Key result
Subcostal ICD placement in young adults demonstrated comparable lead survival to conventional pectoral placement (97% vs 95%, non-significant) with potentially fewer procedural complications.
Why the study?
Does subcostal ICD placement reduce procedural complications and adverse events compared to conventional pectoral placement in young adults?
Cohort (n=106)
No
Does subcostal ICD placement reduce procedural complications and adverse events compared to conventional pectoral placement in young adults?
Subcostal ICD placement in young adults is a viable alternative to conventional pectoral placement, offering potentially better procedural outcomes and comparable lead performance.
Answers are grounded in this paper and cite their sources.
May warrant consideration to reduce complications in young adults; hypothesis-generating and should not yet change practice.
AIM: The aim of our study is to compare two approaches of implantable cardiac defibrillator (ICD) implantation, conventional (supra/subpectoral) and subcostal in young adults in terms of procedural complications and adverse events encountered during follow-up. METHODS AND RESULTS: From January 2007 to December 2013, all patients under the age of 50 years who received an ICD in our centre were included in this study. Patient's hospital records were analysed for procedural complications and adverse events during follow-up until December 2014. Data from device on first interrogation after implantation and on follow-up were also noted. A total of 106 patients of which 40.6% had Brugada's syndrome (65.1% male, age 33.6 ± 10.97 years) were included in analysis; 71 (61%) had ICD placed in (sub/supra) pectoral and 35 (33%) in subcostal position. Only seven patients received an epicardial lead system. During the follow-up period of 2.1 ± 1.8 years, 84.90% of the patients had no adverse events. Most of the complications, procedural and during follow-up, occur in conventionally placed, pectoral ICD. Lead follow-up data in both groups, conventional and subcostal, showed no difference in right ventricular (RV) shock impedance and R wave sensing, P-value = 0.56 and 0.77, respectively. Lead survival was 95 and 97%, respectively, in conventional and subcostal groups over a mean follow-up of 2.1 ± 1.8 years. Log-rank test for lead survival was not significant in terms of site of implantation. CONCLUSION: To the best our knowledge, this is the first study demonstrating subcostal ICD placement in young adults and resulting in equivalent to better outcomes when compared with conventionally placed pectoral ICD. Subcostal ICD placement might be considered an alternative option in young adults as it results in better procedural outcomes and also comparable rate of adverse events during follow-up, but bigger studies with a larger number of patients are needed for a definitive conclusion.
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Irfan et al. (2016) conducted a cohort in Young adults requiring implantable cardiac defibrillator (ICD) (n=106). Subcostal ICD implantation vs. Conventional (supra/subpectoral) ICD implantation was evaluated on Lead survival (p=not significant). Subcostal ICD placement in young adults demonstrated comparable lead survival to conventional pectoral placement (97% vs 95%, non-significant) with potentially fewer procedural complications.
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