On the basis of our prospective multicentre study, the new hand-powered bidirectional rotational mechanical LE sheath is an effective and safe tool for the extraction of chronically implanted leads without major complications and lead wrapping or lead damage.

Background: The traditional technique for subcutaneous implantable cardioverter defibrillator (S-ICD) implantation, which involves three incisions and a subcutaneous pocket (PACE 2017; 40:278-285) implantable cardioverter defibrillator complications, subcutaneous implantable cardioverter defibrillator (S-ICD), two-incision technique

Background-Routine diagnostic work-up occasionally does not identify any abnormality among patients with monomorphic ventricular arrhythmias (VAs) of left ventricular (LV) origin. Aim of this study was to investigate the value of cardiac MRI (cMRI) for the diagnostic work-up and prognostication of these patients. Methods and Results-Forty-six consecutive patients (65% males; mean age, 44±15 years) with monomorphic VAs of LV origin and negative routine diagnostic work-up were included. Seventy-four consecutive patients (60% males; mean age, 40±17 years) with apparently idiopathic monomorphic VAs of right ventricular origin served as control group. Both groups underwent comprehensive cMRI study and were followed-up for a median of 14 months (25th-75th percentiles, 7-37 months). The outcome event was an arrhythmic composite end point of sudden cardiac death or nonfatal episode of ventricular fibrillation or sustained ventricular tachycardia requiring external cardioversion or appropriate implantable cardioverter defibrillator therapy. The 2 groups of patients did not differ in age (P=0.14) and sex (P=0.57). No significant difference was observed between patients with VAs of LV origin and VAs of right ventricular origin about biventricular volumes and systolic function. cMRI demonstrated myocardial structural abnormalities in 19 (41%) patients with VAs of LV origin versus 4 (5%) patients with VAs of right ventricular origin (P<0.001). The outcome event occurred in 9 patients; myocardial structural abnormalities on cMRI were significantly related to the outcome event (hazard ratio, 41.6; 95% confidence interval, 5.2-225.0; P<0.001). identification of concealed cardiac abnormalities in patients with apparently idiopathic LV arrhythmias. Moreover, scarce data are available about the prognostic value of concealed structural abnormalities detected by cMRI in these patients. Accordingly, the aim of this study was 2-fold: (1) to investigate the value of comprehensive cardiac magnetic resonance tissue characterization imaging, including T1-weighted imaging, T2-weighted imaging, and late gadolinium enhancement (LGE) imaging, for the detection of structural changes in patients with monomorphic VAs of LV versus RV origin and negative routine diagnostic work-up; and (2) to determine the prognostic value of concealed structural abnormalities detected by cMRI in these patients. Conclusions-Myocardial Methods Patient PopulationA total of 46 consecutive patients with monomorphic VAs of LV origin (ie, frequent premature ventricular beats [PVBs] >1000/24 hours, nonsustained ventricular tachycardia [NSVT], or sustained ventricular tachycardia [SVT] with right bundle branch block [RBBB] morphology) and negative routine diagnostic work-up were included in the study. Negative routine diagnostic work-up was defined on the basis of (1) absence of systemic diseases, arterial hypertension, and diabetes mellitus; (2) absence of plasma electrolyte abnormalities; (3) normal 12-lead ECG; (4) normal 2-dimensional echocardiography; and (5) absenc...

Introduction:The recently developed second-generation subcutaneous implantable cardioverter defibrillator (S-ICD) and the intermuscular two-incision implantation technique demonstrate potential favorable features that reduce inappropriate shocks and complications. However, data concerning large patient populations are lacking.The aim of this multicentre prospective study was to evaluate the safety and outcome of second-generation S-ICD using the intermuscular two-incision technique in a large population study. Methods and Results:The study population included 101 consecutive patients (75% male; mean age, 45 ± 13 years) who received second-generation S-ICD (EMBLEM; Boston Scientific, Marlborough, MA) implantation using the intermuscular twoincision technique as an alternative to the standard implantation technique. Twenty nine (29%) patients were implanted for secondary prevention. Twenty four (24%) patients had a previously implanted transvenous ICD. All patients were implanted without any procedure-related complications. Defibrillation testing was performed in 80 (79%) patients, and ventricular tachycardia was successfully converted at less than or equal to 65 J in 98.75% (79/80) of patients without pulse generator adjustments.During a median follow-up of 21 ± 10 months, no complications requiring surgical revision or local or systemic device-related infections were observed. Ten patients Disclosures: None.(9.9%) received appropriate and successful shocks for ventricular arrhythmias. Three (2.9%) patients experienced inappropriate shocks due to oversensing the cardiac signal (n = 1), noncardiac signal (n = 1), and a combination of both cardiac and noncardiac signals (n = 1), with one patient requiring device explantation. No patients required device explantation due to antitachycardia pacing indications.Conclusions: According to our multicentre study, second-generation S-ICD implanted with the intermuscular two-incision technique is an available safe combination and appears to be associated with a low risk of complications, such as inappropriate shocks. K E Y W O R D S implantable cardioverter defibrillator, intermuscular technique, subcutaneous implantable cardioverter defibrillator, two-incision technique 1 | INTRODUCTION Current guidelines state that the subcutaneous implantable cardioverter defibrillator (S-ICD) represents a therapeutic option for patients at highrisk of sudden cardiac death, in whom pacing or cardiac resynchronization therapy is not required. 1 The recent development of an entirely S-ICD constitutes a major evolution of defibrillator technology, and there has been consistent clinical evidence regarding its safety. 2-4 The standard S-ICD implantation technique requires three incisions and the placement of a midaxillary pulse generator under subcutaneous tissue. However, various alternative implantation techniques have been explored, 3 including the intermuscular two-incision technique. 4-6 New techniques may reduce complications such as erosion while improving the esthetic appeal of the puls...