AIMS: Complications of implantable cardioverter-defibrillator (ICD) therapy are often linked to transvenous lead insertion, lead failure, or infections. An entirely subcutaneous ICD system (S-ICD) avoids the need for the placement of electrodes within the heart and can provide clinical advantages. METHODS AND RESULTS: A 45-year-old patient with Brugada syndrome (spontaneous type 1 Brugada ECG, syncope during fever, family history of sudden death <45 years old) was implanted with an entirely S-ICD. A left lateral incision was made over the sixth rib in the anterior axillary line for pocket formation and pulse generator placement. The subcutaneous electrode was placed subcutaneously, parallel to and 2 cm to the left of the sternal midline, and was connected to the generator. The insertion of the system was guided only by anatomical landmarks, and no fluoroscopy was required. Ventricular fibrillation was induced and terminated by a 65-J shock (15-J safety margin). No complication occurred, and subsequent course was uneventful. CONCLUSIONS: S-ICD is a new system for delivering lifesaving shock therapy in patients at risk of sudden cardiac death, without the need of intracardiac leads. Young patients with inherited arrhythmogenic syndromes could benefit the most from this system. This is the first case of Brugada syndrome implanted with a first-generation S-ICD in Italy.
AIMS: Complications of implantable cardioverter-defibrillator (ICD) therapy are often linked to transvenous lead insertion, lead failure, or infections. An entirely subcutaneous ICD system (S-ICD) avoids the need for the placement of electrodes within the heart and can provide clinical advantages. METHODS AND RESULTS: A 45-year-old patient with Brugada syndrome (spontaneous type 1 Brugada ECG, syncope during fever, family history of sudden death <45 years old) was implanted with an entirely S-ICD. A left lateral incision was made over the sixth rib in the anterior axillary line for pocket formation and pulse generator placement. The subcutaneous electrode was placed subcutaneously, parallel to and 2 cm to the left of the sternal midline, and was connected to the generator. The insertion of the system was guided only by anatomical landmarks, and no fluoroscopy was required. Ventricular fibrillation was induced and terminated by a 65-J shock (15-J safety margin). No complication occurred, and subsequent course was uneventful. CONCLUSIONS: S-ICD is a new system for delivering lifesaving shock therapy in patients at risk of sudden cardiac death, without the need of intracardiac leads. Young patients with inherited arrhythmogenic syndromes could benefit the most from this system. This is the first case of Brugada syndrome implanted with a first-generation S-ICD in Italy.
Authors: Gust H Bardy; Warren M Smith; Margaret A Hood; Ian G Crozier; Iain C Melton; Luc Jordaens; Dominic Theuns; Robert E Park; David J Wright; Derek T Connelly; Simon P Fynn; Francis D Murgatroyd; Johannes Sperzel; Jörg Neuzner; Stefan G Spitzer; Andrey V Ardashev; Amo Oduro; Lucas Boersma; Alexander H Maass; Isabelle C Van Gelder; Arthur A Wilde; Pascal F van Dessel; Reinoud E Knops; Craig S Barr; Pierpaolo Lupo; Riccardo Cappato; Andrew A Grace Journal: N Engl J Med Date: 2010-05-12 Impact factor: 91.245
Authors: Bruce L Wilkoff; Charles J Love; Charles L Byrd; Maria Grazia Bongiorni; Roger G Carrillo; George H Crossley; Laurence M Epstein; Richard A Friedman; Charles E H Kennergren; Przemyslaw Mitkowski; Raymond H M Schaerf; Oussama M Wazni Journal: Heart Rhythm Date: 2009-05-22 Impact factor: 6.343
Authors: Raphael Rosso; Aharon Glick; Michael Glikson; Abraham Wagshal; Moshe Swissa; Shimon Rosenhek; Israel Shetboun; Vladimir Khalamizer; Therese Fuchs; Munther Boulos; Michael Geist; Boris Strasberg; Michael Ilan; Bernard Belhassen Journal: Isr Med Assoc J Date: 2008-06 Impact factor: 0.892