Subcutaneous cardioverter defibrillator has longer time to therapy but is less cardiotoxic than transvenous cardioverter defibrillator. Study carried out in a preclinical porcine model

Garcia, Rodrigue; Inal, Sofiane; Favreau, Fréderic; Jayle, Christophe; Hauet, Thierry; Bruneval, Patrick; Kerforne, Thomas; Hajj-Chahine, Jamil; Degand, Bruno

doi:10.1093/europace/eux074

Cited by 8 publications

(12 citation statements)

References 18 publications

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“…However, no data in humans are available to confirm these observations. More recently, Garcia et al 20 compared S-ICD and transvenous ICD shocks delivered after VF induction in 14 pigs. High-sensitivity troponin T levels were significantly higher in the transvenous ICD group, whereas creatine phosphokinase activity levels were significantly higher in the S-ICD group from 1 h to 24 h after the procedure.…”

Section: Discussionmentioning

confidence: 99%

Effects of defibrillation shock in patients implanted with a subcutaneous defibrillator: a biomarker study

et al. 2017

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AimsImplantable cardioverter defibrillator (ICD) shocks are associated with a subsequent increased risk of death, and an elevation of cardiac enzymes has been measured after defibrillation testing (DFT). In an experimental swine study, subcutaneous ICD (S-ICD) shocks caused less myocardial damage than traditional ICD shocks. The aim of our study was to investigate the association between S-ICD shock and acute cardiac damage in humans, as evaluated by means of sensitive and highly specific circulating biomarkers.Methods and resultsWe calculated the variation in the serum levels of high-sensitivity cardiac troponin I (hs-CTnI) and creatine kinase-MB mass concentration (CK-MB mass), measured before and after an S-ICD shock delivered during intraoperative DFT. We also measured the degree of haemodynamic stress, as the variation in the serum levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and copeptin (CP), after the S-ICD shock. We analysed 30 consecutive patients who received an S-ICD and who underwent DFT by means of a single 65 J shock. The levels of biomarkers did not change from baseline to 1 h post-shock, i.e. hs-CTnI (from 0.029 ± 0.005 ng/mL to 0.030 ± 0.005 ng/mL, P = 0.079) and CK-MB mass (from 1.37 ± 0.17 ng/mL to 1.41 ± 0.18, P = 0.080) and remained stable 6 and 24 h after DFT. The plasma NT-proBNP did not change, whereas CP levels were significantly higher at 1 h post-shock evaluation. However, 6 h after DFT, the levels had returned to the baseline and remained stable at 24 h.ConclusionThe S-ICD shock did not seem to cause myocardial injuries. Although CP levels temporarily rose after DFT, they returned to basal levels within 6 h, which suggests that DFT does not have long-term prognostic implications. ICD shocks are associated with a subsequent increased risk of death, and an elevation of cardiac enzymes has been measured after DFT. We showed that serum levels of biomarkers of myocardial damage did not increase after high-energy DFT in patients who had undergone S-ICD device implantation. This suggests that S-ICD shock does not have long-term prognostic implications.

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Section: Discussionmentioning

confidence: 99%

Effects of defibrillation shock in patients implanted with a subcutaneous defibrillator: a biomarker study

et al. 2017

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“…Haemodynamically comprising complications are more prevalent in patients with a left ventricular function <30%, which is the case for most cardiovascular ICD patients [6,7]. Moreover, several studies found that defibrillation shocks may cause myocardial damage, depicted as transient depression of left ventricular function, prolonged asystole and an increase in serum troponin levels [8][9][10][11][12][13][14]. The latter, however, may be associated with the active fixation…”

Section: Disadvantages Of Dft In S-icd Recipientsmentioning

confidence: 99%

Defibrillation testing during implantation of the subcutaneous implantable cardioverter-defibrillator: a necessary standard or becoming redundant?

2020

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Since the publication of the SIMPLE and NORDIC trials, defibrillation testing (DFT) is rarely performed during routine implantation of transvenous implantable cardioverter-defibrillators (ICD). However, the results of these trials cannot be extrapolated to the later introduced subcutaneous ICD (S-ICD) and a class I recommendation to perform DFT during the implantation of these devices remains in the current guidelines. Due to the high conversion success rate of DFT on one hand, and the risk of complications on the other, a significant number of physicians omit DFT in S-ICD recipients. Several retrospective analyses have assessed the safety of the omission of DFT and report contradicting results and recommendations. It is known that implant position, as well as device factors and patient characteristics, influence defibrillation success. A better comprehension of these factors and their relationship could lead to more reliable and safer alternatives to DFT. An ongoing randomised clinical trial, which is expected to end in 2023, is the first study to implement a method that assesses implant position to identify patients who are likely to fail their DFT.

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“…In a porcine study, the mean time to therapy delivery was significantly longer with an S-ICD than a transvenous system (19 vs. 9 seconds, p = 0.001) but the S-ICD shocks were associated with less elevation of cardiac biomarkers. The longer time to therapy may be advantageous in that device patients often experience short runs of nonsustained VT. On the other hand, S-ICD shocks were associated with more skeletal muscle injuries than transvenous device shocks owing to the energy patterns resulting from the device placement but the clinical relevance of this is likely negligible [26].…”

Section: Safetymentioning

confidence: 99%

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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Subcutaneous cardioverter defibrillator has longer time to therapy but is less cardiotoxic than transvenous cardioverter defibrillator. Study carried out in a preclinical porcine model

Abstract: Time to therapy in S-ICD was twice as long as for T-ICD, but didn't induce relevant brain injury. Conversely, S-ICD shocks were less cardiotoxic than T-ICD shocks.

Cited by 8 publications

References 18 publications

Effects of defibrillation shock in patients implanted with a subcutaneous defibrillator: a biomarker study

Effects of defibrillation shock in patients implanted with a subcutaneous defibrillator: a biomarker study

Defibrillation testing during implantation of the subcutaneous implantable cardioverter-defibrillator: a necessary standard or becoming redundant?

The Subcutaneous Implantable Cardioverter-Defibrillator

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