Long‐term follow‐up of the two‐incision implantation technique for the subcutaneous implantable cardioverter‐defibrillator

Abstract

Introduction: The two-incision implantation technique of the subcutaneous implantable cardioverter-defibrillator (S-ICD) was introduced as an alternative to the standard three-incision approach by omitting the superior parasternal incision. Thereby, complications may be prevented. Short-term follow-up demonstrated the safety and efficacy of the two-incision technique. However, long-term results are lacking. Methods: This retrospective study included patients implanted between February 2009 and June 2020. Patients were divided into a group of patients who were implanted with the standard three-incision technique and a group who were implanted with the two-incision technique. Outcomes were defibrillation impedance and efficacy and complications requiring intervention. Results: A total of 268 patients were included (age 42.4 ± 16.6 years, 35.4% female, BMI 25.1 ± 4.5 kg/m 2). Thirty-one patients underwent S-ICD implantation with the three-incision technique and 237 patients with the two-incision technique. First shock efficacy during defibrillation testing was 93% in the three-incision group versus 94% in the two-incision group (P = .69), and shock impedance was 85 versus 68 ohms (P = .04). First shock success was 75% versus 76% for spontaneous episodes (P = 1.00). Complication-free survival at 5-year follow-up in the three-incision group was estimated at 0.96 (95% CI 0.90-1.00) versus 0.98 (95% CI 0.96-1.00) in the two-incision group (P = .20) and for inappropriate shocks at 5-year 0.77 (95% CI 0.63-0.94) versus 0.83 (95% CI 0.77-0.89, P = .30), respectively. Conclusion: Five-year follow-up in this S-ICD cohort showed similar complication rates and effectiveness of two-incision technique compared to the three-incision

Two‐incision versus three‐incision implantation technique of subcutaneous implantable cardioverter defibrillator: Systematic review and meta‐analysis of 2076 patients

“…This hypothesis did not align with our findings, which revealed no statistically significant difference between the two groups in lead dislocation, inappropriate shocks, defibrillation test failure, and first shock efficacy. Our findings match the results of previous studies by El Chami et al., Stuijt et al., and Brouwer et al 17,18,21 . Brouwer et al 21 .…”

“…We couldn't meta-analyze hematoma as this outcome was reported only in two studies. 18,21 In Brouwer et al, 21 no hematomas occurred in 2IT or 3IT groups, making the estimation of pooled RR inappropriate.…”

Evolution of implantation technique and indications for a subcutaneous cardioverter-defibrillator: over 7 years of experience in Poland

“…That selection factor became dominant, which brought Polish data closer to European reports [8]. Novel operational techniques reported in the literature, such as regional anesthesia, 2-incision technique and intramuscular pocket [9][10][11][12], have been introduced in Polish centers ever since. Those techniques have become dominant, and our results suggest that general anesthesia may be soon replaced by local and regional anesthetic techniques.…”

A real‐world experience of subcutaneous and transvenous implantable cardiac defibrillators—comparison with the PRAETORIAN study

“…Although operators have evolved with regard to surgical techniques at our center over time, the number of patients with two and three‐incision techniques was similar. In a study by Stujit et al, 5‐year follow‐up of the S‐ICD cohort showed similar complication rates and effectiveness of the two‐incision technique compared with the three‐incision technique 27 …”