Concomitant Use of the Subcutaneous Implantable Cardioverter Defibrillator and a Permanent Pacemaker

Abstract

In unique situations, combined use of the S-ICD and a permanent pacemaker may be preferable to alternative options. In our experience, this approach was successful in varying conditions including complex congenital heart disease, recurrent device infection, and limited vascular access.

Factors determining the choice between subcutaneous or transvenous implantable cardioverter-defibrillators in Poland in comparison with other European countries: a sub-study of the European Heart Rhythm Association prospective survey

“…In over 83% of cases they were associated with the limitations of S-ICD systems, such as the need for pacing, CRT, and the possibility to deliver ATP. At present, S-ICD is not conventionally an option for patients who require permanent pacing; nonetheless, when combined with a transvenous pacemaker, such a combination is feasible [17][18][19].…”

Combined Use of Subcutaneous ICD and Pacemakers: The Beginning of a New Era?

“…8 More recently, Huang et al identified 4 S-ICD patients with a coexisting transvenous pacemaker who did not experience any trouble during follow-up. 9 Other sporadic problem-free cases have been reported by Porterfield et al and Steinberg et al 10,11 This very initial experience provides some evidence that a transvenous pacemaker/CRT device can be used safely with an S-ICD. In order to minimize risks of crosstalk between the implanted devices, however, some steps are recommended.…”

“…More recently, Huang et al . identified 4 S‐ICD patients with a coexisting transvenous pacemaker who did not experience any trouble during follow‐up . Other sporadic problem‐free cases have been reported by Porterfield et al .…”

Candidacy for a Subcutaneous Implantable Cardioverter Defibrillator in Patients with Cardiac Resynchronization Therapy

“…It has been reported that venous occlusion is observed in 26-33% of patients with previous transvenous leads of ICDs or pacemakers. [1][2][3] Prior to our study, there have been some reports of patients with previous transvenous or epicardial pacemakers in whom S-ICD was newly implanted and used together, [7][8][9][10][11][12][13][14] but the clinical experience is still limited. The pooled cohort of the 2 largest S-ICD trials, the Food and Drug Administration-mandated U.S. Investigational Device Exemption (IDE) Registry and the Evaluation oF FactORs ImpacTing CLinical Outcome and Cost EffectiveneSS of the S-ICD (EFFORTLESS S-ICD) registry, excluded patients with unipolar pacemakers or implanted devices that revert to unipolar pacing and included only 19 individuals who had a bipolar pacemaker prior to S-ICD implantation.…”

“…6) One disadvantage, though, is that S-ICDs cannot provide pacing therapy lacking transvenous leads. There have been several case reports of patients with previous transvenous or epicardial pacemakers, in whom S-ICD was newly implanted and used together, [7][8][9][10][11][12][13] as well as of prior cardiac resynchronization therapy (CRT) with an S-ICD. 7,14) In clinical settings, the number of such patients whose venous access cannot be secured, resulting in no choice other than the concomitant use of pacemakers and S-ICDs, might in-crease in the future.…”