Exercise stress test reveals ineligibility for subcutaneous implantable cardioverter defibrillator in patients with Brugada syndrome

Tachibana, Motomi; Nishii, Nobuhiro; Morita, Hiroshi; Nakagawa, Koji; Watanabe, Atsuyuki; Nakamura, Kazufumi; Ito, Hiroshi

doi:10.1111/jce.13315

Cited by 23 publications

(16 citation statements)

References 25 publications

(41 reference statements)

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“…In their study, in 13 of 69 patients (18.4%) the sensing vector was changed due to the automatic setup prior to discharge, which is comparable to our results. 16 Sharma et al 17 12 In the first 17 patients of the cited study, an automatic setup was performed at every appointment in the first year of follow- have significantly reduced T-wave oversensing, 13 avoidance of IASs is still a problem to solve.…”

Section: Resultsmentioning

confidence: 99%

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Change of sensing vector in the subcutaneous ICD during follow‐up and after device replacement

Bettin

Rath

Ellermann

et al. 2018

Cardiovasc electrophysiol

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Section: Resultsmentioning

confidence: 99%

“…15 Furthermore, there is evidence that ECG morphology varies at higher heart rates. 16 Sharma et al 17…”

Section: Resultsmentioning

confidence: 99%

Change of sensing vector in the subcutaneous ICD during follow‐up and after device replacement

Bettin

Rath

Ellermann

et al. 2018

Cardiovasc electrophysiol

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“…The median length of hospital stay was not significantly different in patients with S-ICD and TV-ICD (13 days [IQR: 10-20.5] vs 12 days [IQR: [10][11][12][13][14][15][16][17][18]). The prevalence of in-hospital complications after ICD implantation was similar between the groups: lead removal (0 vs 2), blood transfusion (0 vs 1), and heart failure (2 vs 3).…”

Section: Discussionmentioning

confidence: 95%

Patient characteristics and in‐hospital complications of subcutaneous implantable cardioverter‐defibrillator for Brugada syndrome in Japan

Kawamura

Nakajima

Kitamura

et al. 2019

Journal of Arrhythmia

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BackgroundClinical features and complications of subcutaneous implantable cardioverter‐defibrillator (S‐ICD) implantation for Brugada syndrome have not been well studied.MethodsWe used the Japanese Diagnosis Procedure Combination database to retrospectively investigate patients who had undergone ICD implantation between April 2016 and March 2017. We compared the characteristics and in‐hospital complications of patients with Brugada syndrome implanted with S‐ICD or transvenous (TV)‐ICD.ResultsWe extracted 3090 patients who received ICD implantation. Among them, we identified 278 Brugada patients. The mean age was 43 ± 14.4 years and 262 (94%) were male. Of these 278 patients, 136 (49%) received S‐ICD and 142 (51%) received TV‐ICD. TV‐ICD recipients had a history of atrial fibrillation more frequently compared with S‐ICD recipients. The median (interquartile range) of length of hospital stay was not significantly different between patients with S‐ICD and TV‐ICD (13 days [10‐20.5] vs 12 days [10‐18], respectively). The prevalence of in‐hospital complications after ICD implantation was similar between the two groups. There were no patients with cardiac tamponade, hemothorax, pneumothorax, cardiovascular event, stroke, and death following the procedure during hospitalization in either group.ConclusionsShort‐term safety of S‐ICD implantation may be identical to that of TV‐ICD. Large prospective studies are warranted to compare the effects and long‐term safety of S‐ICD compared with TV‐ICD.

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“…We have previously reported that the amplitude of T waves increased during exercise testing, and some lead vectors were erroneously classified as unsuitable for S‐ICD . As a result, patients who were eligible at rest became ineligible during exercise testing.…”

Section: Discussionmentioning

confidence: 99%

“…S‐ICD eligibility was determined using the Boston Scientific screening template, at the following time points: (a) supine rest; (b) on standing; (c) at peak exercise; (d) at 1‐minute recovery; (e) at 3‐minutes recovery; and (f) at 5‐minutes recovery. A vector was considered eligible when all points from ECG met the eligibility criteria during TMT …”

Section: Methodsmentioning

confidence: 99%

SMART pass will prevent inappropriate operation of S‐ICD

Tachibana

Nishii

Banba

et al. 2018

Journal of Arrhythmia

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BackgroundCompared to screening ECG before implantation of a subcutaneous implantable cardioverter‐defibrillator (S‐ICD), selectable vectors without T‐wave oversensing increase after S‐ICD implantation. Newer algorithms have recently become available to reduce T‐wave oversensing, such as SMART pass (SP). With this function, more selectable vectors are identified after S‐ICD implantation. However, this improvement in eligibility utilizing SP has not yet been well validated. We aimed to clarify S‐ICD eligibility before and after S‐ICD implantation with and without SP.MethodsParticipants comprised 34 patients implanted with an S‐ICD at Okayama University Hospital and its affiliated hospitals between February 2016 and August 2017. A total of 102 S‐ICD vectors were assessed for eligibility before and after S‐ICD implantation, at rest and during exercise testing. Vector availability was evaluated in the presence and absence of SP after S‐ICD implantation.ResultsSubcutaneous implantable cardioverter‐defibrillator eligibility was significantly better after implantation even without SP than S‐ICD screening before S‐ICD implantation, both at rest (before 65.7% vs after 95.1%, P < 0.01) and during exercise (before 59.3% vs after 90.6%, P < 0.01). SP improved S‐ICD eligibility during exercise (SP on 97.9% vs off 90.6%, P = 0.03). Multivariate analysis showed the prevalence of S‐ICD eligibility increased significantly after S‐ICD implantation compared to screening before implantation. SP further increased selectable vectors in multivariate analysis.ConclusionAvailable vectors increased significantly after S‐ICD implantation compared to preoperative vectors as assessed by S‐ICD screening ECG. T‐wave oversensing during exercise has been an unresolved issue for S‐ICD, but SP will help prevent inappropriate operation with S‐ICD.

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Exercise stress test reveals ineligibility for subcutaneous implantable cardioverter defibrillator in patients with Brugada syndrome

Abstract: CRBBB was a predictor of ineligibility for S-ICD in patients with BrS. Sinus tachycardia changes ECG morphology in some patients and stress testing should be considered before S-ICD implantation.

Cited by 23 publications

References 25 publications

Change of sensing vector in the subcutaneous ICD during follow‐up and after device replacement

Change of sensing vector in the subcutaneous ICD during follow‐up and after device replacement

Patient characteristics and in‐hospital complications of subcutaneous implantable cardioverter‐defibrillator for Brugada syndrome in Japan

SMART pass will prevent inappropriate operation of S‐ICD

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