Federico Migliore1, Giuseppe Allocca2, Vittorio Calzolari3, Martino Crosato3, Domenico Facchin4, Elisabetta Daleffe4, Massimo Zecchin5, Mauro Fantinel6, Sergio Cannas7, Rocco Arancio7, Procolo Marchese8, Francesco Zanon9, Alessandro Zorzi1, Sabino Iliceto1, Emanuele Bertaglia1. 1. Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy. 2. Department of Cardiology, General Hospital of Conegliano, Treviso, Italy. 3. Department of Cardiology, Cà Foncello, Civil Hospital, Treviso, Italy. 4. Ospedale S. Maria della Misericordia, University of Udine, Udine, Italy. 5. Cardiovascular Department, University of Trieste, Trieste, Italy. 6. Department of Cardiology, Civil Hospital, Feltre, Belluno, Italy. 7. Department of Cardiology, Santorso Civil Hospital, Thiene, Vicenza, Italy. 8. Department of Cardiology, Mazzoni Civil Hospital, Ascoli Piceno, Italy. 9. Cardiology Department, Arrhythmia and Electrophysiology Unit, Santa Maria Della Misericordia Hospital, Rovigo, Italy.
Abstract
BACKGROUND: The traditional technique for subcutaneous implantable cardioverter defibrillator (S-ICD) implantation, which involves three incisions and a subcutaneous pocket, is associated with possible complications, including inappropriate interventions. The aim of this prospective multicenter study was to evaluate the efficacy and safety of an alternative intermuscular two-incision technique for S-ICD implantation. METHODS: The study population included 36 consecutive patients (75% male, mean age 44 ± 12 years [range 20-69]) who underwent S-ICD implantation using the intermuscular two-incision technique. This technique avoids the superior parasternal incision for the lead placement and consists of creating an intermuscular pocket between the anterior surface of the serratus anterior and the posterior surface of the latissimus dorsi muscles instead of a subcutaneous pocket. RESULTS: All patients were successfully implanted in the absence of any procedure-related complications with a successful 65-J standard polarity defibrillation threshold testing, except in one, who received a second successful shock after pocket revision. During a mean follow-up of 10 months (range 3-30), no complications requiring surgical revision were observed. At device interrogation, stable sensing without interferences was observed in all patients. Two patients (5.5%) experienced appropriate and successful shock on ventricular fibrillation and in four patients (11%), a total of seven nonsustained self-terminated ventricular tachycardias were correctly detected. No inappropriate interventions were observed. CONCLUSIONS: Our experience suggests that the two-incision intermuscular technique is a safe and efficacious alternative to the current technique for S-ICD implantation that may help reducing complications including inappropriate interventions and offer a better cosmetic outcome, especially in thin individuals.
BACKGROUND: The traditional technique for subcutaneous implantable cardioverter defibrillator (S-ICD) implantation, which involves three incisions and a subcutaneous pocket, is associated with possible complications, including inappropriate interventions. The aim of this prospective multicenter study was to evaluate the efficacy and safety of an alternative intermuscular two-incision technique for S-ICD implantation. METHODS: The study population included 36 consecutive patients (75% male, mean age 44 ± 12 years [range 20-69]) who underwent S-ICD implantation using the intermuscular two-incision technique. This technique avoids the superior parasternal incision for the lead placement and consists of creating an intermuscular pocket between the anterior surface of the serratus anterior and the posterior surface of the latissimus dorsi muscles instead of a subcutaneous pocket. RESULTS: All patients were successfully implanted in the absence of any procedure-related complications with a successful 65-J standard polarity defibrillation threshold testing, except in one, who received a second successful shock after pocket revision. During a mean follow-up of 10 months (range 3-30), no complications requiring surgical revision were observed. At device interrogation, stable sensing without interferences was observed in all patients. Two patients (5.5%) experienced appropriate and successful shock on ventricular fibrillation and in four patients (11%), a total of seven nonsustained self-terminated ventricular tachycardias were correctly detected. No inappropriate interventions were observed. CONCLUSIONS: Our experience suggests that the two-incision intermuscular technique is a safe and efficacious alternative to the current technique for S-ICD implantation that may help reducing complications including inappropriate interventions and offer a better cosmetic outcome, especially in thin individuals.
Authors: Jin-Jun Liang; Hideo Okamura; Roshini Asirvatham; Andrew Schneider; David O Hodge; Mei Yang; Xu-Ping Li; Ming-Yan Dai; Ying Tian; Pei Zhang; Bryan C Cannon; Cong-Xin Huang; Paul A Friedman; Yong-Mei Cha Journal: Chin Med J (Engl) Date: 2019-03-20 Impact factor: 2.628
Authors: Raul Weiss; George E Mark; Mikhael F El-Chami; Mauro Biffi; Vincent Probst; Pier D Lambiase; Marc A Miller; Timothy McClernon; Linda K Hansen; Bradley P Knight; Larry M Baddour Journal: J Cardiovasc Electrophysiol Date: 2022-06-09 Impact factor: 2.942