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

Abstract

Within the last decade, implantable cardioverter-defibrillator (ICD) systems with nontransvenous leads were developed in order to minimize complications related to the cardiovascular position of transvenous ICD leads. This national expert consensus gives an overview of potential indications for the implantation of non-transvenous ICD systems, and provides specific recommendations for implantation, follow-up, and complication management in patients with subcutaneous ICD. Regarding particular issues like the necessity for shock efficacy testing, or the clinical outcome as compared to transvenous ICD, randomized data are expected in the near future.

Subcutaneous implantable cardioverter defibrillator: Can it overtake its transvenous counterpart

“…The procedure is typically performed using the either the two or three incision technique. One incision for the device pocket and xiphoid, with or without a superior sternal incision 9 . The device in inserted into the left thoracic region at the level of the 5th intercostal space between the mid and anterior axillary lines.…”

Importância da Técnica Anestésica e Analgesia no Implante de Desfibrilador Subcutâneo e Endovascular: Um Aspecto Geralmente Ignorado

“…Originally introduced by Mirowski 50 years ago, the implantable cardioverter-defibrillator (ICD) has become a cornerstone to preventing SCD related to ventricular tachyarrhythmias. 1 However, besides their lifesaving capacities, the transvenous leads carry their own risk.…”

“…The technological improvement and the observation of these complications and limitations led to the appearance of the subcutaneous ICD (S-ICD). 1 This technique is rapidly evolving to become a safe and effective alternative for the TV-ICD, leaving the heart and vasculature untouched, with reduced lead-related complications. [1][2][3][4][5] New interventions and devices necessarily demand a constant analysis of the appropriate anesthetic technique to be used.…”

“…1 This technique is rapidly evolving to become a safe and effective alternative for the TV-ICD, leaving the heart and vasculature untouched, with reduced lead-related complications. [1][2][3][4][5] New interventions and devices necessarily demand a constant analysis of the appropriate anesthetic technique to be used. Only recently, the first studies that deal with the implantation of S-ICD have appeared and analyzed the issue of perioperative safety and postoperative analgesia, as well as its impact on the patient.…”

“…8 The recent incorporation of truncal plane nerve block techniques, called PECS I&II, guided by ultrasound, provides anesthesia to the transversus thoracic muscle plane, and the serratus anterior plane blocks, covering both the anterior thoracic region (including the pectoralis major and minor muscle) as well as anesthetizes the intercostobrachial nerve, intercostal nerves three through six, and the long thoracic nerve. 1,[8][9][10] The advantages of truncal plane blocks are that they are quick and easy for anesthesia. However, even with adequate regional block, patients undergoing S-ICD may still require GA or MAC but perhaps to a lesser extent.…”