Two-incision technique for implantation of the subcutaneous implantable cardioverter-defibrillator

Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: .
Heart rhythm: the official journal of the Heart Rhythm Society (Impact Factor: 5.08). 05/2013; 10(8). DOI: 10.1016/j.hrthm.2013.05.016
Source: PubMed

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.

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    • "The details of the S-ICD system and implantation technique have been described elsewhere [2, 7•]. In summary, the device is placed in the left lateral position via a lateral submammary incision and the lead tunnelled to be positioned parasternally sensing the surface ECG electrogram in three vectors (Fig. 1). "
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