The subcutaneous implantable cardioverter-defibrillator in review

Kamp, Nicholas J.; Al‐Khatib, Sana M.

doi:10.1016/j.ahj.2019.08.010

Cited by 43 publications

(35 citation statements)

References 39 publications

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“…4 The subcutaneous ICD (S-ICD) has evolved to a safe alternative to transvenous systems especially in patients with high risk for infections. 5,6 S-ICD may be of particular interest in patients with LVAD, since systemic infections are associated with significant morbidity and mortality in these patients. 4 A recent study showed S-ICD eligibility rates of 73.3% in patients with LVAD.…”

Section: Introductionmentioning

confidence: 99%

A novel screening tool to unmask potential interference between S‐ICD and left ventricular assist device

Zormpas

Eiringhaus

Hillmann

et al. 2020

Cardiovasc electrophysiol

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Introduction: In patients with a left ventricular assist device (LVAD), the subcutaneous implantable cardioverter-defibrillator (S-ICD) can be an alternative to transvenous ICD systems due to reduced risk of systemic infection, which could lead to extraction of the ICD as well as the LVAD. S-ICD eligibility is lower in patients with LVAD than in patients with end-stage heart failure without LVAD. Several reports have shown inappropriate S-ICD therapy in the coexistence of LVAD and S-ICD. The aim of the present study was to evaluate S-ICD eligibility in patients with LVAD using the established electrocardiogram (ECG)-based screening test as well as a novel device-based screening test to identify potentially inappropriate S-ICD sensing in this specific patient cohort. Methods and Results: The present study included 115 patients implanted with an LVAD. The standard ECG-based screening test and a novel device-based screening test were performed in all patients. Eighty patients (70%) were eligible for S-ICD therapy with the standard ECG-based screening test. Performance of the novel device-based screening test identified device-device interference in 14 of these 80 patients (12%). Conclusion: Using a novel extended device-based S-ICD screening method, a small number of patients with LVAD deemed eligible for S-ICD with the standard ECG-based screening test exhibit device-device interference. Careful S-ICD screening should be performed in patients with LVAD, who are candidates for S-ICD therapy, to prevent inappropriate sensing or ICD therapy.

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Section: Introductionmentioning

confidence: 99%

A novel screening tool to unmask potential interference between S‐ICD and left ventricular assist device

Zormpas

Eiringhaus

Hillmann

et al. 2020

Cardiovasc electrophysiol

View full text Add to dashboard Cite

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“…Recently, subcutaneous ICDs (SICDs) have been widely implanted in patients who are candidates for ICDs. SICDs are reported to be superior to transvenous ICDs to decrease the risk of device infections, lead‐related complications, and periprocedural complications; 13 however, lacking the ability to pace may become a potential weakness when patients suffer from ESs because recurrent painful shocks can cause anxiety or depression 14 and reduce the battery longevity. Previous clinical trials with ICDs indicated that the age, secondary prevention indication, and a higher New York heart association functional class were independent risk factors for the occurrence of ESs 3,15,16 .…”

Section: Discussionmentioning

confidence: 99%

Efficacy of antitachycardia pacing for electrical storms in patients with implantable defibrillators

Hayashi

Shimizu

Iwasaki

et al. 2021

Cardiovasc electrophysiol

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Introduction Although antitachycardia pacing (ATP) is effective in terminating ventricular tachyarrhythmias in patients with implantable cardioverter defibrillators (ICDs), the efficacy of ATP during an electrical storm (ES) and the positive impact on all‐cause mortality have not been fully elucidated. Methods and Results From 2010 to 2012, 1570 patients who underwent ICD implantation in 48 ICD centers in Japan were enrolled in the study and prospectively followed up. Patients with long QT syndrome, Brugada syndrome, and idiopathic ventricular fibrillation were excluded. The prevalence of shocks during ESs and impact on the all‐cause mortality were evaluated. During a median follow‐up of 28 months, there were 127 ESs in 84 patients. Of those 127 ESs, 80 ESs (63%) in 37 patients were treated by only ATP and the remaining 47 ESs in 47 patients required at least one shock. The lower ventricular rate of the initial arrhythmia during ES (odds ratio [OR]: 1.02 per unit; 95% confidence interval [CI]: 1.00–1.04; p = .02) and narrower QRS complex (OR: 1.03 per unit; 95% CI: 1.01–1.06; p < .01) were the independent predictors of ATP success during the ES. The patients treated with ATP alone tended to have lower all‐cause mortality compared to those that required shocks during the ES (log‐rank p = .10). Conclusions ATP was effective in patients suffering from ESs as it avoided painful shocks in more than half of the cases. Patients who received only ATP during ES tended to have lower mortality compared to those who received the shock.

