Joachim Winter1, Markus Siekiera2, Dong-In Shin2, Christian Meyer2, Patric Kröpil3, Harald Clahsen4, Stephen O'Connor5. 1. Division of Cardiac Surgery, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany. 2. Division of Cardiology, Pulmonology and Vascular Medicine, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany. 3. Department of Diagnostic and Interventional Radiology, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany. 4. Institute for Anatomy II Medical Faculty, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany. 5. City University London, Northampton Sq., London, UK.
Abstract
AIMS: The subcutaneous cardioverter defibrillator was designed to overcome electrode complications of transvenous defibrillation systems. While largely achieved, pocket complications have increased. Subcutaneous implantation of the pulse generator leaves it prone to erosion, extrusion, discomfort, and poor cosmesis. METHODS AND RESULTS: We use a demonstration electrode and pulse generator with fluoroscopy, prior to prepping and draping, to maximize the left ventricular mass between them. We adapted a submuscular abdominal ICD technique to implant the S-ICD intermuscularly between the anterior surface of serratus anterior and the posterior surface of latissimus dorsi. Surgery in our patients beyond the subcutaneous tissue was bloodless, as muscle layers were carefully separated but not incised, which also protected the long thoracic nerve. Two layers of muscle protect the pulse generator. We have implanted 82 consecutive patients with this technique, taking ∼65 min. All patients were converted with 65 J standard polarity shock during induced arrhythmia conversion testing, with six (7.3%) patients requiring a repositioning of the pulse generator prior to successful conversion. Seven spontaneous episodes of ventricular fibrillation were detected in three (3.6%) patients, all successfully converted back to sinus rhythm. Long-term patient outcomes have been good with low complication rates over the mean ± standard deviation 3.6 ± 1.2 years. CONCLUSION: Our intermuscular technique and implant methodology is successful for placement of the subcutaneous defibrillator pulse generator. Our technique leads to an excellent cosmetic result and high levels of patient satisfaction. Rates of first shock conversion during defibrillation testing, inappropriate shocks, and complications during follow-up compare favourably with previous published case series. There were no left arm movement limitations post-operatively. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: The subcutaneous cardioverter defibrillator was designed to overcome electrode complications of transvenous defibrillation systems. While largely achieved, pocket complications have increased. Subcutaneous implantation of the pulse generator leaves it prone to erosion, extrusion, discomfort, and poor cosmesis. METHODS AND RESULTS: We use a demonstration electrode and pulse generator with fluoroscopy, prior to prepping and draping, to maximize the left ventricular mass between them. We adapted a submuscular abdominal ICD technique to implant the S-ICD intermuscularly between the anterior surface of serratus anterior and the posterior surface of latissimus dorsi. Surgery in our patients beyond the subcutaneous tissue was bloodless, as muscle layers were carefully separated but not incised, which also protected the long thoracic nerve. Two layers of muscle protect the pulse generator. We have implanted 82 consecutive patients with this technique, taking ∼65 min. All patients were converted with 65 J standard polarity shock during induced arrhythmia conversion testing, with six (7.3%) patients requiring a repositioning of the pulse generator prior to successful conversion. Seven spontaneous episodes of ventricular fibrillation were detected in three (3.6%) patients, all successfully converted back to sinus rhythm. Long-term patient outcomes have been good with low complication rates over the mean ± standard deviation 3.6 ± 1.2 years. CONCLUSION: Our intermuscular technique and implant methodology is successful for placement of the subcutaneous defibrillator pulse generator. Our technique leads to an excellent cosmetic result and high levels of patient satisfaction. Rates of first shock conversion during defibrillation testing, inappropriate shocks, and complications during follow-up compare favourably with previous published case series. There were no left arm movement limitations post-operatively. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Victoria Galizia Brito; Aina Bibiloni Cladera; Maria Del Carmen Exposito Pineda; Carlos Grande Morales Journal: Eur Heart J Case Rep Date: 2020-12-29
Authors: Krzysztof Kaczmarek; Maciej Kempa; Marcin Grabowski; Mateusz Tajstra; Adam Sokal; Iwona Cygankiewicz; Radosław Zwoliński; Marcin Michalak; Michal Kowara; Szymon Budrejko; Anna Kurek; Jerzy K Wranicz; Grzegorz Raczak; Grzegorz Opolski; Mariusz Gąsior; Oskar Kowalski; Paweł Ptaszyński Journal: Arch Med Sci Date: 2019-05-21 Impact factor: 3.318