Michael Sponder1, Cesar Khazen2, Wolfgang Dichtl3, Lukas Fiedler4, Deddo Mörtl5, Alexander Teubl6, Clemens Steinwender7, Martin Martinek8, Michael Nürnberg9, Daniel Dalos1, Johannes Kastner1, Christoph Schukro10. 1. Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria. 2. Medical University of Vienna, Department of Surgery, Division of Cardiac Surgery, Vienna, Austria. 3. Medical University of Innsbruck, Department of Internal Medicine III, Innsbruck, Austria. 4. Thermenklinikum Mödling, Department of Internal Medicine, Mödling, Austria. 5. University Hospital St. Pölten, Department of Internal Medicine III, St. Pölten, Austria. 6. Landesklinikum Wiener Neustadt, Department of Internal Medicine III, Wiener Neustadt, Austria. 7. Kepler University Hospital Linz, Department of Internal Medicine I, Linz, Austria. 8. Ordensklinikum Linz, Department of Internal Medicine I, Linz, Austria. 9. Wilhelminen Hospital Vienna, Department of Internal Medicine III, Vienna, Austria. 10. Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria. Electronic address: christoph.schukro@meduniwien.ac.at.
Abstract
BACKGROUND: Subcutaneous implantable cardioverter-defibrillators (S-ICD) are an innovative and less invasive alternative to transvenous ICD (TV-ICD) in selected patients. We aimed to investigate the underlying diseases and the specific indications for implanting S-ICD in clinical practice, as well as the prevalence of shock delivery and complications. METHODS AND RESULTS: From December 2012, data of 236 patients (30,5% female; age 48,6±16,8years) were gathered from 12 centres in Austria. Follow-up data over a period of 1,7±1,1years were available for 231 patients (in total 359,2 patient-years). Predominant underlying diseases were ischemic cardiomyopathy (iCMP; 32,0%), idiopathic ventricular fibrillation (22,6%) and dilated cardiomyopathy (dCMP; 17,3%). The most frequent indications for implantation were sudden cardiac death survival (27,4%), primary prevention for iCMP (23,9%) and for dCMP (12,8%), and previous explantation of TV-ICD (12,4%). Appropriate shocks were documented in 16 patients (6,9%), iCMP being the predominant underlying disease. Arrhythmia conversion was successful in all patients, efficacy of the first shock was 96%. Inappropriate shock rate was 5,2%, predominantly caused by oversensing of T wave or artefacts. A device upgrade to an ICD system with pacing function was necessary in <1%. Clinical complications needing surgical revision occurred in 8 patients (3,5%). CONCLUSIONS: S-ICD were mostly implanted for primary prevention, one fourth of our cases were sudden death survivors. Clinical and functional complication rate was relatively low. In conclusion, S-ICD is a safe and efficient alternative in a larger population of ICD candidates, when no cardiac pacing is needed. EC-number: C-136-17.
BACKGROUND: Subcutaneous implantable cardioverter-defibrillators (S-ICD) are an innovative and less invasive alternative to transvenous ICD (TV-ICD) in selected patients. We aimed to investigate the underlying diseases and the specific indications for implanting S-ICD in clinical practice, as well as the prevalence of shock delivery and complications. METHODS AND RESULTS: From December 2012, data of 236 patients (30,5% female; age 48,6±16,8years) were gathered from 12 centres in Austria. Follow-up data over a period of 1,7±1,1years were available for 231 patients (in total 359,2 patient-years). Predominant underlying diseases were ischemic cardiomyopathy (iCMP; 32,0%), idiopathic ventricular fibrillation (22,6%) and dilated cardiomyopathy (dCMP; 17,3%). The most frequent indications for implantation were sudden cardiac death survival (27,4%), primary prevention for iCMP (23,9%) and for dCMP (12,8%), and previous explantation of TV-ICD (12,4%). Appropriate shocks were documented in 16 patients (6,9%), iCMP being the predominant underlying disease. Arrhythmia conversion was successful in all patients, efficacy of the first shock was 96%. Inappropriate shock rate was 5,2%, predominantly caused by oversensing of T wave or artefacts. A device upgrade to an ICD system with pacing function was necessary in <1%. Clinical complications needing surgical revision occurred in 8 patients (3,5%). CONCLUSIONS: S-ICD were mostly implanted for primary prevention, one fourth of our cases were sudden death survivors. Clinical and functional complication rate was relatively low. In conclusion, S-ICD is a safe and efficient alternative in a larger population of ICD candidates, when no cardiac pacing is needed. EC-number: C-136-17.
Authors: Christoph Schukro; David Santer; Günther Prenner; Markus Stühlinger; Martin Martinek; Alexander Teubl; Deddo Moertl; Stefan Schwarz; Michael Nürnberg; Lukas Fiedler; Robert Hatala; Cesar Khazen Journal: Clin Cardiol Date: 2020-08-14 Impact factor: 2.882