Right versus left parasternal electrode position in the entirely subcutaneous ICD

Bettin, Markus; Dechering, Dirk G.; Frommeyer, Gerrit; Larbig, Robert; Löher, Andreas; Reinke, Florian; Köbe, Julia; Eckardt, Lars

doi:10.1007/s00392-017-1194-y

Cited by 13 publications

(10 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…An in silico study reported a lower defibrillation threshold for right-sided than for left-sided S-ICD lead placement. 29 An observational study in a general S-ICD population 30 demonstrated similar rates of successful defibrillation with the first 65J shock (79% left-sided and 73% right-sided lead; P=NS), and similar rates of ineffective shocks (2.9% left-sided and 1.9% right-sided lead; P=NS). A randomized controlled trial is needed before right-sided S-ICD lead placement can be recommended as preferential in ACHD.…”

Section: Discussionmentioning

confidence: 92%

Eligibility for Subcutaneous Implantable Cardioverter Defibrillator in Congenital Heart Disease

Wang

Javadekar

Rajagopalan

et al. 2019

Preprint

View full text Add to dashboard Cite

Background: The goals of this study were: assess left-and right-sided subcutaneous implantable cardioverter-defibrillator (SICD) eligibility in adult congenital heart disease (ACHD) patients, use machine learning to predict SICD eligibility in ACHD patients, and transform 12-lead ECG to S-ICD 3-lead ECG, and vice versa. Methods: ACHD outpatients (n=101; age 42±14 y; 52% female; 85% white; left ventricular ejection fraction (LVEF) 56±9%) were enrolled in a prospective study. Supine and standing 12-lead ECG was recorded simultaneously with a right- and left-sided S-ICD 3-lead ECG. Peak-to-peak QRS and T amplitudes, RR, PR, QT, QTc, QRS intervals, Tmax, and R/Tmax (31 predictor variables) were tested. Model selection, training, and testing were performed using supine ECG datasets. Validation was performed using standing ECG datasets and out-of-sample non-ACHD population (n=68; age 54±16 y; 54% female; 94% white; LVEF 61±8%). Results: A 40% of participants were ineligible for S-ICD. Tetralogy of Fallot patients passed right-sided screening (57%) more often than left-sided (21%; McNemar's χ2 P=0.025). The ridge model demonstrated the best cross-validation function. Validation of the ridge models was satisfactory for standing left-sided [ROC AUC 0.687 (95%CI 0.582-0.791)] and right-sided [ROC AUC 0.655(95%CI 0.549-0.762)] SICD eligibility prediction. Out-of-sample validation in the non-ACHD population yielded a 100% sensitivity of the pre-selected threshold for the elastic net model. Validation of the transformation matrices showed satisfactory agreement (<0.1 mV difference). Conclusion: Nearly half of the contemporary ACHD population is ineligible for S-ICD. Machine-learning prediction of SICD eligibility can be used for screening of SICD candidates. Clinical Trial Registration: URL: www.clinicaltrials.gov Unique identifier: NCT03209726

show abstract

Section: Discussionmentioning

confidence: 92%

Eligibility for Subcutaneous Implantable Cardioverter Defibrillator in Congenital Heart Disease

Wang

Javadekar

Rajagopalan

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

“…[Correction added on 03 March 2021, after first online publication: In the preceding sentence, the number of patients has been corrected in this version.] Previous studies have shown even higher S‐ICD eligibility rates in the right parasternal position 30,31 . Because of the special heart anatomies of ACHD patients, it is not groundless to address both parasternal positions, and this should be further examined.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have shown even higher S-ICD eligibility rates in the right parasternal position. 30,31 Because of the special heart anatomies of ACHD patients, it is not groundless to address both parasternal positions, and this should be further examined.…”

Section: Eligibility For S-icdmentioning

confidence: 99%

Eligibility for subcutaneous implantable cardioverter‐defibrillator in adults with congenital heart disease

