Subcutaneous Implantable Cardioverter Defibrillators: An Overview of Implantation Techniques and Clinical Outcomes

Figures

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  Fig. (1). Subcutaneous Implantable Cardioverter Defibrillator (S-ICD) system components.

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  Fig. (2). A: Schematic presentation of the S-ICD system position. B: Shocking vectors of the S-ICD system: Primary, secondary and alternate. S-ICD – Subcutaneous Implantable Cardioverter Defibrillator – Boston Scientific. (Image courtesy of Boston Scientific Corporation, with kind permission to reprint).

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  Fig. (3). A: Location of the surface electrocardiogram (ECG) electrodes positions during screening for eligibility for subcutaneous implantable cardioverter- defibrillators (S-ICD) in conventional left and right parasternal configurations. B: ECG screening tool with examples of acceptable and unacceptable QRS complexes and T-waves. RA: right arm; LA: left arm; LL: left leg.

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  Fig. (4). Anatomical landmarks for the intermuscular device pocket. The skin incision is made along the inframammary crease about 2 cm above and tangent to the anterior belly latissimus dorsi (A). Note the display of the latisssimus dorsi using the fingers as shown in (B). (adapted from reference 30 Migliore F et al. Intermuscular Two-Incision Technique for Subcutaneous Implantable Cardioverter Defibrillator Implantation: Results from a Multicenter Registry. Pacing Clin Electrophysiol 2017; 40(3): 278-85).

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  Fig. (5). Intermuscular pocket is created by blunt dissection between the anterior surface of the serratus anterior muscle and the posterior surface of the latissimus dorsi muscle, over the left sixth rib between the midline and anterior axillary line (A and B). The pulse generator is placed into the virtual anatomical space between the two muscles and anchored to the fascia to prevent possible migration. Subsequently, the two muscles are sutured using conventional absorbable suture (C and D). (adapted from reference 30 Migliore F et al. Intermuscular Two-Incision Technique for Subcutaneous Implantable Cardioverter Defibrillator Implantation: Results from a Multicenter Registry. Pacing Clin Electrophysiol 2017; 40(3): 278-85).