Why the study?
Rising S-ICD implantations have led to increased device-related complications requiring removal, but literature on S-ICD lead extraction indications, techniques, complications, and success rates had not been systematically synthesized.
What are the indications, techniques, and outcomes of subcutaneous implantable cardioverter defibrillator (S-ICD) lead extraction?
What are the indications, techniques, and outcomes of subcutaneous implantable cardioverter defibrillator (S-ICD) lead extraction?
S-ICD lead extraction is primarily performed for non-infective causes using a variety of techniques, highlighting the need for dedicated extraction tools and standardized approaches.
Answers are grounded in this paper and cite their sources.
May guide S-ICD extraction strategies in practice; extends limited observational data but leaves prospective validation open.
BACKGROUND AND PURPOSE: Subcutaneous implantable cardioverter defibrillators (S-ICDs) have emerged in recent years as a valid alternative to traditional transvenous ICDs (TV-ICDs). Therefore, the number of S-ICD implantations is rising, leading to a consequent increase in S-ICD-related complications sometimes requiring complete device removal. Thus, the aim of this systematic review is to gather all the available literature on S-ICD lead extraction (SLE), with particular reference to the type of indication, techniques, complications and success rate. METHODS: Studies were identified by searching electronic databases (Medline via PubMed, Scopus and Web of Science) from inception to 21 November 2022. The search strategy adopted was developed using the following key words: subcutaneous, S-ICD, defibrillator, ICD, extraction, explantation. Studies were included if they met both of the following criteria: (1) inclusion of patients with S-ICD; (2) inclusion of patients who underwent SLE. RESULTS: Our literature search identified 238 references. Based on the abstract evaluation, 38 of these citations were considered potentially eligible for inclusion, and their full texts were analyzed. We excluded 8 of these studies because no SLE was performed. Eventually, 30 studies were included, with 207 patients who underwent SLE. Overall, the majority of SLEs were performed for non-infective causes (59.90%). Infection of the device (affecting either the lead or the pocket) was the cause of SLE in 38.65% of cases. Indication data were not available in 3/207 cases. The mean dwelling time was 14 months. SLEs were performed using manual traction or with the aid of a tool designed for transvenous lead extraction (TLE), including either a rotational or non-powered mechanical dilator sheath. CONCLUSIONS: SLE is performed mainly for non-infective causes. Techniques vary greatly across different studies. Dedicated tools for SLE might be developed in the future and standard approaches should be defined. In the meantime, authors are encouraged to share their experience and data to further refine the existing variegated approaches.
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Vio et al. (2023) studied this question.
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