The role of entirely subcutaneous ICD™ systems in patients with dilated cardiomyopathy

Abstract

Background: The subcutaneous implantable-cardioverter defibrillator (S-ICD TM , Boston Scientific, Natick, MA, USA) is an important advance in device therapy for the prevention of sudden cardiac death (SCD). Although current guidelines recommend S-ICD TM use, long-term data are still limited, especially in subgroups. Dilated cardiomyopathy (DCM) is a common reason for the implantation of an ICD. However, there are no sufficient data on the performance of the S-ICD TM in this patient cohort. Materials and methods: All S-ICD TM patients with DCM as the main indication for ICD implantation (n = 47 patients) in our large-scaled single-center S-ICD TM registry (n = 294 patients) were included in this study. Baseline characteristics, appropriate and inappropriate shocks, and complications were documented in a mean follow-up of 22.9 AE 18.5 months. Results: A total of 47 patients with DCM as the underlying structural heart disease received an S-ICD TM in our institution. Mean left ventricular ejection fraction was 37 AE 12% and a 28% had a history of ventricular tachyarrhythmia. During follow-up eight ventricular tachyarrhythmias were adequately terminated in three patients. In four patients, oversensing resulting in an inappropriate shock was observed, which could be managed by changing the sensing vector. There was no need for a change to a cardiac resynchronization (CRT) system while one system was changed to a VVI-ICD due to S-ICD TM wound infection. Conclusion:The S-ICD TM seems to be a valuable option for the prevention of SCD in patients with DCM and no indication for CRT. As clinically relevant ventricular arrhythmias consisted of ventricular fibrillation or fast ventricular tachycardia in all patients in our cohort, no change to transvenous ICDs for anti-tachycardia pacing delivery was necessary.

Implantable Cardioverter Defibrillator Therapy in Patients with Acute Decompensated Heart Failure with Reduced Ejection Fraction: An Observation from the KCHF Registry

“…Recently, the study of subcutaneous ICD implantation in dilated cardiomyopathy (DCM) patients with ICD indications reported efficacy against ventricular arrhythmias. Subcutaneous ICD, which has a lower risk of infection than intravenous ICD, is a useful option for younger DCM patients without CRT indication [24,25].…”

Usefulness of the MADIT-ICD Benefit Score in a Large Mixed Patient Cohort of Primary Prevention of Sudden Cardiac Death

“…The subcutaneous ICD (S-ICD) (Boston Scientific, Natick, Massachusetts) is widely accepted as a valuable alternative to transvenous ICDs in a variety of clinical constellations requiring ICD therapy [ 1 , 2 , 3 , 4 , 5 , 6 ]. Quite recently, the highly anticipated results of the PRAETORIAN trial have been published, showing non-inferiority of the subcutaneous ICD compared to transvenous ICDs with regard to safety in a randomized controlled trial [ 7 ].…”

Usefulness of the MADIT-ICD Benefit Score in a S-ICD Patient Cohort

“…The subcutaneous ICD (S-ICD) (Boston Scienti c, Natick, Massachusetts) is widely accepted as a valuable alternative to transvenous ICDs in a variety of clinical constellations requiring ICD therapy. [1][2][3][4][5][6] Quite recently the highly anticipated results of the PRAETORIAN trial have been published showing noninferiority of the subcutaneous ICD compared to transvenous ICDs with regard to safety in a randomized controlled trial. 7 The MADIT-ICD bene t score is a new score, which has recently been developed to predict the individual patient risk for a sudden cardiac death and/or appropriate ICD therapy on the one hand and a nonsudden death on the other hand.…”