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“…The utility of WB LGE imaging has predominantly been studied in patients with traditional transvenous devices (TV‐ICD), and less is known about its effectiveness in patients with other ICD subtypes. These include ICDs for cardiac resynchronization therapy (CRT‐D), which involve an additional pacing lead in the coronary sinus, and subcutaneous ICDs (S‐ICD), which were approved for clinical use within the last 10 years 8 . Compared to conventional TV‐ICD systems, in which the pulse generator pocket is placed in the upper chest, the S‐ICD pulse generator pocket is typically in the left mid‐axillary line, with a lead tunneled in along the left subcostal margin.…”

Section: Introductionmentioning

confidence: 99%

Impact of Wideband Late Gadolinium Enhancement Cardiac Magnetic Resonance Imaging on Device‐Related Artifacts in Different Implantable Cardioverter‐Defibrillator Types

Singh

Chen

Patel

et al. 2021

Magnetic Resonance Imaging

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Background Late gadolinium enhancement (LGE) imaging in patients with implantable cardioverter‐defibrillators (ICD) is limited by device‐related artifacts (DRA). The use of wideband (WB) LGE protocols improves LGE images, but their efficacy with different ICD types is not well known. Purpose To assess the effects of WB LGE imaging on DRA in different non‐MR conditional ICD subtypes. Study Type Retrospective. Population A total of 113 patients undergoing cardiac magnetic resonance imaging with three ICD subtypes: transvenous (TV‐ICD, N = 48), cardiac‐resynchronization therapy device (CRT‐D, N = 48), and subcutaneous (S‐ICD, N = 17). Field Strength/Sequence 5 T scanner, standard LGE, and WB LGE imaging with a phase‐sensitive inversion recovery segmented gradient echo sequence. Assessment DRA burden was defined as the number of artifact‐positive short‐axis LGE slices as percentage of the total number of short‐axis slices covering the left ventricle from based to apex, and was determined for WB and standard LGE studies for each patient. Additionally, artifact area on each slice was quantified. Statistical Tests Shapiro–Wilks, Kruskal–Wallis analysis of variance, Dunn tests with Bonferroni correction, and Mann–Whitney U‐test. Results In patients with TV‐ICD, DRA burden was significantly reduced and nearly eliminated with WB LGE compared to standard LGE imaging (median [interquartile range]: 0 [0–7]% vs. 18 [0–50]%, P < 0.05), but WB imaging had less of an impact on DRA in the CRT‐D (8 [0–23]% vs. 16 [0–45]%, p = 0.12) and S‐ICD (60 [15–71]% vs. 67 [50–92]%, P = 0.09) patients. Residual DRA was significantly greater (P < 0.05) for S‐ICD compared to other device types with WB LGE imaging, despite the generators of all three ICD types having similar proximity to the heart. The area of S‐ICD associated DRA was smaller with WB LGE (P < 0.001) than with standard LGE imaging and the artifacts had different characteristics (dark signal void instead of a bright hyperenhancement artifact). Data Conclusion Although WB LGE imaging reduced the burden of DRA caused by S‐ICD, the residual artifact was greater than that observed with TV‐ICD and CRT‐D devices. Further developments are needed to better resolve S‐ICD artifacts. Level of Evidence 1 Technical Efficacy: Stage 5

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The subcutaneous implantable cardioverter-defibrillator in review

Cited by 43 publications

References 39 publications

A novel screening tool to unmask potential interference between S‐ICD and left ventricular assist device

A novel screening tool to unmask potential interference between S‐ICD and left ventricular assist device

Efficacy of antitachycardia pacing for electrical storms in patients with implantable defibrillators

Impact of Wideband Late Gadolinium Enhancement Cardiac Magnetic Resonance Imaging on Device‐Related Artifacts in Different Implantable Cardioverter‐Defibrillator Types

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