Implantation of the Subcutaneous Implantable Cardioverter-Defibrillator

Abstract

Background— Alternative techniques to the traditional 3-incision subcutaneous implantation of the subcutaneous implantable cardioverter-defibrillator may offer procedural and cosmetic advantages. We evaluate 4 different implant techniques of the subcutaneous implantable cardioverter-defibrillator. Methods and Results— Patients implanted with subcutaneous implantable cardioverter-defibrillators from 2 hospitals between 2009 and 2016 were included. Four implantation techniques were used depending on physician preference and patient characteristics. The 2- and 3-incision techniques both place the pulse generator subcutaneously, but the 2-incision technique omits the superior parasternal incision for lead positioning. Submuscular implantation places the pulse generator underneath the serratus anterior muscle and subfascial implantation underneath the fascial layer on the anterior side of the serratus anterior muscle. Reported outcomes include perioperative parameters, defibrillation testing, and clinical follow-up. A total of 246 patients were included with a median age of 47 years and 37% female. Fifty-four patients were implanted with the 3-incision technique, 118 with the 2-incision technique, 38 with submuscular, and 37 with subfascial. Defibrillation test efficacy and shock lead impedance during testing did not differ among the groups; respectively, P =0.46 and P =0.18. The 2-incision technique resulted in the shortest procedure duration and time-to-hospital discharge compared with the other techniques ( P <0.001). A total of 18 complications occurred, but there were no significant differences between the groups ( P =0.21). All infections occurred in subcutaneous implants (3-incision, n=3; 2-incision, n=4). In the 2-incision group, there were no lead displacements. Conclusions— The presented implantation techniques are feasible alternatives to the standard 3-incision subcutaneous implantation, and the 2-incision technique resulted in shortest procedure duration.

Multicentre early experience with totally subcutaneous cardioverter-defibrillators in Poland

“…Implantation of an S-ICD is technically a novel procedure for cardiologists, thus new surgical skills are needed to be mastered [6,23,25,27]. All procedures were successfully performed in our population, which is consistent with the high success rate of S-ICD implantation reported by other authors [15,28].…”

“…In combined analysis of the IDE study and EFFORTLESS registry [15] the incidence of primary electrical disease was only 15%, while ischaemic and dilated cardiomyopathy were diagnosed in almost 70% of patients. Papers describing early experience with S-ICD reported that primary prophylaxis of SCD was an indication for high-voltage systems usually in more than half of the patients (50-67%) [21][22][23]25]. The pooled analysis of IDE and the EFFORTLESS registry revealed that 70% of their group were implanted in primary prophylaxis of SCD [15].…”

Single incision technique for implantation of subcutaneous implantable cardioverter defibrillators

“…The parasternal incisions can be cosmetically less appealing, particularly in women and young patients. Although the procedural duration was longer compared to the conventional technique, this is still a very early experience with the procedure. As with any newly introduced technique, there is a learning curve that needs to be overcome after which the procedure duration is expected to decrease to that like other implantation techniques of S‐ICD …”

“…The parasternal incisions can be cosmetically less appealing, particularly in women and young patients. Although the procedural duration was longer compared to the conventional technique, 16 this is still a very early experience with the procedure.…”

Anesthesia for subcutaneous implantable cardioverter‐defibrillator implantation: Perspectives from the clinical experience of a U.S. panel of physicians

“…The subcutaneous implantable cardioverter‐defibrillator (S‐ICD; Boston Scientific, Marlborough, MA, USA) was developed as an alternative to transvenous (TV) ICDs among patients without the need for pacing. It has been shown to be safe and effective and global adoption is increasing . Much focus has been on the appropriate populations for this device.…”