Determinants of Subcutaneous Implantable Cardioverter-Defibrillator Efficacy

Abstract

The model suggests that an S-ICD implantation strategy involving posterior generator location and coil and generator directly over the fascia without underlying fat is likely to markedly lower DFTs with the S-ICD and assist in troubleshooting of patients with unacceptably high DFTs.

Subcutaneous implantable cardioverter‐defibrillator in primary and secondary prevention of sudden cardiac death: A meta‐analysis

“…Four studies reported problems of device malfunction such as rates of inappropriate arrhythmia detection (two studies; N = 418) and device failure (four studies; N = 1338) . Overall, no differences were found between groups in the meta‐analysis for inappropriate arrhythmia detection (OR = 3.05; 95% CI: 0.47, 19.62), or device failure (OR = 2.01; 95% CI: 0.50, 8.09).…”

Anesthesia for subcutaneous implantable cardioverter‐defibrillator implantation: Perspectives from the clinical experience of a U.S. panel of physicians

“…The best anesthetic for S‐ICD implantation and DT is unknown, as a paucity of randomized data exists; however, a review of the literature demonstrates efficacy and safety for S‐ICD implantation using several modalities: GA, MAC, regional anesthesia, and local anesthesia supplemented with sedation/analgesia techniques . These data suggest that a successful procedure can be accomplished with a variety of anesthetic modalities and thus selection of an anesthetic is often based upon multiple features including patient comorbidities, physician preference, and hospital policy.…”

“…Regional techniques, which provide coverage to these areas, include thoracic epidural and thoracic paravertebral block. A combination of more recently described truncal plane nerve block techniques including the PECS I&II, the transversus thoracic muscle plane, and the serratus anterior plane blocks also provide coverage of these areas . While thoracic epidural block provides dense coverage of the chest wall, it may be of limited utility in this patient population.…”

“…The PECS II block anesthetizes the intercostobrachial nerve, intercostal nerves three through six, and the long thoracic nerve and was developed for breast surgery . The serratus anterior plane and the transversus thoracic muscle plane blocks anesthetize the long thoracic and thoracodorsal nerves, lateral cutaneous and anterior cutaneous branches of the thoracic intercostal nerves, and provide analgesia to the anterolateral chest wall and the parasternal area, respectively, and have been reported to provide significant postprocedure analgesia after S‐ICD implantation . Even with adequate regional block, patients undergoing S‐ICD may still require GA or MAC but perhaps to a lesser extent.…”

“…Even with adequate regional block, patients undergoing S‐ICD may still require GA or MAC but perhaps to a lesser extent. To date, however, there are only a few case reports and a retrospective study describing the usefulness of regional anesthesia use for S‐ICD implantation and/or postprocedure pain control, and this technique may not be the best initial anesthetic approach, but an analgesic adjunct to GA or MAC …”