Current Evidence Base for Use of the Implantable Cardioverter–Defibrillator

Hohnloser, Stefan H.; Israel, Carsten W.

doi:10.1161/circulationaha.112.000547

Cited by 27 publications

(22 citation statements)

References 96 publications

(89 reference statements)

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“…In Brugada patients the incidence of endocardial lead dysfunction was reported to be as high as 2%/year versus 0.58%/year of the general ICD population and the overall risk of device-related complications can be as high as 8-9%/year, so they would benefit from a therapeutic option not requiring endocardial lead implantation [1, 2, 28]. However the issues of S-ICD therapy efficacy and detection accuracy are particularly relevant in Brugada Syndrome: indeed, the unique QRS to T wave ratio and morphology, carries the risk of double QRS/T wave counting and inappropriate therapy.…”

Section: Choosing the Right Patient For The S-icdmentioning

confidence: 99%

“…The S-ICD could represent a valuable option also in hypertrophic cardiomyopathy, as traditional transvenous ICD is associated with a high complication rate [1, 2]. …”

Section: Choosing the Right Patient For The S-icdmentioning

confidence: 99%

“…The implantable cardioverter-defibrillator (ICD) has been a major advancement in the hard battle against sudden cardiac death (SCD), with extensive and secure evidence supporting its use [1, 2]. Since the first human implantation in 1980 we have observed a striking evolution of these devices, from surgically-applied epicardial patches with a big abdominally-placed generator to miniaturized pectoral systems capable not only of defibrillation but also of pacing and cardiac resynchronization and with leads inserted into venous circulation through cephalic, axillary or subclavian veins.…”

Section: Introductionmentioning

confidence: 99%

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The Entirely Subcutaneous Defibrillator (S-Icd): State of the Art and Selection of the Ideal Candidate

Maria

Olaru²,

Cappelli³

2014

CCR

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The traditional transvenous defibrillator has been one of the greatest advancement in Cardiology in the last 30 years and has demonstrated to reduce arrhythmic and total mortality in selected patients. However the traditional defibrillator can have a high price to pay in terms of complications, the “weakest link” being the transvenous/endocardial leads. The entirely subcutaneous defibrillator (S-ICD) has recently entered into the clinical scenario and represents a valid alternative to the transvenous device. S-ICD can provide substantial advantages, especially among some subgroups of patients (i.e. after device infection, in young patients and arrhythmogenic syndromes). However, given its characteristics, it is fundamental to choose patients that can benefit the most. In this review we will describe advantages and limitations of the S-ICD and point-out how to select the “ideal candidate” for the implantation.

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Section: Choosing the Right Patient For The S-icdmentioning

confidence: 99%

“…The S-ICD could represent a valuable option also in hypertrophic cardiomyopathy, as traditional transvenous ICD is associated with a high complication rate [1, 2]. …”

Section: Choosing the Right Patient For The S-icdmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Entirely Subcutaneous Defibrillator (S-Icd): State of the Art and Selection of the Ideal Candidate

Maria

Olaru²,

Cappelli³

2014

CCR

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“…[12][13][14][15] Additionally, implantable cardioverter-defibrillators can further improve prognosis by decreasing sudden deaths. 16,17 However, they do not target ventricular failure itself; instead, they just treat one of its consequences: potentially fatal arrhythmias. Therefore, further improving prognosis of this population remains an unmet clinical need.…”

Section: Introductionmentioning

confidence: 99%

Stem‐cell therapy in ST‐segment elevation myocardial infarction with reduced ejection fraction: A multicenter, double‐blind randomized trial

Nicolau

Furtado

Silva

et al. 2018

Clinical Cardiology

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BackgroundLeft ventricular ejection fraction (LVEF) is a major determinant of long‐term prognosis after ST‐segment elevation myocardial infarction (STEMI). STEMI patients with reduced LVEF have a poor prognosis, despite successful reperfusion and the use of renin‐angiotensin‐aldosterone inhibitors.HypothesisIntracoronary infusion of bone marrow–derived mononuclear cells (BMMC) may improve LVEF in STEMI patients successfully reperfused.MethodsThe main inclusion criteria for this double‐blind, randomized, multicenter study were patient age 30 to 80 years, LVEF ≤50%, successful angioplasty of infarct‐related artery, and regional dysfunction in the infarct‐related area analyzed before cell injection. Cardiac magnetic resonance imaging was used to assess LVEF, left ventricular volumes, and infarct size at 7 to 9 days and 6 months post–myocardial infarction.ResultsOne hundred and twenty‐one patients were included (66 patients in the BMMC group and 55 patients in the placebo group). The primary endpoint, mean LVEF, was similar between both groups at baseline (44.63% ± 10.74% vs 42.23% ± 10.33%; P = 0.21) and at 6 months (44.74% ± 12.95 % vs 43.50 ± 12.43%; P = 0.59). The groups were also similar regarding the difference between baseline and 6 months (0.11% ± 8.5% vs 1.27% ± 8.93%; P = 0.46). Other parameters of left ventricular remodeling, such as systolic and diastolic volumes, as well as infarct size, were also similar between groups.ConclusionsIn this randomized, multicenter, double‐blind trial, BMMC intracoronary infusion did not improve left ventricular remodeling or decrease infarct size.

