Antonio D'Onofrio1, Paolo Pieragnoli2, Mauro Biffi3, Gerardo Nigro4, Federico Migliore5, Pietro Francia6, Paolo De Filippo7, Alessandro Capucci8, Giovanni Luca Botto9, Massimo Giammaria10, Pietro Palmisano11, Ennio Pisanò12, Giovanni Bisignani13, Carmelo La Greca14, Berardo Sarubbi15, Simone Sala16, Miguel Viscusi17, Maurizio Landolina18, Mariolina Lovecchio19, Sergio Valsecchi19, Maria Grazia Bongiorni20. 1. "Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie", Monaldi Hospital, Naples, Italy. Electronic address: donofrioant@iol.it. 2. University of Florence, Florence, Italy. 3. University of Bologna, Division of Cardiology, Policlinico S.Orsola-Malpighi, Bologna, Italy. 4. Second University of Naples, Naples, Italy. 5. Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy. 6. Sapienza University of Rome, St. Andrea Hospital, Rome, Italy. 7. Papa Giovanni XXIII Hospital, Bergamo, Italy. 8. Università Politecnica delle Marche, Ancona, Italy. 9. S. Anna Hospital, Como, Italy. 10. Maria Vittoria Hospital, Turin, Italy. 11. "Card. G. Panico" Hospital, Tricase, Lecce, Italy. 12. Ospedale Vito Fazzi, Lecce, Italy. 13. Division of Cardiology, Castrovillari Hospital, Cosenza, Italy. 14. Fondazione Poliambulanza, Brescia, Italy. 15. Paediatric Cardiology Unit, Second University of Naples, Naples, Italy. 16. San Raffale Hospital, Milan, Italy. 17. Ospedale S. Anna e S. Sebastiano, Caserta, Italy. 18. Maggiore Hospital, Crema, Cremona, Italy. 19. Boston Scientific, Milan, Italy. 20. Second Cardiology Division, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
Abstract
BACKGROUND: The subcutaneous implantable cardioverter defibrillator (S-ICD) is a relatively novel alternative to the transvenous ICD for the treatment of life-threatening ventricular arrhythmias, and is currently used in the clinical practice of several centers. The aim of this analysis was to describe current Italian practice regarding S-ICD implantation and its evolution over the years. METHODS: We analyzed 607 consecutive patients (78% male, 48 ± 16 years) who underwent S-ICD implantation in 39 Italian centers from 2013 to 2017. RESULTS: Structural cardiomyopathy was present in 78% of patients and 30% of patients received their device for secondary prevention. The proportion of patients with dilated cardiomyopathy and with left ventricular ejection fraction ≤35% increased from ≤2014 to 2017 (from 38% to 58%, from 33% to 53%, respectively; both p < 0.05). Almost all procedures (97%) were performed in electrophysiology laboratories. Over the last 4 years, the 2-incision implantation technique has been widely adopted, with sub- or inter-muscular positioning of the generator, under local anesthesia or deep sedation (≤2014 versus 2017: all p < 0.001). Defibrillation testing was performed in 81% of patients. Shock energy of ≤65 J was successful in 93.9% of patients and the overall cardioversion success rate at ≤80 J was 99.8%. CONCLUSIONS: Our analysis confirmed that the S-ICD continues to be preferentially used in specific patients (younger, less frequently with dilated cardiomyopathy and low ejection fraction.). Nonetheless, we noted a trend toward the wider use of S-ICD in patients with dilated cardiomyopathy and systolic dysfunction over the years. Novel approaches have been adopted while the acute efficacy of the system has remained stably high.
BACKGROUND: The subcutaneous implantable cardioverter defibrillator (S-ICD) is a relatively novel alternative to the transvenous ICD for the treatment of life-threatening ventricular arrhythmias, and is currently used in the clinical practice of several centers. The aim of this analysis was to describe current Italian practice regarding S-ICD implantation and its evolution over the years. METHODS: We analyzed 607 consecutive patients (78% male, 48 ± 16 years) who underwent S-ICD implantation in 39 Italian centers from 2013 to 2017. RESULTS:Structural cardiomyopathy was present in 78% of patients and 30% of patients received their device for secondary prevention. The proportion of patients with dilated cardiomyopathy and with left ventricular ejection fraction ≤35% increased from ≤2014 to 2017 (from 38% to 58%, from 33% to 53%, respectively; both p < 0.05). Almost all procedures (97%) were performed in electrophysiology laboratories. Over the last 4 years, the 2-incision implantation technique has been widely adopted, with sub- or inter-muscular positioning of the generator, under local anesthesia or deep sedation (≤2014 versus 2017: all p < 0.001). Defibrillation testing was performed in 81% of patients. Shock energy of ≤65 J was successful in 93.9% of patients and the overall cardioversion success rate at ≤80 J was 99.8%. CONCLUSIONS: Our analysis confirmed that the S-ICD continues to be preferentially used in specific patients (younger, less frequently with dilated cardiomyopathy and low ejection fraction.). Nonetheless, we noted a trend toward the wider use of S-ICD in patients with dilated cardiomyopathy and systolic dysfunction over the years. Novel approaches have been adopted while the acute efficacy of the system has remained stably high.
Authors: Szymon Budrejko; Maciej Kempa; Wojciech Krupa; Tomasz Królak; Tomasz Fabiszak; Grzegorz Raczak Journal: Int J Environ Res Public Health Date: 2022-08-06 Impact factor: 4.614