However, with the increasing application of transvenous ICDs and higher patients' life expectancy, long-term technical difficulties, such as lead failure or device infection, have become important issues in clinical practice. [2][3][4] In addition, complications during lead placement, such as lead dislocation, perforation, or pneumothorax, bear a substantial perioperative risk. 5 The subcutaneous ICD (S-ICD) offers an alternative, novel approach to avoid lead-associated complications. 6 A first report from a single center has shown a promising device performance, with a sensitivity of 100% to detect ventricular tachyarrhythmia and 100% cardioversion efficacy. 7 Here, we report an initial multicenter experience with patients offered the S-ICD for both primary and secondary preventions of sudden cardiac death. Clinical Perspective on p 919 Methods PatientsThe study included all 40 consecutive patients (42±15 years [range, 19-73 Correspondence to Ali Aydin, MD, Department of Cardiology/Electrophysiology, University Heart Center, University Medical Center HamburgEppendorf, Martinistr, 5220246 Hamburg, Germany. E-mail aydin@uke.de Background-Recently, subcutaneous implantable cardioverter-defibrillator (S-ICD) has become available. The aim of our study was to assess the efficacy of S-ICD in a clinical setting. Table 1. Of note, the majority of our patients had an indication for secondary prevention (n=23; 58%). Methods and Results-Between Patient SelectionFiles of all patients receiving an S-ICD between June 2010 and July 2011 at the participating institutions were reviewed for this report. Patients were selected for an S-ICD if they fulfilled the indication criteria specified by the American College of Cardiology/ American Heart Association/European Society of Cardiology guidelines for primary or secondary prevention of sudden cardiac death. 1According to the recommendations given by the manufacturer, the S-ICD was not implanted in patients with symptomatic bradycardia, incessant ventricular tachycardia, or documented spontaneous, frequently recurring ventricular tachycardia that was reliably terminated with antitachycardia pacing. Patients with pacemakers were also classified as not suitable for an S-ICD. ECG morphology was preoperatively screened in accordance with the recommendations of the manufacturer to exclude patients with atrioventricular block, bundle branch block, and long-QT interval. S-ICD therapy was offered to all patients who fulfilled the criteria mentioned above; therefore, the patients' preference was 1 decision factor on transvenous ICD versus S-ICD. Also, patients with previous transvenous ICDs and an indication for removal were given the choice for another transvenous ICD or the S-ICD. Magnetic resonance tomography or transthoracic echocardiography was performed to assess left ventricular ejection fraction. Subcutaneous ICD SystemA commercially available S-ICD system (pulse generator model SQ-RX 1010 and subcutaneous lead model Q-Trak 3010, both from Cameron Health Inc, San Clemente, CA) wa...

Sudden myocardial stretch can elicit VF when it occurs during a vulnerable window that is based on repolarization inhomogeneity. Stretch pulses applied during this vulnerable window can lead to nonuniform activation. Repolarization dispersion might play a crucial role in the occurrence of fatal tachyarrhythmias during commotio cordis.

AF is common in patients with HCM who need a CRM device. More than 50% of these patients develop de novo AF that was predominantly subclinical in our cohort.

Ipsilateral implantation of a temporary active-fixation RV-lead connected to an externalized PM and pursued antibiotic therapy seems to be a good option for patients with CIED infection and PM dependency, showing no temporary pacing-related complications and no reinfection after mean follow-up time of 21.1 months.

Hemorrhage following vaginal hysterectomy or LAVH can be treated by laparoscopy in the majority of patients. Laparoscopy is recommended if the source of bleeding cannot be identified clearly by vaginal examination and/or if an intraabdominal bleeding source is suspected.