Subcutaneous implantable cardioverter defibrillator implantation: An analysis of Italian clinical practice and its evolution

D’Onofrio, Antonio; Pieragnoli, Paolo; Biffi, Mauro; Nigro, Gerardo; Migliore, Federico; Francia, Pietro; Filippo, Paolo De; Capucci, Alessandro; Botto, Giovanni Luca; Giammaria, Massimo; Palmisano, Pietro; Pisanò, E; Bisignani, Giovanni; Greca, Carmelo La; Sarubbi, Berardo; Sala, Simone; Viscusi, Miguel; Landolina, Maurizio; Lovecchio, Mariolina; Valsecchi, Sergio; Bongiorni, Maria Grazia

doi:10.1016/j.ijcard.2018.07.139

Cited by 30 publications

(35 citation statements)

References 18 publications

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“…Moreover, we did not confirm the previously reported association between left ventricle wall thickness and defibrillation success 12 : our study is indeed more powered to assess the role of hypertrophy, because 33% of our patients had hypertrophic cardiomyopathy (the six with wall thickness in the 30-41 mm range had successful VF termination with ≤30 J), and the mean wall thickness of the whole population was 16 ± 8 mm, well above other literature reports. [3][4][5][6][7][8]12,13 As described by Friedman et al, 13 severely decreased ejection fraction was associated to a lower defibrillation safety margin also in our experience. However, defibrillation was successful at low shock energies even in patients with ejection fraction ≤35% in intermuscular implants, failure at ≤40 J being more common in the setting of a subcutaneous device placement.…”

Section: Discussionsupporting

confidence: 81%

“…A thinner body habit enables to place both the subcutaneous coil and the generator directly over the fascia without underlying fat tissue, thus resulting in lowered energy requirement to terminate VF. Moreover, we did not confirm the previously reported association between left ventricle wall thickness and defibrillation success: our study is indeed more powered to assess the role of hypertrophy, because 33% of our patients had hypertrophic cardiomyopathy (the six with wall thickness in the 30‐41 mm range had successful VF termination with ≤30 J), and the mean wall thickness of the whole population was 16 ± 8 mm, well above other literature reports . As described by Friedman et al, severely decreased ejection fraction was associated to a lower defibrillation safety margin also in our experience.…”

Section: Discussioncontrasting

confidence: 71%

“…This occurred in 11% of our patients and in 19% of previous larger samples, 8 for clinical reasons or for lack of VF inducibility. Most recent reports show that, despite a Class I recommendation, VF termination testing is declining in clinical practice due to physician preference.…”

Section: Discussionmentioning

confidence: 61%

“…The demonstration that the safety margin of currently adopted S‐ICD is frequently higher than what generally accepted for transvenous ICDs is also reassuring in situations where the defibrillation test is not performed. This occurred in 11% of our patients and in 19% of previous larger samples, for clinical reasons or for lack of VF inducibility. Most recent reports show that, despite a Class I recommendation, VF termination testing is declining in clinical practice due to physician preference .…”

Section: Discussionmentioning

confidence: 68%

“…2 Current S-ICD devices deliver a maximum of 80 J, thus the test is usually conducted by delivering a shock energy of 65 J to ensure a safety defibrillation margin of at least 15 J. Recent findings from clinical practice in the US and Europe [5][6][7][8] show high rates (above 90%) of successful conversion at ≤65 J, but limited data on the conversion success at lower energies exist.…”

Section: Introductionmentioning

confidence: 99%

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Successful defibrillation verification in subcutaneous implantable cardioverter‐defibrillator recipients by low‐energy shocks

Biffi

Ziacchi

Angeletti

et al. 2019

Clinical Cardiology

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Background The subcutaneous implantable cardioverter‐defibrillator (S‐ICD) is an effective alternative to the transvenous one. Defibrillation efficacy depends on maximum device output and on the optimal device location at device implantation. Hypothesis We sought to investigate the defibrillation safety margin in real life clinical practice. Methods We sought to understand what is the efficacy of induced ventricular fibrillation (VF) termination at S‐ICD implantation using lower energies than the recommended 65 J. Results Sixty‐four consecutive S‐ICD recipients underwent VF termination attempts at implantation with energies ranging from 20 to 50 J. Overall, VF termination occurred in 84% of patients with ≤40 J, in 88% with 45 J, and in 100% with 60 J. Intermuscular S‐ICD placement was associated with 94% VF termination at ≤40 J. An ejection fraction <35% was associated to higher energy requirement for defibrillation; however, an intermuscular S‐ICD placement conferred 90% defibrillation efficacy at 31 ± 5 J in this patients subset. Conclusions This is a hypothesis‐generating observation that prompts a methodologically correct investigation to prove that a 60 J output S‐ICD can provide an adequate safety margin to terminate VF in clinical practice. This would enable superior device longevity and/or device downsizing for pediatric/small size patients.

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Section: Discussionsupporting

confidence: 81%

Section: Discussioncontrasting

confidence: 71%

Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 68%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Successful defibrillation verification in subcutaneous implantable cardioverter‐defibrillator recipients by low‐energy shocks

Biffi

Ziacchi

Angeletti

et al. 2019

Clinical Cardiology

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Serratus anterior plane block and postoperative pain control in obese patients undergoing S‐ICD implantation: A case series and literature analysis

Coletta,

Schettino,

Tomasello

et al. 2024

Clinical Case Reports

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Key Clinical MessageWe report five case series of obese patients with severe left ventricular ejection fraction impairment undergoing Serratus Anterior Plane Block during S‐ICD Implantation. This anesthesia approach has a reduced impact on the patient's hemodynamics and adequately manages postprocedural pain.AbstractSubcutaneous implantable cardioverter‐defibrillator (S‐ICD) procedures are frequently performed under analgosedation or general anesthesia, leading to prolonged postoperative hospital stays and increased costs. This anesthetic technique may also have a greater hemodynamic impact, particularly in obese and cardiac patients. However, an alternative anesthetic technique can be employed: ultrasound‐guided serratus anterior plane block (US‐SAPB). We analyzed the anesthetic clinical course in 5 patients, 3 males and 2 females, who were obese (BMI ≥ 30) and underwent S‐ICD implantation for primary prevention using a two‐incision intermuscular technique and ultrasound‐guided serratus anterior plane block. All patients had a left ventricular ejection fraction less than or equal to 35%. It significantly facilitated pain control during the procedure and, especially, in the postoperative phase. However, the data available in the literature are mostly derived from case reports and small comparative studies. Therefore, further studies with a larger sample size and direct comparison with general anesthesia or deep sedation are needed.

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Subcutaneous implantable cardioverter defibrillator in children and adolescents: results from the S-ICD “Monaldi care” registry

Sarubbi

Colonna

Correra

et al. 2021

J Interv Card Electrophysiol

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Subcutaneous implantable cardioverter defibrillator implantation: An analysis of Italian clinical practice and its evolution

Cited by 30 publications

References 18 publications

Successful defibrillation verification in subcutaneous implantable cardioverter‐defibrillator recipients by low‐energy shocks

Successful defibrillation verification in subcutaneous implantable cardioverter‐defibrillator recipients by low‐energy shocks

Serratus anterior plane block and postoperative pain control in obese patients undergoing S‐ICD implantation: A case series and literature analysis

Subcutaneous implantable cardioverter defibrillator in children and adolescents: results from the S-ICD “Monaldi care” registry

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