What question did this study set out to answer?

To evaluate the clinical efficacy, therapeutic outcomes, and complication rates associated with subcutaneous implantable cardioverter-defibrillator (S-ICD) placement.

September 1, 2014Revista Portuguesa de Cardiologia (English Edition)Open Access

Subcutaneous implantable cardioverter-defibrillator: Initial experience

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Why the study?

Is subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation safe and feasible in patients with specific indications such as vascular access problems or high infection risk?

Key Points

To evaluate the clinical efficacy, therapeutic outcomes, and complication rates associated with subcutaneous implantable cardioverter-defibrillator (S-ICD) placement.
S-ICD placement was planned in N=23 patients indicated for device therapy due to vascular access issues, elevated infection risk, or young age with long life expectancy.
The cohort represented varied etiologies, including left ventricular noncompaction (n=5), ischemic heart disease (n=4), hypertrophic cardiomyopathy (n=4), Brugada syndrome (n=4), and arrhythmogenic right ventricular cardiomyopathy (n=3).
S-ICDs were successfully implanted in 21 of 23 patients (2 failed initial screening) with a mean procedural duration of 77 minutes and zero acute procedural complications.
Defibrillation testing required generator repositioning in 1 patient to reach an acceptable threshold.
During a mean follow-up of 14 months, 10 patients received shocks (50% appropriate), 1 patient developed an infection, 1 required early device replacement due to telemetry loss, and 1 noncardiac death occurred.

Structured PICO

Is subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation safe and feasible in patients with specific indications such as vascular access problems or high infection risk?

Population

23 patients with indications for ICD but with vascular access problems, increased risk of infection, or young patients with long predicted follow-up. Underlying conditions included ischemic heart disease (n=4), left ventricular noncompaction (n=5), Brugada syndrome (n=4), arrhythmogenic right ventricular cardiomyopathy (n=3), transposition of the great vessels (n=1), dilated cardiomyopathy (n=2), and hypertrophic cardiomyopathy (n=4).

Intervention

Subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation

Outcome

Therapeutics and complications associated with S-ICD systemssafety

S-ICD implantation is a feasible and safe alternative for patients requiring an ICD who have vascular access issues or high infection risk, though inappropriate shocks and device complications can occur.

Limitations

Small sample size
Short follow-up time

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

Supports S-ICD feasibility in select patients; leaves open need for larger prospective data on shocks and durability.

Cite This Study

Galvão et al. (2014) studied this question.

synapsesocial.com/papers/6a7176b735aa2c282ce2c1cb https://doi.org/10.1016/j.repce.2014.01.015

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Subcutaneous implantable cardioverter-defibrillator: Initial experience

Key Points

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Subcutaneous implantable cardioverter-defibrillator: Initial experience

Key Points

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Also Consider

Also Consider