Implantation of a Subcutaneous Lead Array in Combination with a Transvenous Defibrillation Electrode via a Single Infraclavicular Incision

Kall, John G.; Kopp, Douglas E.; Lonchyna, Vassyl A.; Blakeman, Bradford; Cadman, Christopher S.; O'Connor, M.; Kinder, Charles; Gilkerson, J.; Avery, Robert; Wilber, David J.

doi:10.1111/j.1540-8159.1995.tb02550.x

Cited by 13 publications

(3 citation statements)

References 8 publications

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“…Several recent studies have shown that the intraoperative DFT can be decreased significantly by using an additional subcutaneous electrode. Acute success rates at implant are high and few complications occur during short‐term follow‐up 5‐12 . However, there has been insufficient data about the long‐term performance of different types of subcutaneous leads so far.…”

Section: Discussionmentioning

confidence: 99%

“…Then, subcutaneous three‐finger array electrodes (SQ‐A3) and single element subcutaneous array electrodes (SQ‐A1) were developed in an effort to achieve a better defibrillation field and an easier implantation procedure. However, there are only a few studies that analyze the efficacy of these three types of subcutaneous electrodes, 5‐12 and all of them focus on acute success rates at implant. There is few data about the long‐term performance of different types of subcutaneous leads 13‐15 .…”

Section: Introductionmentioning

confidence: 99%

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Long‐Term Experience with Subcutaneous ICD Leads:

Kettering¹,

Mewis²,

Dörnberger³

et al. 2004

Pacing Clinical Electrophis

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ICDs provide protection against sudden cardiac death in patients with life-threatening arrhythmias. Nevertheless, efficacy of defibrillation remains an important issue to guarantee the future safety of patients who receive an ICD. There is a significant number of patients who need an additional subcutaneous lead to obtain a defibrillation safety margin of at least 10 J between the maximum output of the ICD and the energy needed for ventricular defibrillation. However, few data exists about the long-term performance of different types of subcutaneous leads. Therefore, the aim of this study was to analyze the long-term experience with three different types of subcutaneous leads. The study included 132 patients (109 men, 23 women; mean age 59.8 years [SD +/- 10.7 years]). All of them received a subcutaneous lead in addition to a single chamber or dual chamber ICD between October 1990 and April 2002. Two patients received a second subcutaneous lead after the first lead had been removed so that a total of 134 subcutaneous leads were evaluated. Inclusion criteria for the implantation of an additional subcutaneous lead were (1) unsuccessful ventricular defibrillation at implant without a subcutaneous lead, (2) insufficient safety margin (< 10 J) between the maximum output of the ICD and the energy needed for ventricular defibrillation, or (3) clinical evaluation of a new subcutaneous lead (Medtronic 13014). There were no significant differences between the three study groups with regard to age, sex, underlying cardiac disease, left ventricular ejection fraction, NYHA class assessment and clinical arrhythmia. The results of the DFT testing during follow-up (prehospital discharge test and 1 and 3 years) were compared to the baseline value obtained during the implantation procedure. All lead related complications were analyzed. Eighty-two single element subcutaneous array electrodes (SQ-A1), 31 subcutaneous three-finger electrodes (SQ-A3), and 21 subcutaneous patch electrodes (SQ-P) were implanted during the study period. The median follow-up was 1,499 days (25th percentile: 798 days, 75th percentile: 1,976 days) in the SQ-A1 group, 2,209 days (25th percentile: 1,242 days, 75th percentile: 2,710 days) in the SQ-A3 group, and 1,419 days (25th percentile: 787 days, 75th percentile: 2,838 days) in the SQ-P group. None of the three groups had a significant change of the DFT during follow-up compared to baseline. Major complications occurred in six (7.3%) patients in group SQ-A1 and in two (9.5%) patients in group SQ-P. There were no major complications in group SQ-A3. Kaplan-Meier curves analyzing freedom from subcutaneous lead related complications did not show a significant difference between the three study groups (P = 0.16). SQ-A1, SQ-A3, and SQ-P leads provide stable DFTs during long-term follow-up. Major complications are rare. However, a careful follow-up including chest radiographs at regular intervals is needed to detect potentially fatal complications like lead fractures.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Long‐Term Experience with Subcutaneous ICD Leads:

Kettering¹,

Mewis²,

Dörnberger³

et al. 2004

Pacing Clinical Electrophis

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“…In the last decade, the trend has been to almost total use of transvenous electrode systems, made possible by the biphasic waveform, mounted on one or more catheters and with or without an auxiliary electrode outside the heart or venous system, eliminating the need for a thoracotomy to implant the system (83). The fields generated by small electrodes inside the heart can be highly uneven (79), and defibrillation is improved by adding a subcutaneous patch (55) or array electrode (38,45) or even by incorporating the metal housing that contains the generator as an active element (10,31).…”

Section: Leadsmentioning

confidence: 99%

Automatic Implantable Cardioverter-defibrillators

Smith

Ideker²

1999

Annu. Rev. Biomed. Eng.

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Ventricular fibrillation, a loss of synchronous electrical activity in the heart which leads to hemodynamic collapse, is a leading cause of death. Because of the devastating personal and societal effects of this phenomenon, the automatic cardioverter-defibrillator has been developed for automatic detection and termination of the arrhythmia and is in widespread clinical use. Advances in circuits, leads, waveforms, and signal processing along with increased knowledge of the mechanisms of fibrillation have led to continuing improvements in this device, extending its use to many patients. A device has also been developed for the automatic or semiautomatic treatment of atrial fibrillation, an arrhythmia less life-threatening than ventricular fibrillation, but still a serious health problem. Continued improvement of these devices and the development of qualitatively new approaches hold great promise for exciting therapeutic advances in this area.

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Indications for implantable cardioverter defibrillator therapy, device, and lead selection

Cohen

Etheridge

2017

Cardiac Pacing and Defibrillation in Pediatric and Congenital Heart Disease

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Implantation of a Subcutaneous Lead Array in Combination with a Transvenous Defibrillation Electrode via a Single Infraclavicular Incision

Cited by 13 publications

References 8 publications

Long‐Term Experience with Subcutaneous ICD Leads:

Long‐Term Experience with Subcutaneous ICD Leads:

Automatic Implantable Cardioverter-defibrillators

Indications for implantable cardioverter defibrillator therapy, device, and lead selection

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