Successful defibrillation verification in subcutaneous implantable cardioverter-defibrillator recipients by low-energy shocks.
defibrillation test
energy
implantable defibrillator
subcutaneous
ventricular fibrillation
Journal
Clinical cardiology
ISSN: 1932-8737
Titre abrégé: Clin Cardiol
Pays: United States
ID NLM: 7903272
Informations de publication
Date de publication:
Jun 2019
Jun 2019
Historique:
received:
22
01
2019
revised:
05
04
2019
accepted:
13
04
2019
pubmed:
17
4
2019
medline:
18
12
2019
entrez:
17
4
2019
Statut:
ppublish
Résumé
The subcutaneous implantable cardioverter-defibrillator (S-ICD) is an effective alternative to the transvenous one. Defibrillation efficacy depends on maximum device output and on the optimal device location at device implantation. We sought to investigate the defibrillation safety margin in real life clinical practice. We sought to understand what is the efficacy of induced ventricular fibrillation (VF) termination at S-ICD implantation using lower energies than the recommended 65 J. Sixty-four consecutive S-ICD recipients underwent VF termination attempts at implantation with energies ranging from 20 to 50 J. Overall, VF termination occurred in 84% of patients with ≤40 J, in 88% with 45 J, and in 100% with 60 J. Intermuscular S-ICD placement was associated with 94% VF termination at ≤40 J. An ejection fraction <35% was associated to higher energy requirement for defibrillation; however, an intermuscular S-ICD placement conferred 90% defibrillation efficacy at 31 ± 5 J in this patients subset. This is a hypothesis-generating observation that prompts a methodologically correct investigation to prove that a 60 J output S-ICD can provide an adequate safety margin to terminate VF in clinical practice. This would enable superior device longevity and/or device downsizing for pediatric/small size patients.
Sections du résumé
BACKGROUND
BACKGROUND
The subcutaneous implantable cardioverter-defibrillator (S-ICD) is an effective alternative to the transvenous one. Defibrillation efficacy depends on maximum device output and on the optimal device location at device implantation.
HYPOTHESIS
OBJECTIVE
We sought to investigate the defibrillation safety margin in real life clinical practice.
METHODS
METHODS
We sought to understand what is the efficacy of induced ventricular fibrillation (VF) termination at S-ICD implantation using lower energies than the recommended 65 J.
RESULTS
RESULTS
Sixty-four consecutive S-ICD recipients underwent VF termination attempts at implantation with energies ranging from 20 to 50 J. Overall, VF termination occurred in 84% of patients with ≤40 J, in 88% with 45 J, and in 100% with 60 J. Intermuscular S-ICD placement was associated with 94% VF termination at ≤40 J. An ejection fraction <35% was associated to higher energy requirement for defibrillation; however, an intermuscular S-ICD placement conferred 90% defibrillation efficacy at 31 ± 5 J in this patients subset.
CONCLUSIONS
CONCLUSIONS
This is a hypothesis-generating observation that prompts a methodologically correct investigation to prove that a 60 J output S-ICD can provide an adequate safety margin to terminate VF in clinical practice. This would enable superior device longevity and/or device downsizing for pediatric/small size patients.
Identifiants
pubmed: 30989668
doi: 10.1002/clc.23184
pmc: PMC6553357
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
612-617Informations de copyright
© 2019 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc.
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