Shock Efficacy of Subcutaneous Implantable Cardioverter-Defibrillator for Prevention of Sudden Cardiac Death

Abstract

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...

Safety and Efficacy of a Totally Subcutaneous Implantable-Cardioverter Defibrillator

“…Our study had similar results and had more spontaneous events along with the chronic conversion study for induced VF that is additive to the literature of S-ICD System experience. A recent article 19 from Germany evaluating 40 patients with the S-ICD System demonstrated a lower first shock efficacy for spontaneous episodes. However, this was in only 4 patients (10%) with idiopathic VF and may represent an outlier population of patients compared with the ≈83% first shock efficacy in this larger, more diverse cohort of primary prevention patients with well-monitored prospective follow-up.…”

2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

“…Terapia z powodu VT lub VF została zastosowana w 169 z tych przypadków (53%) i tylko 1 pacjent zmarł z powodu nawracającego VF i znacznej bradykardii [161]. Próby kliniczne z użyciem podskórnych ICD podsumowano w dodatkowej tabeli 6 [157][158][159][160][161][162][163][164][165].…”

Right Parasternal Lead Placement Increases Eligibility for Subcutaneous Implantable Cardioverter Defibrillator Therapy in Adults With Congenital Heart Disease

“…Recognizing the caveat that this approach does not provide chronic pacing support, the efficacy of S-ICD has been proven in multiple studies. [22][23][24][25][26][27][28] Eligibility in CHD Patients for S-ICD The potential eligibility of CHD patients for S-ICD has been reported in a small 30-patient cohort that screened 10 patients with tetralogy of Fallot, 10 patients with transposition of great arteries and 10 patients with single ventricle/Fontan circulation. 14 This screening was compared with 10 control patients without CHD, and it was found that 87% of CHD patients vs. 100% of the controls met S-ICD eligibility.…”