Subcutaneous Implantable Cardioverter-Defibrillator Implantation Without Defibrillation Testing

Miller, Marc A.; Palaniswamy, Chandrasekar; Dukkipati, Srinivas R.; Balulad, Sujata; Smietana, Jeffrey; Vigdor, Aaron; Koruth, Jacob S.; Choudry, Subbarao; Whang, William; Reddy, Vivek Y.

doi:10.1016/j.jacc.2017.04.037

Cited by 20 publications

(13 citation statements)

References 3 publications

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“…A trend towards omitting DFT, just as in TV-ICD patients, was observed in implanters in the United States even though current guidelines recommend conversion testing in all patients. 14,[18][19][20] As the S-ICD is implanted completely subcutaneously, implanters must be aware of factors known to increase DFT exponentially, such as implant position, before DFT can be omitted safely. The PRAETORIAN score, which aims to replace conversion testing during implant in S-ICD patients, will be validated prospectively in the PRAETORIAN-DFT trial.…”

Section: Discussionmentioning

confidence: 99%

Minimal defibrillation thresholds and the correlation with implant position in subcutaneous implantable‐defibrillator patients

Quast

Baalman

Stuijt

et al. 2019

Cardiovasc electrophysiol

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Background Since the introduction of the subcutaneous implantable‐defibrillator (S‐ICD) knowledge of factors elevating the defibrillation threshold (DFT), have increased. Optimal device positioning most likely results in a decrease in DFT. The PRAETORIAN score is a tool to systematically evaluate S‐ICD implant position and predict conversion success by estimating the DFT on a chest X‐ray. The objective of this study is to determine DFT in de novo S‐ICD patients. Methods De novo S‐ICD patients were enrolled with DFT testing using a single 30 J shock or a prespecified step‐down protocol. Chest X‐rays were obtained and implant position was evaluated using the PRAETORIAN score. Results Fifteen patients, age 47 (±18) years and body mass index (BMI) 25(±3) kg/m2, underwent conversion testing with a single 30 J shock. Fourteen patients (93%) converted successfully. Implant position was optimal in all patients, PRAETORIAN score of 30 (100%). Twelve patients were available for analysis in the step‐down DFT cohort, age 46 years (±15), left ventricular ejection fraction 50% (±15%) and a median BMI of 25.7 kg/m2 (range 23.8‐29.1 kg/m2). No complications occurred during DFT testing. Mean DFT was 29 J (±12 J). Time to shock was 11 seconds (±2 seconds) for a 20 J shock compared with 17 seconds in case of a 70 J shock output. Nearly all patients were implanted with optimal device positioning with the lowest possible PRAETORIAN score of 30 (92%). Conclusion DFT in S‐ICD patients with optimal device positioning is lower than previously reported. Conversion testing using a low shock output reduced time to therapy by 6 seconds on average.

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Section: Discussionmentioning

confidence: 99%

Minimal defibrillation thresholds and the correlation with implant position in subcutaneous implantable‐defibrillator patients

Quast

Baalman

Stuijt

et al. 2019

Cardiovasc electrophysiol

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“…Two smaller studies have suggested the safety of S-ICD implantation without DFT testing with reasonable patient outcomes and good shock efficacy. 27,28 Overall, these findings show that, while recommended, not every patient can be a suitable candidate for DFT testing. For instance, the patient may be in atrial fibrillation and has not received appropriate anticoagulation, and there is concern that the shock will convert the rhythm to normal sinus.…”

Section: Efficacy and Safety Of The Subcutaneous Implantable Cardiovementioning

confidence: 93%

The Subcutaneous Implantable Cardioverter-defibrillator: New Features and Implant Techniques and Future Developments

Zeineh

Prutkin

2018

J Innov Cardiac Rhythm Manage.

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The use of subcutaneous implantable cardioverter-defibrillators (S-ICDs) has increased over time. Device-based algorithms have been developed to reduce inappropriate shocks. New implant techniques have been developed including the two-incision technique and the placement of the generator submuscularly. More patients are being implanted without general anesthesia. This review summarizes the newest S-ICD features, surgical implantation methods, and device-related safety and efficacy findings.

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“…Figure demonstrates the final locations of the planned implant site and the incision locations (based on fluoroscopy) in relation to where the truncal blocks had been performed. The pulse generator was implanted below the serratus anterior fascia (subfascial) and a three‐incision technique was used in all patients, as previously described . Invasive hemodynamic monitoring (radial arterial) was performed at the discretion of the anesthesiologist.…”

Section: Methodsmentioning

confidence: 99%

“…Total perioperative opioid consumption was defined as the sum of opioids administered to the patient in the operating room, recovery area and in the hospital over 24 hours or at discharge (whichever came first). Total opioid consumption was converted to oral morphine equivalents using the following formula: intravenous fentanyl (μg) x 0.3 + intravenous hydromorphone (mg) x 20 + intravenous morphine (mg) x 3 + [number of oral oxycodone 5 mg/acetaminophen 325 mg tabs x 7.5] . The doses are expressed as milligram morphine equivalents (MME).…”

Section: Methodsmentioning

confidence: 99%

Feasibility of subcutaneous implantable cardioverter‐defibrillator implantation with opioid sparing truncal plane blocks and deep sedation

Miller

Garg

Salter

et al. 2018

Cardiovasc electrophysiol

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Subcutaneous Implantable Cardioverter-Defibrillator Implantation Without Defibrillation Testing

Cited by 20 publications

References 3 publications

Minimal defibrillation thresholds and the correlation with implant position in subcutaneous implantable‐defibrillator patients

Minimal defibrillation thresholds and the correlation with implant position in subcutaneous implantable‐defibrillator patients

The Subcutaneous Implantable Cardioverter-defibrillator: New Features and Implant Techniques and Future Developments

Feasibility of subcutaneous implantable cardioverter‐defibrillator implantation with opioid sparing truncal plane blocks and deep sedation

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