Importance of exercise testing shortly after subcutaneous implantable cardioverter‐defibrillator implantation in patients with Brugada syndrome – The first case of associated inappropriate shock in Japan

Ishibashi, Keiichiro; Noda, Takashi; Kamakura, Tsukasa; Wada, Mitsuru; Inoue, Yuko; Okamura, Hideo; Kusano, Kengo

doi:10.1016/j.joa.2016.07.006

Cited by 5 publications

(4 citation statements)

References 5 publications

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“…Remarkably, our study showed that patients with IS were significantly younger both at diagnosis and at S‐ICD implantation. Younger individuals are more prone to engage in intense physical activities; hence, they develop exercise‐related IS due to electric noise (myopotentials) or TWOS, 7–10 owing to the dynamic behavior of R‐ and T‐waves during exercise. In a study by Kooiman et al, 10 16% patients implanted with an S‐ICD experienced IS, with 72% of them secondary to TWOS at exercise during a median follow‐up of 21 months.…”

Section: Discussionmentioning

confidence: 99%

“…Our findings suggest the potential benefit of an adequate screening process to select suitable candidates for S‐ICD among BrS patients, especially in those diagnosed at a younger age. Besides the classical requirements, the new proposed criteria may include screening patients during or immediately after an exercise test 7,17,18 and drug challenge, 19 as well as using higher QRS voltage and DASS values and requiring more than one vector passed. The application of these new, stricter criteria plus other strategies, such us pharmacological treatment to reduce heart rate during exercise or advising the patient to avoid certain activities may result in a reduction of this frequent complication, minimizing the need for more aggressive solutions (e.g., repositioning of the electrode and/or the device, replacing the device with a TV‐ICD), or choosing a transvenous device in the first place.…”

Section: Discussionmentioning

confidence: 99%

“…Our findings suggest the potential benefit of an adequate screening process to select suitable candidates for S-ICD among BrS patients, especially in those diagnosed at a younger age. Besides the classical requirements, the new proposed criteria may include screening patients during or immediately after an exercise test 7,17,18 and drug challenge, 19…”

Section: Frequency Of Ismentioning

confidence: 99%

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Predictors of inappropriate shock in Brugada syndrome patients with a subcutaneous implantable cardiac defibrillator

Casu

Bisbal

Viola³

et al. 2021

Cardiovasc electrophysiol

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Background Subcutaneous implantable cardioverter defibrillators (S‐ICDs) avoid complications secondary to transvenous leads, but inappropriate shocks (ISs) are frequent. Furthermore, IS data from patients with Brugada syndrome (BrS) with an S‐ICD are scarce. Objective We aimed to establish the frequency and predictors of IS in this population. Methods We analyzed the clinical and electrocardiographic characteristics, automated screening test data, device programming, and IS occurrence in adult patients with BrS with an S‐ICD. Results Thirty‐nine patients were enrolled (69% male, mean age at diagnosis 46 ± 13 years, mean age at implantation 48 ± 13 years). During a mean follow‐up of 26 ± 21 months, 18% patients experienced IS. Patients with IS were younger at the time of diagnosis (36 ± 8 vs. 48 ± 13 years, p = .018) and S‐ICD implantation (38 ± 9 vs. 50 ± 23 years, p = .019) and presented with spontaneous type 1 Brugada electrocardiogram pattern more frequently at diagnosis or during follow‐up (71% vs. 25%, p = .018). During automated screening tests, patients with IS showed lower QRS voltage in the primary vector in the supine position (0.58 ± 0.26 vs. 1.10 ± 0.35 mV, p = .011) and lower defibrillator automated screening score in the primary vector in the supine (123 ± 165 vs. 554 ± 390 mV, p = .005) and standing (162 ± 179 vs. 486 ± 388 mV, p = .038) positions. Age at diagnosis was the only independent predictor of IS (hazard ratio = 0.873, 95% confidence interval: 0.767–0.992, p = .037). Conclusion IS was a frequent complication in patients with BrS with an S‐ICD. Younger age was independently associated with IS. A more thorough screening process might help prevent IS in this population.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Frequency Of Ismentioning

confidence: 99%

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Predictors of inappropriate shock in Brugada syndrome patients with a subcutaneous implantable cardiac defibrillator

Casu

Bisbal

Viola³

et al. 2021

Cardiovasc electrophysiol

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“…36 However, contemporary data including new generation S-ICDs, adequate screening, and programming are scarce; indeed some data indicate that the contemporary rates of inadequate therapies in this context may be lower than previously reported. [37][38][39] This notwithstanding, especially patients with Brugada syndrome pose a challenge for current S-ICD systems; diligent screening, implantation, and follow-up are required to reduce the inherently elevated risk of inappropriate shocks in these individuals. 30 Available data from UNTOUCHED also indicate that expert programming and optimal implantation techniques are crucial in order to achieve this level.…”

Section: Safety and Efficacy Of The S-icd-the Prospective Multicentermentioning

confidence: 99%

The subcutaneous ICD for prevention of sudden cardiac death: Current evidence and future directions

Steffel¹

2020

Pacing Clinical Electrophis

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Despite major advances in medical therapy, sudden cardiac death remains an important cause of cardiovascular mortality. In order to improve the risk‐benefit balance of transvenous implantable cardioverter‐defibrillator (ICD) systems, a totally subcutaneous ICD (S‐ICD) system was developed and approved for use in Europe in 2009. The currently available S‐ICD system has undergone several important hardware‐ and software‐related modifications and improvements over the last 10 years aimed at further improving its efficacy and safety. The results of the PRAETORIAN trial, that is, the first randomized comparison of S‐ICD versus transvenous ICDs, of the prospective UNTOUCHED study, and the overall consistent observational data underline that current generation S‐ICD systems may be a valid alternative in patients with an ICD indication in whom bradycardia pacing or cardiac resynchronization therapy is not required due to a lower risk of system‐related problems. This review summarizes the key differences between the two systems, improvements in hardware components and algorithms over time, as well as most recent clinical evidence regarding the efficacy and safety of the S‐ICD.

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Specific Cardiovascular Diseases and Competitive Sports Participation: Pacemakers and ICD

Miljoen

Lampert

Heidbüchel

2020

Textbook of Sports and Exercise Cardiology

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Importance of exercise testing shortly after subcutaneous implantable cardioverter‐defibrillator implantation in patients with Brugada syndrome – The first case of associated inappropriate shock in Japan

Cited by 5 publications

References 5 publications

Predictors of inappropriate shock in Brugada syndrome patients with a subcutaneous implantable cardiac defibrillator

Predictors of inappropriate shock in Brugada syndrome patients with a subcutaneous implantable cardiac defibrillator

The subcutaneous ICD for prevention of sudden cardiac death: Current evidence and future directions

Specific Cardiovascular Diseases and Competitive Sports Participation: Pacemakers and ICD

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