ventricular tachycardia as the only predictor for appropriate and successful ATP. 13 In the pooled analysis of IDE study and EFFORTLESS registry, four patients of 882 patients required S-ICD extraction for a new pacing requirement after 651 days-only one was for ATP. 14 ing has also been shown to reduce inappropriate exclusions in cases of Brugada syndrome, congenital heart disease, 19 and hypertrophic cardiomyopathy.…”

Section: Patient Selectionmentioning

confidence: 99%

Perioperative considerations during implantation of the subcutaneous defibrillator: State‐of‐the‐art review

Singh

Afzal

Weiss

2020

Pacing Clinical Electrophis

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The subcutaneous implantable cardioverter‐defibrillator (S‐ICD) is an important tool in the armamentarium of an electrophysiologist. Multiple randomized trials over the last decade have shown that S‐ICDs are as efficacious as the transvenous ICDs and eliminate complications related to vascular access. In this review, we highlight issues unique to S‐ICD implantation, focusing not only on the surgical implantation procedure, but also the pre‐ and postimplant management of the patient.

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Clinical parameters to optimize patient selection for subcutaneous and transvenous implantable defibrillator therapy

Abstract: A history of NSVT or MVT is a significant predictor for appropriate and successful ATP therapy. One in three patients with NSVT or MVT received appropriate ATP versus one in 10 patients without a history of NSVT or MVT over a 2-year period of follow-up.

Cited by 5 publications

References 15 publications

Cycle length of nonsustanied ventricular tachycardias among ICD patients: implications on subsequent appropriate therapies

Cycle length of nonsustanied ventricular tachycardias among ICD patients: implications on subsequent appropriate therapies

Subcutaneous Implantable Cardioverter Defibrillator: A Contemporary Overview

Perioperative considerations during implantation of the subcutaneous defibrillator: State‐of‐the‐art review

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