Subcutaneous implantable cardioverter defibrillator after transvenous lead extraction: safety, efficacy and outcome

Abstract

Background Subcutaneous implantable cardioverter defibrillator (S-ICD) is a suitable alternative for transvenous ICD (TV-ICD) patients who have undergone transvenous lead extraction (TLE). Limited data are available on the outcome of S-ICD patients implanted after TLE. We assessed the safety, efficacy, and outcome of S-ICD implantation after TLE of TV-ICD. Methods The study population consisted of 36 consecutive patients with a median age of 52 (44–66) years who underwent S-ICD implantation after TLE of TV-ICD. Results Indications for TLE were infection (63.9%) and lead malfunction (36.1%). During a median follow-up of 31 months, 3 patients (8.3%) experienced appropriate therapy and 7 patients (19.4%) experienced complications including inappropriate therapy (n = 4; 11.1%), isolated pocket erosion (n = 2; 5.5%), and ineffective therapy (n = 1; 2.8%). No lead/hardware dysfunction was reported. Premature device explantation occurred in 4 patients (11%). Eight patients (22.2%) died during follow-up, six of them (75%) because of refractory heart failure (HF). There were no S-ICD-related deaths. Predictors of mortality included NYHA class ≥ 2 (HR 5.05; 95% CI 1.00–26.38; p = 0.04), hypertension (HR 22.72; 95% CI 1.05–26.31; p = 0.02), diabetes (HR 10.64; 95% CI 2.05–55.60; p = 0.001) and ischemic heart disease (HR 5.92; 95% CI 1.17–30.30; p = 0.01). Conclusion Our study provides evidences on the use of S-ICD as an alternative after TV-ICD explantation for both infection and lead failure. Mortality of S-ICD patients who underwent TV-ICD explantation does not appear to be correlated with the presence of a prior infection, S-ICD therapy (appropriate or inappropriate), or S-ICD complications but rather to worsening of HF or other comorbidities.

Transvenous Lead Extraction in a European Low-Volume Center without On-Site Surgical Support

“…The 30-day mortality rate was 3.4%. Our success rates and 30-day mortality rate are like those in other TLE publications [40][41][42][43][44][45][46][47][48][49]. Patient characteristics, devices, and lead characteristics were in line with other studies published in the literature.…”

“…As for reimplantation, other options such as leadless pacemakers and subcutaneous ICD may be considered, as suggested by various papers [44,45]. However, higher thresholds for pacing may occur in the setting of deploying a leadless pacemaker in the same RV area where previous leads have been removed [46].…”

Regional Anesthesia for the Implantation of a Subcutaneous Implantable Cardioverter-Defibrillator Using Pectoserratus Plane Block and Superficial Serratus Anterior Plane Block

“…Then a pocket under the latissimus dorsi muscle measuring 5×5 cm was created “bluntly”. Using a bayonet guidewire, an electrode was implanted along the parasternal line, and at the level of the fifth intercostal space, a gentle subcutaneous arc tunnel was created into the pocket under the axillary fossa ( Figure 4A ) [ 24 , 26 , 44 , 48 ].…”

Practical Considerations for Cardiac Electronic Devices Reimplantation Following Transvenous Lead Extraction Due to Related Endocarditis

“…The S-ICD offers a valuable alternative in patients following TLE for systemic infection or IE who do not require pacing therapies (anti-bradycardia, anti-tachycardia or CRT) [30]. The S-ICD nature, having no contact with the endovascular system or bloodstream, eliminates the risk of related IE as confirmed in long-term data of the EFFORTLESS registry including 984 patients with 5-year follow-up [31].…”