SMART pass will prevent inappropriate operation of S‐ICD

Abstract

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.

Impact of diabetes as a risk factor in patients undergoing subcutaneous implantable cardioverter defibrillator implantation: A single-centre study

“… 6 The majority of inappropriate shocks were resulting of T-wave oversensing. A significant overall reduction in inappropriate therapy was seen in dual-zone programming 2 , 22 as well as the new SMART-PASS 23 algorithm of advanced technology with second-generation S-ICD. All our S-ICD patients were implanted with a second-generation Emblem S-ICD with new SMART-PASS algorithm and had dual-zone programming, resulting in complete absence of inappropriate therapies due to T-wave oversensing.…”

Subcutaneous Implantable Cardioverter Defibrillator in a Patient with Pacemaker

“…Further studies have demonstrated that MRI could be performed with no significant clinical effects and no differences in the type and number of complications in patients who had a pacemaker that was non-MRI-compatible compared with patients with MRI-compatible devices, taking the necessary precautions and applying a safety protocol. (3,4) This protocol consists in programming the pacemaker to an asynchronous pacing mode in pacingdependent patients, or inhibiting it (turning it off) in non-pacing-dependent cases, and in the inhibition of tachycardia monitoring and deactivation of therapies in patients with defibrillators. ( 4)…”

“…(5) However, two recently published studies that included more than 2,500 patients who received MRI with 1.5 T scanner showed no significant complications applying the safety protocol. (3,4) It should be pointed out that devices implanted before certain dates (pacemakers prior to 1998 or defibrillators prior to 2000) were taken as contraindication in these studies.…”

“…Mid-and long-term outcomes in different series, such as those of David and Navia, support this procedure for endocarditis involving the aortic valve and part of the mitral valve, without need for a double prosthetic replacement. (4,5) In previous complicated replacements with extensive destruction, choosing homograft in combination with a bovine pericardial patch to reconstruct the cardiac anatomy is an excellent strategy. (4,5) We believe that the hemi-commando procedure is a valid option, even in very complex scenarios such as cardiac reinterventions.…”

Uncommon inappropriate shock of subcutaneous defibrillator in early postoperative period due to air in close proximity of shock electrode is presented

“…Пациенту 18 лет c гипертрофической кардиомиопатией (ГКМП) и осложненным семейным анамнезом (ВСС отца с ГКМП) с классом показаний для имплантации ИКД IIa согласно национальным рекомендациям по определению риска и профилактике ВСС [6] [4]. Однако, в этой публикации была показана большая частота неадекватных шоков в течение…”