Intermuscular Two‐Incision Technique for Subcutaneous Implantable Cardioverter Defibrillator Implantation: Results from a Multicenter Registry

Migliore, Federico; Allocca, Giuseppe; Calzolari, Vittorio; M, Crosato; Facchin, Domenico; Daleffe, Elisabetta; Zecchin, Massimo; Fantinel, Mauro; Cannas, Sergio A.; Arancio, Rocco; Marchese, Procolo; Zanon, Francesco; Zorzi, Alessandro; Iliceto, Sabino; Bertaglia, Emanuele

doi:10.1111/pace.12987

Cited by 55 publications

(66 citation statements)

References 12 publications

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“…All patients underwent device implantation in the standard fashion using either a 2-or 3-incision approach as described previously. 3,[8][9][10][11][12] Briefly, the lateral pocket incision was made at the midaxillary line between the fourth and sixth intercostal space using a #10 blade.…”

Section: Device Implantationmentioning

confidence: 99%

Increased risk of hematoma with uninterrupted warfarin in patients undergoing implantation of subcutaneous implantable cardioverter defibrillator

Evenson

Saour

Afzal

et al. 2019

Pacing Clinical Electrophis

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Background The perioperative management of anticoagulation with the use of subcutaneous implantable cardioverter‐defibrillator (S‐ICD) implantation is still evolving. Objective The purpose of this study was to assess whether it is safe to perform S‐ICD implantation with uninterrupted warfarin. Methods This is a multi‐center retrospective review of patients undergoing S‐ICD implantation between October 1, 2012 and June 30, 2017. Forty‐eight patients underwent successful S‐ICD implantation during the study period. The most common indication for implantation was primary prevention of sudden cardiac death. In 23 (47.9%) patients, warfarin was continued without any interruption. In 25 (52.1%) patients, warfarin was interrupted prior to implantation. The incidence of clinically significant lateral pocket hematoma was compared in the two groups. Results The mean international normalized ratio was 2.0 ± 0.4 in the uninterrupted group and 1.4 ± 0.4 for the interrupted group. A total of seven patients developed a hematoma at the lateral pocket. No patient developed a hematoma at the parasternal pockets. Six patients in the uninterrupted group (26.1%) and one patient in the interrupted group (0.04%) developed a significant lateral pocket hematoma (P = .04). The concomitant use of dual antiplatelet therapy did not increase the risk of hematoma. There was no significant difference between HASBLED and CHA2DS2VASc scores between the groups. None of the patients with a hematoma developed infection or required hematoma evacuation. Conclusions The uninterrupted use of warfarin in the perioperative period of S‐ICD implantation is associated with an increased risk of lateral pocket hematoma.

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Section: Device Implantationmentioning

confidence: 99%

Increased risk of hematoma with uninterrupted warfarin in patients undergoing implantation of subcutaneous implantable cardioverter defibrillator

Evenson

Saour

Afzal

et al. 2019

Pacing Clinical Electrophis

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“…The two-incision approach creates an intermuscular pocket for the pulse generator rather than a subcutaneous pocket by incising the inframammary crease at the anterior border of the latissimus dorsi, allowing the generator to fit between the two muscles. Then a small incision at the xiphoid process (in the same direction as pocket incision) allows an electrode insertion device to tunnel the lead in place [8,9]. In a study of 36 patients, the two-incision approach was found to be safe and effective and it may produce superior cosmetic results compared to the three-incision approach [9].…”

Section: Implant Techniques and Considerationsmentioning

confidence: 99%

“…Then a small incision at the xiphoid process (in the same direction as pocket incision) allows an electrode insertion device to tunnel the lead in place [8,9]. In a study of 36 patients, the two-incision approach was found to be safe and effective and it may produce superior cosmetic results compared to the three-incision approach [9]. See Figure 2.…”

Section: Implant Techniques and Considerationsmentioning

confidence: 99%

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The Subcutaneous Implantable Cardioverter-Defibrillator

Magnusson¹,

Pergolizzi²,

LeQuang³

2019

Cardiac Pacing and Monitoring - New Methods, Modern Devices

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The subcutaneous ICD (S-ICD) represents an important advancement in defibrillation therapy that obviates the need for a transvenous lead, the most frequent complication with transvenous devices. The S-ICD has been shown similarly safe and effective as transvenous ICD therapy, but the two devices are not interchangeable. The S-ICD is only suitable for patients who do not require bradycardia or antitachycardia pacing functionality. In patients with underlying diseases associated with polymorphic ventricular tachycardia and a long life expectancy, an S-ICD may be the preferred choice. Moreover, it is advantageous in the situation of increased risk of endocarditis, i.e., previous device system infection and immunosuppression, including hemodialysis. In patients with abnormal vascular access and/or right-sided heart structural abnormalities, it may be the only option. The S-ICD is bulkier, the battery longevity is shorter, and the device cost is higher, even though remote follow-up is possible. A two-or three-incision implant procedure has been described with a lateral placement of the device and a single subcutaneous lead. The rate of inappropriate therapy for both S-ICD and transvenous systems is similar, but S-ICD inappropriate shocks are more frequently attributable to oversensing, which can often be resolved with sensing adjustments.

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“…3,4 The subcutaneous implantable cardioverter defibrillator (S-ICD) was developed as an alternative therapy to T-ICD system, as it is a fully subcutaneous system without any transvenous or epicardial leads. 5,6 Thus, the S-ICD system has the potential to decrease periprocedural implantation risks, eliminate the problem of difficult venous access, reduce endovascular mechanical stress on leads, and decrease the risk of systemic device-related infection typically observed in patients with a T-ICD, even with the limit of lack of pacing capability as either antitachycardia pacing or sustained pacing for bradycardia. Therefore, S-ICD could play an important clinical role in a significant portion of patients with HF.…”

mentioning

confidence: 99%

Subcutaneous implantable cardioverter defibrillator in patients awaiting cardiac transplantation or left ventricular assist device for refractory heart failure: a feasible alternative to transvenous device?

et al. 2018

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Intermuscular Two‐Incision Technique for Subcutaneous Implantable Cardioverter Defibrillator Implantation: Results from a Multicenter Registry

Cited by 55 publications

References 12 publications

Increased risk of hematoma with uninterrupted warfarin in patients undergoing implantation of subcutaneous implantable cardioverter defibrillator

Increased risk of hematoma with uninterrupted warfarin in patients undergoing implantation of subcutaneous implantable cardioverter defibrillator

The Subcutaneous Implantable Cardioverter-Defibrillator

Subcutaneous implantable cardioverter defibrillator in patients awaiting cardiac transplantation or left ventricular assist device for refractory heart failure: a feasible alternative to transvenous device?

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