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“…Its effectiveness is largely not questioned [1], although the appropriate population who should receive an ICD is still being refined [2]. The wearable cardioverter-defibrillator (WCD) was approved by the U.S. Food and Drug Administration in 2001 as a temporary device that continuously monitors cardiac rhythm and is highly effective in terminating potentially lethal arrhythmias [3][4][5].…”

mentioning

confidence: 99%

Long-term use of the wearable cardioverter-defibrillator: prolonging life or prolonging indecision?

Adelstein

2016

J Interv Card Electrophysiol

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Predicting future risk is difficult. Predicting sudden cardiac death (SCD) is a particular challenge, given its finality, suddenness, inherent unpredictability, and medicolegal ramifications. Yet the task of prognosticating SCD risk is often thrust upon electrophysiologists in the setting of a new cardiomyopathy.The implantable cardioverter-defibrillator (ICD) mitigates SCD risk in patients at increased risk for ventricular arrhythmias. Its effectiveness is largely not questioned [1], although the appropriate population who should receive an ICD is still being refined [2]. The wearable cardioverter-defibrillator (WCD) was approved by the U.S. Food and Drug Administration in 2001 as a temporary device that continuously monitors cardiac rhythm and is highly effective in terminating potentially lethal arrhythmias [3][4][5]. It has been marketed for use in patients deemed at elevated risk of SCD from ventricular arrhythmias in whom a permanent ICD is either contraindicated or under consideration. To date, there have been several publications describing its use in clinical registries [5,6], national experiences [4,7], and single-center studies [8], primarily as a short-term means of mitigating risk while patients undergo more comprehensive evaluation or titration of medical therapy. There are, at present, no currently published randomized WCD clinical trials demonstrating a mortality benefit.In this issue of the Journal of Interventional Cardiac Electrophysiology, Lamichhane et al. [9] describe the U.S. experience with long-term WCD use in patients with ischemic or non-ischemic cardiomyopathy, primary or secondary prevention indication, no prior ICD, and LVEF ≤35%. Remarkably, 220 patients were prescribed with the WCD for ≥1 year, and the median number of actual use days was 394. Despite such prolonged use, over half of all the patients wore the WCD >80% of the day.Long-term WCD use has not been heretofore described in the literature. In the present study, some reasons cited for longterm use rather than ICD implantation included continued optimization of medical therapy (7.7%), non-compliance for follow-up (10%), patient postponement or unwillingness to have an ICD (16.8%), ongoing evaluation for an ICD (34.5%), and contraindication to an ICD because of cancer, poor prognosis, or vascular access issues (23.2%). The incidence of appropriate shocks was 4.1%; 9 of the 220 patients received a shock, 3 of whom already had prior sustained ventricular arrhythmias (i.e., secondary prevention indication). Of the remaining 6 (2.9%) primary prevention patients, 4 had ischemic cardiomyopathy and 2 had non-ischemic cardiomyopathy. One non-ischemic patient had reported WolffParkinson-White syndrome, and another had chronic lymphocytic leukemia.The WCD has proven effectiveness in terminating tachyarrhythmias. In this study, the WCD successfully terminated 92% of VT/VF episodes. However, there is no mention of cost, either personal or monetary. On a psychosocial level, wearing the WCD consistently for a year requires tremendous pers...

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Current Evidence Base for Use of the Implantable Cardioverter–Defibrillator

Cited by 27 publications

References 96 publications

The Entirely Subcutaneous Defibrillator (S-Icd): State of the Art and Selection of the Ideal Candidate

The Entirely Subcutaneous Defibrillator (S-Icd): State of the Art and Selection of the Ideal Candidate

Stem‐cell therapy in ST‐segment elevation myocardial infarction with reduced ejection fraction: A multicenter, double‐blind randomized trial

Long-term use of the wearable cardioverter-defibrillator: prolonging life or prolonging indecision?

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