Two-incision technique for implantation of the subcutaneous implantable cardioverter-defibrillator
ABSTRACT BACKGROUND: Three incisions in the chest are necessary for the implantation of the entirely subcutaneous implantable defibrillator (S-ICD). The superior parasternal incision is a possible risk for infection and a potential source of discomfort. A less invasive alternative technique of implanting the S-ICD electrode avoids the superior parasternal incision: The two incision technique. OBJECTIVE: In this prospective cohort study, we sought to evaluate the safety and efficacy of the two incision technique for the implantation of the S-ICD. METHODS: Consecutive patients who received a S-ICD between October 2010 and December 2011 were implanted using the two incision technique, which positions the parasternal part of the S-ICD electrode using a standard 11 French peel-away sheath. All patients were routinely evaluated for at least one year for complications and device interrogation at the outpatient clinic. RESULTS: Thirty-nine patients (46% male, mean age 44±15 years) were implanted with a S-ICD using the two incision techniques. During a mean follow-up of 18 months (range 14-27) no dislocations were observed and there was no need for repositioning of either the ICD or the electrode. No serious infections occurred during follow-up except for two superficial wound infections of the pocket incision site. Device function was normal in all patients and no inappropriate sensing occurred related to the implantation technique. CONCLUSION: The two incision technique is a safe and efficacious alternative for S-ICD implantations and may help to reduce complications. The two incision technique offers physicians a less invasive and simplified implantation procedure of the S-ICD.
Circulation Arrhythmia and Electrophysiology 12/2014; 7(6):1281. DOI:10.1161/CIRCEP.114.002348 · 5.42 Impact Factor
Circulation Arrhythmia and Electrophysiology 10/2014; 7(5):986-7. DOI:10.1161/CIRCEP.113.001139 · 5.42 Impact Factor
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ABSTRACT: The subcutaneous implantable cardioverter-defibrillator (S-ICD) represents an exciting development in ICD technology. It has relative advantages over traditional transvenous systems, particularly for young patients in whom the lifetime risk of device-related complications may be deemed to be unacceptably high. While data relating to device longevity and long term safety profile is yet to be accrued, several recent studies have demonstrated good clinical efficacy comparable to transvenous ICDs. Indeed, new techniques have also been developed to simplify the S-ICD implantation procedure and attempts have been made to address challenges pertaining to T-wave oversensing to reduce the delivery of inappropriate shocks. The impact of inappropriate shocks and lack of anti-tachycardia pacing (ATP) function are not only contentious matters, but also have important implications for patients in whom the S-ICD would be suitable. It is envisaged that subsequent models of this device will be less cumbersome, with the possibility that an entirely leadless pacemaker-defibrillator will one day be possible. Although the S-ICD may not completely replace transvenous devices in its current form, evidence suggests that it is a viable alternative particularly in preventing sudden cardiac death in non-pacing dependent patients.