Use of an electrocardiographic screening tool to determine candidacy for a subcutaneous implantable cardioverter-defibrillator

Groh, Christopher A.; Sharma, Sudhish; Pelchovitz, Daniel J.; Bhave, Prashant D.; Rhyner, John; Verma, Nishant; Arora, Rishi; Chicos, Alexandru B.; Kim, Susan S.; Lin, Albert; Passman, Rod; Knight, Bradley P.

doi:10.1016/j.hrthm.2014.04.025

Cited by 102 publications

(76 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, the proportion of patients with 1 or more qualifying leads in our study population is comparable to that observed in previous series with different heart diseases 7, 8. Of note, hypertrophic cardiomyopathy was an independent predictor of screening failure in 1,7 but not in other, studies 8, 9. Indeed, the small number of hypertrophic cardiomyopathy patients enrolled in previous studies may explain the discrepancy in eligibility rates.…”

Section: Discussionsupporting

confidence: 83%

Low Prevalence of Inappropriate Shocks in Patients With Inherited Arrhythmia Syndromes With the Subcutaneous Implantable Defibrillator Single Center Experience and Long‐Term Follow‐Up

Rudic

Tülümen

Berlin

et al. 2017

JAHA

View full text Add to dashboard Cite

BackgroundUp to 40% of patients with transvenous implantable cardioverter‐defibrillator (ICD) experience lead‐associated complications and may suffer from high complication rates when lead extraction is indicated. Subcutaneous ICD may represent a feasible alternative; however, the efficacy of the subcutaneous ICD in the detection and treatment of ventricular arrhythmias in patients with hereditary arrhythmia syndromes has not been fully evaluated.Methods and ResultsPatients with primary hereditary arrhythmia syndromes who fulfilled indication for defibrillator placement were eligible for enrollment. Between 2010 and 2016, 62 consecutive patients with primary hereditary arrhythmia syndromes, without indication for antibradycardia therapy, were enrolled in the study. Mean follow‐up was 31.0±14.2 months. The study cohort comprised of 24 patients with Brugada syndrome, 17 with idiopathic ventricular fibrillation, 6 with long‐QT syndrome, 1 with short‐QT syndrome, 3 with catecholaminergic polymorphic ventricular tachycardia, 8 with hypertrophic cardiomyopathy, and 3 with arrhythmogenic right ventricular cardiomyopathy. Thirty‐nine patients were implanted for secondary prevention. Twenty‐two patients had a previous transvenous ICD implanted, but required revision because of infection or lead defects. A total of 20 spontaneous ventricular tachyarrhythmias requiring shock intervention occurred in 10 patients during follow‐up. All episodes were terminated within the first ICD shock delivery with 80 J. Two patients had inappropriate therapies caused by oversensing following an uneventful implantation. No pocket‐site infections and no premature revisions have occurred during follow‐up.ConclusionsOur study supports the use of the subcutaneous ICD for both secondary and primary prevention of sudden cardiac death as a reliable alternative to the conventional transvenous ICD.

show abstract

Section: Discussionsupporting

confidence: 83%

Low Prevalence of Inappropriate Shocks in Patients With Inherited Arrhythmia Syndromes With the Subcutaneous Implantable Defibrillator Single Center Experience and Long‐Term Follow‐Up

Rudic

Tülümen

Berlin

et al. 2017

JAHA

View full text Add to dashboard Cite

show abstract

“…The major cause of ineligibility has been reported to be high T waves, which might lead to T-wave oversensing. [3][4][5][6][7][8][9] Patients with Brugada syndrome (BrS) are usually young and active, do not require pacing, and are likely to benefit greatly from this system. However, inappropriate shocks caused by T-wave oversensing are problems even with conventional transvenous ICDs in patients with BrS.…”

Section: Study Populationmentioning

confidence: 99%

“…6 In a report by Groh et al, T-wave inversion was the only predictor of screening failure. 5 Randles et al 3 used the previously recommended 2-vector rule, which requires at least 2 leads to satisfy the S-ICD screening template in both the supine and upright position. They reported a 15% failure rate in an unselected cardiac patient cohort, with QRS duration as the only predictor of failure.…”

Section: Prevalence Of S-icd Unsuitabilitymentioning

confidence: 99%

Surface Electrocardiogram Screening for Subcutaneous Implantable Cardioverter-Defibrillators in Japanese Patients With and Without Brugada Syndrome

