Single incision technique for implantation of subcutaneous implantable cardioverter defibrillators

Abstract

Background Subcutaneous implantable cardioverter defibrillators (S‐ICDs) have gained increasing popularity because of certain advantages over transvenous ICDs. However, while conventional ICDs require a single surgical incision to implant, S‐ICDS need two or three incisions, making them less appealing. Objective This study sought out to investigate the feasibility of using a single‐incision technique to implant S‐ICDs. Methods Patients qualifying for S‐ICDs were considered for a single incision. A single incision is performed by making a left inframammary incision and then the subcutaneous tissue is dissected medially toward the lower sternum. Two sutures are placed in the fascia in the xiphoid area to anchor the lead and a tunneling tool is used to dissect the tissue to place the lead parallel to the sternum. Then subcutaneous tissues are dissected down the lateral chest wall over the muscle fascia to create the pulse generator pocket in the vicinity of the fifth and sixth intercostal spaces and near the mid‐axillary line. Results Eleven patients (six males and five females) successfully underwent S‐ICD implantation with a single incision without acute complications (64% for primary prevention). The mean age is 47.4 ± 15.8 years. There were no lead dislodgements, inappropriate shocks, or any other issues during a median follow‐up of 10 months (interquartile range 5–17). One patient had a successful appropriate shock for ventricular fibrillation about one year after device implant. Conclusions A single incision for subcutaneous ICDs is feasible and safe in our early experience.

S-ICD Implantation "Tips and Tricks"

“…The clinical outcomes seem to be comparable between those two techniques in terms of the rates of infection, electrode migration, inappropriate shocks and first shock efficacy, but the two-incison technique is more time-efficient [ 54 ]. There is also a report available of a single-incision technique [ 55 ], but that approach has not yet gained wider acceptance. The two-incision procedure typically produces a better cosmetic effect than the three-incision one, as it allows to avoid the upper wound at the sternomanubrial junction (the most exposed and visible).…”

State‐of‐the‐art consensus on non‐transvenous implantable cardioverter‐defibrillator therapy

“…The procedure is usually performed as a “three‐ “or “two‐ “incision technique (at least one incision for device pocket and xyphoid, respectively, with or without superior sternal incision) 30 . Even a “one incision” technique has been reported recently 31 . The advantage of the “two incision” technique is mainly cosmetic.…”