Device updates successfully reduce T‑wave oversensing and inappropriate shocks in subcutaneous ICD patients

Larbig, Robert; Motloch, Lukas J.; Bettin, Markus; Fischer, Alicia Jeanette; Bode, Niklas; Frommeyer, Gerrit; Loeher, Andreas; Koebe, Julia; Reinke, Florian; Eckardt, Lars

doi:10.1007/s12471-018-1160-y

Cited by 7 publications

(10 citation statements)

References 15 publications

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“…While S‐ICD prevents drawbacks of the transvenous lead, an early experience with traditional implantation technique was associated with sizable rates of complications due to the large‐volume pulse generator, including skin erosion, infection, and discomfort, especially, in thin individuals . For these reasons, new implantation techniques were explored to offer both operative and cosmetic advantages, including the intermuscular two‐incision technique and submuscular technique . The two‐incision technique has been developed first to prevent potential skin erosion and infection by omitting the superior parasternal incision and to improve the cosmetic result .…”

Section: Discussionmentioning

confidence: 99%

“…The most commonly adopted technique is the intermuscular two‐incision technique. This approach can offer better cosmetic results due to the deeper position of the pulse, and seems to prevent pocket complications and infections . Furthermore, anatomical landmarks ensure the right position of the pulse generator in obese patients .…”

Section: Discussionmentioning

confidence: 99%

“…This approach can offer better cosmetic results due to the deeper position of the pulse, and seems to prevent pocket complications and infections . Furthermore, anatomical landmarks ensure the right position of the pulse generator in obese patients . Moreover, using the intermuscular pocket approach, a more posterior placement (dorsally) of the device with less adipose tissue between the pulse generator and the chest (Figure ) leads to lower defibrillator threshold test (DFT) compared with the traditional technique, and may help in troubleshooting patients with unacceptably high DFT while likely improving sensing performance .…”

Section: Discussionmentioning

confidence: 99%

“…In 2015, the new S‐ICD and EMBLEM S‐ICD, with this double detection algorithm as the standard, became available. A study by Larbig et al showed that an updated device and software update (including the “SMART Pass”) successfully reduced the incidence of TWOS in S‐ICD patients, thus encouraging the efforts in the development of new devices and algorithms to reduce the incidence of inappropriate shocks. In contrast with previous studies, we observed a lower rate of inappropriate shocks (2.9%), and TWOS was reported in only one case.…”

Section: Discussionmentioning

confidence: 99%

“…Beginning in March 2015, a new generation of the S‐ICD device, the EMBLEM device, has been developed and commercially launched by Boston Scientific (Marlborough, MA). The second‐generation S‐ICD has several favorable features when compared with the first‐generation S‐ICD, including a smaller generator size, an increased battery life, and a software upgrade, which should further improve S‐ICD performance while reducing inappropriate therapies and pocket complications . In fact, while continuous research in the field of S‐ICD technology and implantation technique is ongoing, EMBLEM S‐ICD and intermuscular two‐incision technique represent the most recent advances.…”

Section: Introductionmentioning

confidence: 99%

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Multicentre experience with the second‐generation subcutaneous implantable cardioverter defibrillator and the intermuscular two‐incision implantation technique

Migliore

Mattesi

Franceschi

et al. 2019

Cardiovasc electrophysiol

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Introduction:The recently developed second-generation subcutaneous implantable cardioverter defibrillator (S-ICD) and the intermuscular two-incision implantation technique demonstrate potential favorable features that reduce inappropriate shocks and complications. However, data concerning large patient populations are lacking.The aim of this multicentre prospective study was to evaluate the safety and outcome of second-generation S-ICD using the intermuscular two-incision technique in a large population study. Methods and Results:The study population included 101 consecutive patients (75% male; mean age, 45 ± 13 years) who received second-generation S-ICD (EMBLEM; Boston Scientific, Marlborough, MA) implantation using the intermuscular twoincision technique as an alternative to the standard implantation technique. Twenty nine (29%) patients were implanted for secondary prevention. Twenty four (24%) patients had a previously implanted transvenous ICD. All patients were implanted without any procedure-related complications. Defibrillation testing was performed in 80 (79%) patients, and ventricular tachycardia was successfully converted at less than or equal to 65 J in 98.75% (79/80) of patients without pulse generator adjustments.During a median follow-up of 21 ± 10 months, no complications requiring surgical revision or local or systemic device-related infections were observed. Ten patients Disclosures: None.(9.9%) received appropriate and successful shocks for ventricular arrhythmias. Three (2.9%) patients experienced inappropriate shocks due to oversensing the cardiac signal (n = 1), noncardiac signal (n = 1), and a combination of both cardiac and noncardiac signals (n = 1), with one patient requiring device explantation. No patients required device explantation due to antitachycardia pacing indications.Conclusions: According to our multicentre study, second-generation S-ICD implanted with the intermuscular two-incision technique is an available safe combination and appears to be associated with a low risk of complications, such as inappropriate shocks. K E Y W O R D S implantable cardioverter defibrillator, intermuscular technique, subcutaneous implantable cardioverter defibrillator, two-incision technique 1 | INTRODUCTION Current guidelines state that the subcutaneous implantable cardioverter defibrillator (S-ICD) represents a therapeutic option for patients at highrisk of sudden cardiac death, in whom pacing or cardiac resynchronization therapy is not required. 1 The recent development of an entirely S-ICD constitutes a major evolution of defibrillator technology, and there has been consistent clinical evidence regarding its safety. 2-4 The standard S-ICD implantation technique requires three incisions and the placement of a midaxillary pulse generator under subcutaneous tissue. However, various alternative implantation techniques have been explored, 3 including the intermuscular two-incision technique. 4-6 New techniques may reduce complications such as erosion while improving the esthetic appeal of the puls...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%