Acute shock efficacy of the subcutaneous implantable cardioverter-defibrillator according to the implantation technique.
ICD
conversion
defibrillation test
safety
subcutaneous
Journal
Journal of cardiovascular electrophysiology
ISSN: 1540-8167
Titre abrégé: J Cardiovasc Electrophysiol
Pays: United States
ID NLM: 9010756
Informations de publication
Date de publication:
06 2021
06 2021
Historique:
revised:
19
04
2021
received:
12
01
2021
accepted:
01
05
2021
pubmed:
11
5
2021
medline:
11
8
2021
entrez:
10
5
2021
Statut:
ppublish
Résumé
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. We assessed acute defibrillation efficacy (DE) of S-ICD (DE ≤65 J) according to the implantation technique. 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. 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). 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.
Sections du résumé
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.
Banques de données
ClinicalTrials.gov
['NCT02275637']
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1695-1703Informations de copyright
© 2021 The Authors. Journal of Cardiovascular Electrophysiology Published by Wiley Periodicals LLC.
Références
Bardy GH, Smith WM, Hood MA, et al. An entirely subcutaneous implantable cardioverter-defibrillator. N Engl J Med. 2010;363:36-44.
Weiss R, Knight BP, Gold MR, et al. Safety and efficacy of a totally subcutaneous implantable-cardioverter defibrillator. Circulation. 2013;128:944-953.
Lambiase PD, Barr C, Theuns DA, et al. EFFORTLESS Investigators. Worldwide experience with a totally subcutaneous implantable defibrillator: early results from the EFFORTLESS S-ICD Registry. Eur Heart J. 2014;35:1657-1665.
Knops RE, Olde Nordkamp LRA, Delnoy PHM, et al. PRAETORIAN Investigators. Subcutaneous or transvenous defibrillator therapy. N Engl J Med. 2020;383:526-536.
Gold MR, Lambiase PD, El-Chami MF, et al, UNTOUCHED Investigators. Primary results from the understanding outcomes with the S-ICD in primary prevention patients with low ejection fraction (UNTOUCHED) Trial. Circulation. 2020;143:7-17. https://doi.org/10.1161/CIRCULATIONAHA.120.048728
Wilkoff BL, Fauchier L, Stiles MK, et al. Document reviewers. 2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing. Europace. 2016;18:159-183.
Gold MR, Aasbo JD, El-Chami MF, et al. Subcutaneous implantable cardioverter-defibrillator post-approval study: clinical characteristics and perioperative results. Heart Rhythm. 2017;14:1456-1463.
Friedman DJ, Parzynski CS, Varosy PD, et al. Trends and in-hospital outcomes associated with adoption of the subcutaneous implantable cardioverter defibrillator in the United States. JAMA Cardiol. 2016;1:900-911.
Boersma L, Barr C, Knops R, et al, EFFORTLESS Investigator Group. Implant and midterm outcomes of the subcutaneous implantable cardioverter-defibrillator registry: the EFFORTLESS study. J Am Coll Cardiol. 2017;70:830-841.
D'Onofrio A, Pieragnoli P, Biffi M, et al. “S-ICD Rhythm Detect” Investigators. Subcutaneous implantable cardioverter defibrillator implantation: an analysis of Italian clinical practice and its evolution. Int J Cardiol. 2018;272:162-167.
Knops RE, Olde Nordkamp LR, De Groot JR, Wilde AA. Two-incision technique for implantation of the subcutaneous implantable cardioverter-defibrillator. Heart Rhythm. 2013;10:1240-1243.
Migliore F, Allocca G, Calzolari V, et al. Intermuscular two-incision technique for subcutaneous implantable cardioverter defibrillator implantation: results from a multicenter registry. Pacing Clin Electrophysiol. 2017;40:278-285.
Droghetti A, Basso Ricci E, Scimia P, Harizai F, Marini M. Ultrasound-guided serratus anterior plane block combined with the two-incision technique for subcutaneous ICD implantation. Pacing Clin Electrophysiol. 2018;41:517-523.
Winter J, Siekiera M, Shin DI, et al. Intermuscular technique for implantation of the subcutaneous implantable cardioverter defibrillator: long-term performance and complications. Europace. 2017;19:2036-2041.
Francia P, Biffi M, Adduci C, et al. Implantation technique and optimal subcutaneous defibrillator chest position: a PRAETORIAN score-based study. Europace. 2020;22:1822-1829. https://doi.org/10.1093/europace/euaa231
Francia P, Ziacchi M, De Filippo P, et al. Subcutaneous implantable cardioverter defibrillator eligibility according to a novel automated screening tool and agreement with the standard manual electrocardiographic morphology tool. J Interv Card Electrophysiol. 2018;52:61-67.
Brouwer TF, Miller MA, Quast AB, et al. Implantation of the subcutaneous implantable cardioverter-defibrillator: an evaluation of 4 implantation techniques. Circ Arrhythm Electrophysiol. 2017;10:e004663. https://doi.org/10.1161/CIRCEP.116.004663
Migliore F, Mattesi G, De Franceschi P, et al. Multicentre experience with the second-generation subcutaneous implantable cardioverter defibrillator and the intermuscular two-incision implantation technique. J Cardiovasc Electrophysiol. 2019;30:854-864.
Van der Stuijt W, Baalman SWE, Brouwer TF, Quast ABE, de Groot JR, Knops RE. Long-term follow-up of the two-incision implantation technique for the subcutaneous implantable cardioverter-defibrillator. Pacing Clin Electrophysiol. 2020;43:1476-1480. https://doi.org/10.1111/pace.14022
Friedman DJ, Parzynski CS, Heist EK, et al. Ventricular fibrillation conversion testing after implantation of a subcutaneous implantable cardioverter defibrillator: report from the national cardiovascular data registry. Circulation. 2018;137:2463-2477.
Do K, Chang P, Konecny T, et al. Predictors of elevated defibrillation threshold with the subcutaneous implantable cardioverter-defibrillator. J Innov Card Rhythm Manag. 2017;8:2920-2929.
Biffi M, Ziacchi M, Angeletti A, et al. Successful defibrillation verification in subcutaneous implantable cardioverter-defibrillator recipients by low-energy shocks. Clin Cardiol. 2019;42:612-617.
Heist EK, Belalcazar A, Stahl W, Brouwer TF, Knops RE. Determinants of subcutaneous implantable cardioverter-defibrillator efficacy: a computer modeling study. JACC Clin Electrophysiol. 2017;3:405-414.
Frankel DS, Burke MC, Callans DJ, Stivland TM, Duffy E, Epstein AE. Impact of body mass index on safety and efficacy of the subcutaneous implantable cardioverter-defibrillator. JACC Clin Electrophysiol. 2018;4:652-659.
Amin AK, Gold MR, Burke MC, et al. Factors associated with high-voltage impedance and subcutaneous implantable defibrillator ventricular fibrillation conversion success. Circ Arrhythm Electrophysiol. 2019;12:e006665. https://doi.org/10.1161/CIRCEP.118.006665
Quast ABE, Baalman SWE, Brouwer TF, et al. A novel tool to evaluate the implant position and predict defibrillation success of the subcutaneous implantable cardioverter-defibrillator: the PRAETORIAN score. Heart Rhythm. 2019;16:403-410.