Subcutaneous implantable cardioverter-defibrillator: is it ready for use in children and young adults? A single-centre study

Abstract

S-ICD implantation was safe and effective in young patients with low rates of inappropriate shock. However, the risk of device-related complications during follow-up remains substantial in patients with low BMI. To prevent possible complications, a two-incision technique should be preferred.

Successful defibrillation verification in subcutaneous implantable cardioverter‐defibrillator recipients by low‐energy shocks

“…Based on present results, larger studies are warranted to investigate whether lower defibrillation energies can reliably terminate VF in S‐ICD indications recipients, once an optimized implant is achieved: only two of the intermuscular recipients failed an attempt at ≤40 J in our series, though a well‐designed study with a strict methodology is required to prove the consistency of our observations on consecutive, unselected S‐ICD recipients. A 95% success rate at 45 J would enable to decrease the maximum S‐ICD output at 60 J, thereby increasing its longevity to state‐of‐the‐art transvenous ICDs, or could promote manufacturing of smaller devices meeting the clinical needs of pediatric as well as of small body habit patients . Indeed, although it has been recently shown that S‐ICD implantation is safe and effective in children and young adults, they would either benefit of a smaller can for acceptability or of long‐lasting S‐ICDs to avoid frequent replacements, that increase infection risk …”

“…A 95% success rate at 45 J would enable to decrease the maximum S-ICD output at 60 J, thereby increasing its longevity to state-of-the-art transvenous ICDs, 14 or could promote manufacturing of smaller devices meeting the clinical needs of pediatric as well as of small body habit patients. 15 Indeed, although it has been recently shown that S-ICD implantation is safe and effective in children and young adults, 15 they would either benefit of a smaller can for acceptability or of long-lasting S-ICDs to avoid frequent replacements, that increase infection risk. 16 The demonstration that the safety margin of currently adopted S-ICD is frequently higher than what generally accepted for transvenous ICDs is also reassuring in situations where the defibrillation test is not performed.…”

Sudden Cardiac Death in Children Affected by Cardiomyopathies: An Update on Risk Factors and Indications at Transvenous or Subcutaneous Implantable Defibrillators

“…In 2018 Silvetti et al (90) presented the Italian experience on 15 patients (mean age 15 years, BMI 22,6 ± 3,4) all implanted with S-ICD, mainly for primary prevention (93%). This is the largest population of patients <18 years so far analyzed.…”

“…ICD implantation resulted to be safe and effective with a low rate of appropriate shocks, even though 27% of patients had device related complications that required surgical intervention, with a higher risk in those with BMI <20 and in those in whom the 3-incision technique was performed (90).…”

Intermuscular S-ICD Implantation in Pediatric Patients

“…In the three cases reported, elective S-ICD (EMBLEM MRI S-ICD A219, Boston Scientific) implantation was performed for primary or secondary prevention employing a modified two-incision technique. The device dimensions are 83.1 Â 69.1 Â 12.7 mm (W Â H Â D), 59.5 cm 3 , and 130 g. The implant procedure was initiated by an incision of 5 cm in the left anterolateral thoracic wall between T4 and T7, caudal and posterior to the mammilla, following the oblique costal line. After the dissection of subcutaneous tissue, the plane of the serratus anterior muscle was located (►Fig.…”