et al. 2021

View full text Add to dashboard Cite

Aims Patients with adult congenital heart disease (ACHD) carry an increased risk for sudden cardiac death. Implantable cardioverter-defibrillator (ICD) therapy may be challenging in these patients due to anatomical barriers, repeated cardiac surgery, or complicated transvenous access. Thus, the subcutaneous ICD (S-ICD) can be a promising alternative in this patient population. Patients with ACHD show significant electrocardiogram (ECG) abnormalities, which could affect S-ICD sensing because it depends on surface ECG. Methods and results One hundred patients with ACHD were screened for S-ICD eligibility. Standard ECG-based screening test and automated S-ICD screening test were performed in all patients. Sixty-six patients (66%) were male. Underlying congenital heart disease (CHD) was mainly CHD of great complexity (71%) and moderate complexity (29%), including repaired tetralogy of Fallot (20%), which was the most common entity. Thirty-seven patients (37%) already had a pacemaker (23%) or ICD (14%) implanted. Automated screening test identified 83 patients (83%) eligible for S-ICD implantation in either left parasternal position (78%) or right parasternal position (75%). Absence of sinus rhythm, QRS duration, and a paced QRS complex were associated with S-ICD screening failure in univariate analysis. Receiver operating characteristic curve and multivariate analysis revealed a QRS duration ≥148 ms as the only independent predictor for S-ICD screening failure. Conclusions Patients with ACHD show satisfactory eligibility rates (83%) for S-ICD implantation utilizing the automated screening test, including patients with CHD of high complexity. S-ICD therapy should be considered with caution in ACHD patients with a QRS duration ≥148 ms and/or need for ventricular pacing.

show abstract

“…Subsequently, a number of single‐case studies have reported on the adequate performance of S‐ICD leads positioned in the right parasternal position in selected patients. More recently, Bettin et al demonstrated that a preselected right parasternal lead position based on chest radiographic features in 52 patients was as efficient as a left parasternal lead position in 68 patients in terms of termination of induced ventricular fibrillation and detection and therapy of spontaneous malignant arrhythmias during a mean follow‐up of 24.3 months. Nonetheless, further prospective studies are needed to confirm optimal system performance when the lead is implanted in the right parasternal area.…”

Section: Discussionmentioning

confidence: 99%

Impact of routine right parasternal electrocardiographic screening in assessing eligibility for subcutaneous implantable cardioverter‐defibrillator

Arias

Pachón

Sánchez-Iglesias

et al. 2019

Cardiovasc electrophysiol

View full text Add to dashboard Cite

Introduction: Between 7% and 15% of patients with an indication for an implantable cardioverter-defibrillator (ICD) are not eligible for implantation of a subcutaneous implantable cardioverter-defibrillator (S-ICD) on the basis of the result of the conventional left parasternal electrocardiographic screening (LPES). Our objective was to determine the impact of systematically performing right parasternal electrocardiographic screening (RPES) in addition to conventional LPES, in terms of increasing both the total percentage of potentially eligible patients for S-ICD implantation and the number of suitable vectors per patient. Methods and results: Consecutive patients from the outpatient device clinic who already had an implanted ICD, and no requirement for pacing were enrolled. Conventional left parasternal electrode position and right parasternal electrode positions were used. The automatic screening tool was used to analyze the recordings. Screenings were performed in the supine and standing positions.Overall, 209 patients were included. The mean age was 63.4 ± 13 years, 59.8% had ischemic heart disease, mean QRS duration was 100 ± 31 ms, and 69.9% had a primary prevention ICD indication. Based on conventional isolated LPES, 12.9% of patients were not eligible for S-ICD compared with 11.5% based on RPES alone (P = .664).Considering LPES and RPES together, only 7.2% of patients were not eligible for S-ICD (P < .001). Moreover, the number of patients with more than one suitable vector increased from 66.5% with isolated LPES to 82.3% (23.7% absolute increase [P < .001]). Conclusion: Adding an automated RPES to the conventional automated LPES increased patient eligibility for the S-ICD significantly. Moreover, combined screening increased the number of suitable vectors per eligible patient. K E Y W O R D S automated electrocardiographic screening, electrocardiography, inappropriate shocks, subcutaneous defibrillator, sudden cardiac death How to cite this article: Arias MA, Pachón M, Sánchez-Iglesias I, et al. Impact of routine right parasternal electrocardiographic screening in assessing eligibility for subcutaneous implantable cardioverter-defibrillator.

show abstract

Right versus left parasternal electrode position in the entirely subcutaneous ICD

Cited by 13 publications

References 20 publications

Eligibility for Subcutaneous Implantable Cardioverter Defibrillator in Congenital Heart Disease

Eligibility for Subcutaneous Implantable Cardioverter Defibrillator in Congenital Heart Disease

Eligibility for subcutaneous implantable cardioverter‐defibrillator in adults with congenital heart disease

Impact of routine right parasternal electrocardiographic screening in assessing eligibility for subcutaneous implantable cardioverter‐defibrillator

Contact Info

Product

Resources

About