Mauro Biffi1, Maria Grazia Bongiorni2, Antonio D'Onofrio3, Michele Manzo4, Paolo Pieragnoli5, Pietro Palmisano6, Luca Ottaviano7, Giovanni Battista Perego8, Antonio Pangallo9, Carlo Lavalle10, Vincenzo Bonfantino11, Gerardo Nigro12, Maurizio Eugenio Landolina13, Grigorios Katsouras14, Igor Diemberger15, Stefano Viani2, Valter Bianchi3, Mariolina Lovecchio16, Sergio Valsecchi16, Matteo Ziacchi15. 1. Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy. Electronic address: mauro.biffi@aosp.bo.it. 2. Second Cardiology Division, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy. 3. "Unità Operativa di Elettrofisiologia, Studio e Terapia delle Aritmie," Monaldi Hospital, Naples, Italy. 4. Ospedali Riuniti San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy. 5. University of Florence, Florence, Italy. 6. "Card. G. Panico" Hospital, Tricase, Lecce, Italy. 7. Istituto Clinico Sant'Ambrogio, Milan, Italy. 8. Istituto Auxologico Italiano, Milan, Italy. 9. Riuniti Hospital, Reggio Calabria, Italy. 10. Policlinico Umberto I -"Sapienza" University of Rome, Italy. 11. Di Venere Hospital, Carbonara, Bari, Italy. 12. Second University of Naples, Naples, Italy. 13. Division of Cardiology, "Maggiore" Hospital of Crema, Cremona, Italy. 14. "F. Miulli" Hospital, Acquaviva delle Fonti, Bari, Italy. 15. Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy. 16. Boston Scientific, Milan, Italy.
Abstract
OBJECTIVES: This study evaluated the efficacy of conversion test performed at 40 J (defibrillation margin ≥40 J), and factors potentially associated with test failure were identified. BACKGROUND: Current subcutaneous implantable cardioverter-defibrillator (S-ICD) devices deliver a maximum of 80 J. Functional defibrillation testing is recommended at S-ICD implantation, and it is usually conducted by delivering a shock energy of 65 J to ensure a safety defibrillation margin ≥15 J. Although high rates of successful conversion were reported at 65 J, limited data exist on the defibrillation margin extent. METHODS: Ventricular fibrillation was induced and conversion test was performed by delivering a 40-J shock in 308 patients. Success was defined as termination of ventricular fibrillation by the first shock delivered in standard polarity. The S-ICD system positioning was evaluated with the PRAETORIAN score using bidirectional chest X-rays. RESULTS: The generator was positioned in an intermuscular pocket in 301 patients (98%) and the lead was implanted by means of a 2-incision technique. The PRAETORIAN score was <90 (low risk of conversion failure) in 293 (95%) patients. Overall, ventricular fibrillation termination occurred in 259 (84%) patients with 40 J. Male gender (odds ratio [OR]: 3.79; 95% confidence interval [CI]: 1.09 to 13.14; p = 0.036), body mass index (OR: 1.09; 95% CI: 1.01 to 1.19; p = 0.036), dilated cardiomyopathy with reduced ejection fraction (OR: 0.42; 95% CI: 0.20 to 0.87; p = 0.019), and PRAETORIAN score >50 (OR: 2.93; 95% CI: 1.26 to 6.83; p = 0.013) were independently associated with conversion failure. CONCLUSIONS: The authors showed a high rate of defibrillation success with 40-J shocks in S-ICD systems implanted by means of modern surgical techniques. The variables associated with shock failure were male gender, higher body mass index, and suboptimal device position according to the PRAETORIAN score.
OBJECTIVES: This study evaluated the efficacy of conversion test performed at 40 J (defibrillation margin ≥40 J), and factors potentially associated with test failure were identified. BACKGROUND: Current subcutaneous implantable cardioverter-defibrillator (S-ICD) devices deliver a maximum of 80 J. Functional defibrillation testing is recommended at S-ICD implantation, and it is usually conducted by delivering a shock energy of 65 J to ensure a safety defibrillation margin ≥15 J. Although high rates of successful conversion were reported at 65 J, limited data exist on the defibrillation margin extent. METHODS:Ventricular fibrillation was induced and conversion test was performed by delivering a 40-J shock in 308 patients. Success was defined as termination of ventricular fibrillation by the first shock delivered in standard polarity. The S-ICD system positioning was evaluated with the PRAETORIAN score using bidirectional chest X-rays. RESULTS: The generator was positioned in an intermuscular pocket in 301 patients (98%) and the lead was implanted by means of a 2-incision technique. The PRAETORIAN score was <90 (low risk of conversion failure) in 293 (95%) patients. Overall, ventricular fibrillation termination occurred in 259 (84%) patients with 40 J. Male gender (odds ratio [OR]: 3.79; 95% confidence interval [CI]: 1.09 to 13.14; p = 0.036), body mass index (OR: 1.09; 95% CI: 1.01 to 1.19; p = 0.036), dilated cardiomyopathy with reduced ejection fraction (OR: 0.42; 95% CI: 0.20 to 0.87; p = 0.019), and PRAETORIAN score >50 (OR: 2.93; 95% CI: 1.26 to 6.83; p = 0.013) were independently associated with conversion failure. CONCLUSIONS: The authors showed a high rate of defibrillation success with 40-J shocks in S-ICD systems implanted by means of modern surgical techniques. The variables associated with shock failure were male gender, higher body mass index, and suboptimal device position according to the PRAETORIAN score.
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