Tom F Brouwer1, Antoine H G Driessen2, Louise R A Olde Nordkamp3, Kirsten M Kooiman3, Joris R de Groot3, Arthur A M Wilde3, Reinoud E Knops3. 1. Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Medical Center, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: t.f.brouwer@amc.uva.nl. 2. Department of Cardiothoracic Surgery, Heart Center, Amsterdam Medical Center, University of Amsterdam, Amsterdam, the Netherlands. 3. Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Abstract
OBJECTIVES: This study assessed outcomes in patients in whom subcutaneous implantable cardioverter-defibrillator (S-ICD) therapy was continued after implantation-related complications, in order to avoid conversion to transvenous ICD therapy. BACKGROUND: Patients at risk for sudden cardiac death benefit from ICD therapy, despite a significant risk for complications. S-ICD has a similar complication rate as transvenous ICD therapy, but the absence of transvenous leads may hold long-term benefits, especially in young ICD patients. METHODS: In the largest single-center cohort available to date, S-ICD patients implanted between 2009 and 2015 were included. RESULTS: There were 123 patients at a median age of 40 years. During a median follow-up of 2 years, 10 patients (9.4%) suffered implant-related complications. There were 5 infections, 3 erosions, and 2 implant failures for which 21 surgical procedures were needed. In 9 of 10 patients, S-ICD therapy could be continued after intervention. In 6 patients, the period between extraction and reimplantation of the S-ICD system was bridged with a wearable cardioverter-defibrillator (WCD). The pulse generator was reimplanted at the original site in 5 patients and in 3 underneath the serratus anterior muscle. One patient was not reimplanted following extraction due to recurrent infections. Conversion to a transvenous ICD was not needed in any patient. CONCLUSIONS: In most patients with a complication, S-ICD therapy could be continued after intervention, avoiding the need to convert to a transvenous system. Bridging to recovery with a WCD and submuscular implantation of the pulse generator are effective treatment strategies to manage S-ICD complications.
OBJECTIVES: This study assessed outcomes in patients in whom subcutaneous implantable cardioverter-defibrillator (S-ICD) therapy was continued after implantation-related complications, in order to avoid conversion to transvenous ICD therapy. BACKGROUND:Patients at risk for sudden cardiac death benefit from ICD therapy, despite a significant risk for complications. S-ICD has a similar complication rate as transvenous ICD therapy, but the absence of transvenous leads may hold long-term benefits, especially in young ICD patients. METHODS: In the largest single-center cohort available to date, S-ICD patients implanted between 2009 and 2015 were included. RESULTS: There were 123 patients at a median age of 40 years. During a median follow-up of 2 years, 10 patients (9.4%) suffered implant-related complications. There were 5 infections, 3 erosions, and 2 implant failures for which 21 surgical procedures were needed. In 9 of 10 patients, S-ICD therapy could be continued after intervention. In 6 patients, the period between extraction and reimplantation of the S-ICD system was bridged with a wearable cardioverter-defibrillator (WCD). The pulse generator was reimplanted at the original site in 5 patients and in 3 underneath the serratus anterior muscle. One patient was not reimplanted following extraction due to recurrent infections. Conversion to a transvenous ICD was not needed in any patient. CONCLUSIONS: In most patients with a complication, S-ICD therapy could be continued after intervention, avoiding the need to convert to a transvenous system. Bridging to recovery with a WCD and submuscular implantation of the pulse generator are effective treatment strategies to manage S-ICD complications.
Authors: Larry M Baddour; 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 Journal: Pacing Clin Electrophysiol Date: 2020-04-23 Impact factor: 1.976
Authors: Willeke van der Stuijt; Anne-Floor B E Quast; Sarah W E Baalman; Koen C de Wilde; Tom F Brouwer; Arthur A M Wilde; Reinoud E Knops Journal: Europace Date: 2021-03-08 Impact factor: 5.214