Stefano Viani1, Federico Migliore2, Gianfranco Tola3, Ennio C L Pisanò4, Antonio Dello Russo5, Giovanni Luzzi6, Paolo Sartori7, Agostino Piro8, Roberto Rordorf9, Giovanni Battista Forleo10, Anna Rago11, Luca Segreti12, Emanuele Bertaglia2, Mauro Biffi13, Mariolina Lovecchio14, Sergio Valsecchi14, Igor Diemberger13, Maria Grazia Bongiorni12. 1. Second Cardiology Division, University Hospital of Pisa, Pisa, Italy. Electronic address: s.viani@ao-pisa.toscana.it. 2. Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padua, Italy. 3. Cardiology Division, A.O. Brotzu, Cagliari, Italy. 4. Vito Fazzi Hospital, Lecce, Italy. 5. Centro Cardiologico Monzino IRCCS, Milan, Italy. 6. Cardiology Unit, University Hospital, Bari, Italy. 7. University Hospital IRCCS San Martino, Genoa, Italy. 8. Policlinico Umberto I - "Sapienza" University of Rome, Rome, Italy. 9. Department of Cardiology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy. 10. Cardiology Department, Luigi Sacco Hospital, Milan, Italy. 11. Second University of Naples, Monaldi Hospital, Naples, Italy. 12. Second Cardiology Division, University Hospital of Pisa, Pisa, Italy. 13. University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy. 14. Boston Scientific, Milan, Italy.
Abstract
BACKGROUND: The subcutaneous implantable cardioverter-defibrillator (S-ICD) does not require the insertion of any leads into the cardiovascular system. OBJECTIVE: The aims of the study were to describe current practice and to measure outcomes associated with S-ICD or standard single-chamber transvenous ICD (TV-ICD) use after TV-ICD explantation. METHODS: We analyzed all consecutive patients who underwent transvenous extraction of an ICD and subsequent implantation of an S-ICD or a single-chamber TV-ICD at 12 Italian centers from 2011 to 2017. RESULTS: A total of 229 patients were extracted and subsequently reimplanted with an S-ICD (90; 39%) or a single-chamber TV-ICD (139; 61%). S-ICD implantation increased from 9% in 2011 to 85% in 2017 (P < .001). Patients reimplanted with an S-ICD were younger (53 ± 13 years vs 60 ± 18 years; P = .011) and more frequently had undergone extraction owing to infection (73% vs 52%; P < .001). The rates of complications at follow-up were comparable between groups (hazard ratio 0.97; 95% confidence interval 0.49-1.92; P = .940). No lead failures, systemic infections, or system-related deaths occurred in the S-ICD group. In the TV-ICD group, 1 lead fracture occurred and 2 systemic infections were reported, resulting in death in 1 case. In the S-ICD group, the rate of complications was lower when the generator was positioned in a sub- or intermuscular pocket (hazard ratio 0.21; 95% confidence interval 0.05-0.87; P = .048). CONCLUSION: Our results show an increasing use of S-ICD over the years in patients undergoing TV-ICD explantation. An S-ICD is preferably adopted in young patients, mostly in the case of infection. The complication rate was comparable between groups and decreased when a sub- or intermuscular S-ICD generator position was adopted.
BACKGROUND: The subcutaneous implantable cardioverter-defibrillator (S-ICD) does not require the insertion of any leads into the cardiovascular system. OBJECTIVE: The aims of the study were to describe current practice and to measure outcomes associated with S-ICD or standard single-chamber transvenous ICD (TV-ICD) use after TV-ICD explantation. METHODS: We analyzed all consecutive patients who underwent transvenous extraction of an ICD and subsequent implantation of an S-ICD or a single-chamber TV-ICD at 12 Italian centers from 2011 to 2017. RESULTS: A total of 229 patients were extracted and subsequently reimplanted with an S-ICD (90; 39%) or a single-chamber TV-ICD (139; 61%). S-ICD implantation increased from 9% in 2011 to 85% in 2017 (P < .001). Patients reimplanted with an S-ICD were younger (53 ± 13 years vs 60 ± 18 years; P = .011) and more frequently had undergone extraction owing to infection (73% vs 52%; P < .001). The rates of complications at follow-up were comparable between groups (hazard ratio 0.97; 95% confidence interval 0.49-1.92; P = .940). No lead failures, systemic infections, or system-related deaths occurred in the S-ICD group. In the TV-ICD group, 1 lead fracture occurred and 2 systemic infections were reported, resulting in death in 1 case. In the S-ICD group, the rate of complications was lower when the generator was positioned in a sub- or intermuscular pocket (hazard ratio 0.21; 95% confidence interval 0.05-0.87; P = .048). CONCLUSION: Our results show an increasing use of S-ICD over the years in patients undergoing TV-ICD explantation. An S-ICD is preferably adopted in young patients, mostly in the case of infection. The complication rate was comparable between groups and decreased when a sub- or intermuscular S-ICD generator position was adopted.
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
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: 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