Acute shock efficacy of the subcutaneous implantable cardioverter‐defibrillator according to the implantation technique
Background The traditional technique for subcutaneous implantable cardioverter defibrillator (S‐ICD) implantation involves three incisions and a subcutaneous (SC) pocket. An intermuscular (IM) 2‐incision technique has been recently adopted. Aims We assessed acute defibrillation efficacy (DE) of S‐IC...
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Published in | Journal of cardiovascular electrophysiology Vol. 32; no. 6; pp. 1695 - 1703 |
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Main Authors | , , , , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
United States
Wiley Subscription Services, Inc
01.06.2021
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Subjects | |
Online Access | Get full text |
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Summary: | Background
The traditional technique for subcutaneous implantable cardioverter defibrillator (S‐ICD) implantation involves three incisions and a subcutaneous (SC) pocket. An intermuscular (IM) 2‐incision technique has been recently adopted.
Aims
We assessed acute defibrillation efficacy (DE) of S‐ICD (DE ≤65 J) according to the implantation technique.
Methods
We analyzed consecutive patients who underwent S‐ICD implantation and DE testing at 53 Italian centers. Regression analysis was used to determine the association between DFT and implantation technique.
Results
A total of 805 patients were enrolled. Four groups were assessed: IM + 2 incisions (n = 546), SC + 2 incisions (n = 133), SC + 3 incisions (n = 111), and IM + 3 incisions (n = 15). DE was ≤65 J in 782 (97.1%) patients. Patients with DE ≤65 J showed a trend towards lower body mass index (25.1 vs. 26.5; p = .12), were less frequently on antiarrhythmic drugs (13% vs. 26%; p = .06) and more commonly underwent implantation with the 2‐incision technique (85% vs. 70%; p = .04). The IM + 2‐incision technique showed the lowest defibrillation failure rate (2.2%) and shock impedance (66 Ohm, interquartile range: 57–77). On multivariate analysis, the 2‐incision technique was associated with a lower incidence of shock failure (hazard ratio: 0.305; 95% confidence interval: 0.102–0.907; p = .033). Shock impedance was lower with the IM than with the SC approach (66 vs. 70 Ohm p = .002) and with the 2‐incision than the 3‐incision technique (67 vs. 72 Ohm; p = .006).
Conclusions
In a large population of S‐ICD patients, we observed a high defibrillation success rate. The IM + 2‐incision technique provides lower shock impedance and a higher likelihood of successful defibrillation. |
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Bibliography: | Disclosures http://clinicaltrials.gov/Identifier NCT02275637 Pietro Francia received speaker's fees and educational grants from Boston Scientific and research grants from Abbott. Mariolina Lovecchio and Sergio Valsecchi are employees of Boston Scientific. The other authors report no conflicts. Clinical Trial Registration: URL ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 1045-3873 1540-8167 |
DOI: | 10.1111/jce.15081 |