Kawabata

Goya

Sasaki

et al. 2017

Circ J

View full text Add to dashboard Cite

Background: Subcutaneous implantable cardioverter-defibrillators (S-ICD) could eliminate lead-associated complications. We assessed the prevalence of S-ICD ineligibility in conventional ICD recipients and compared it in patients with and without Brugada syndrome (BrS). Methods and Results:Consecutive patients with a transvenous ICD without an indication for antibradycardia pacing were assessed. A patient was considered eligible for S-ICD if the ECG satisfied the screening template, both supine and standing, in ≥1 lead. Among 130 patients (103 men, age 57±15 years), a total of 18 (13.8%) patients were ineligible. The BrS group (n=33) had a significantly higher prevalence of S-ICD screening failure as compared with the non-BrS group (P=0.003; 30% vs. 8.2%). In the BrS group, the body mass index (BMI) was significantly lower, and T/QRS amplitude in lead I was significantly higher in those who were ineligible than that in the patients who were eligible. Of the 10 BrS patients failing the screening, 4 became eligible in the right parasternal electrode position. Conclusions:Among current ICD patients, there was a high incidence of patients with BrS who were unsuitable for S-ICD based on the left parasternal screening test. Suitability screening of patients for S-ICDs should be conducted carefully in patients with BrS, particularly if the BMI is low. Right parasternal electrode positioning should also be tested in such BrS patients.

show abstract

“…The pass rate in non-congenital patients is generally reported at around 85-95%. 8,10, 11 Although the S-ICD is especially well-designed for certain CHD syndromes, many patients may fail screening due to the unique anatomy and resultant surface ECG characteristics found in CHD. 2 The aim of this study was to investigate the screening failure rate in a series of adult patients with CHD.…”

mentioning

confidence: 99%

Right Parasternal Lead Placement Increases Eligibility for Subcutaneous Implantable Cardioverter Defibrillator Therapy in Adults With Congenital Heart Disease

Okamura

McLeod

DeSimone

et al. 2016

Circ J

View full text Add to dashboard Cite

Background:The subcutaneous implantable cardioverter defibrillator (S-ICD) provides an attractive option for patients with congenital heart disease (CHD) in whom a transvenous defibrillator is contraindicated. Given the unusual cardiac anatomy and repolarization strain, the surface electrocardiogram (ECG) is frequently abnormal, potentially increasing the screen failure rate. Methods and Results:We prospectively screened 100 adult CHD patients regardless of the presence of clinical indication for ICD utilizing a standard left sternal lead placement, as well as a right parasternal position. Baseline patient and 12-lead ECG characteristics were examined to assess for predictors of screen failure. Average patient age was 48±14 years, average QRS duration was 134±37 ms, and 13 patients were pacemaker dependent. Using the standard left parasternal electrode position, 21 patients failed screening. Of these 21 patients with screen failure, 9 passed screening with the use of right parasternal electrode positioning, reducing screening failure rate from 21% to 12%. QT interval and inverted T wave anywhere in V2-V6 leads were found to be independent predictors of left parasternal screening failure (P=0.01 and P=0.04, respectively). Conclusions:Utilization of both left and right parasternal screening should be used in evaluation of CHD patients for S-ICD eligibility. ECG repolarization characteristics were also identified as novel predictors of screening failure in this group. (Circ J 2016; 80: 1328 -1335

show abstract

Use of an electrocardiographic screening tool to determine candidacy for a subcutaneous implantable cardioverter-defibrillator

Cited by 102 publications

References 11 publications

Low Prevalence of Inappropriate Shocks in Patients With Inherited Arrhythmia Syndromes With the Subcutaneous Implantable Defibrillator Single Center Experience and Long‐Term Follow‐Up

Low Prevalence of Inappropriate Shocks in Patients With Inherited Arrhythmia Syndromes With the Subcutaneous Implantable Defibrillator Single Center Experience and Long‐Term Follow‐Up

Surface Electrocardiogram Screening for Subcutaneous Implantable Cardioverter-Defibrillators in Japanese Patients With and Without Brugada Syndrome

Right Parasternal Lead Placement Increases Eligibility for Subcutaneous Implantable Cardioverter Defibrillator Therapy in Adults With Congenital Heart Disease

Contact Info

Product

Resources

About