Why the study?
Although traditional S-ICD implantation involves three incisions and a subcutaneous pocket, an intermuscular 2-incision technique has been recently adopted, prompting evaluation of acute defibrillation efficacy by technique.
Does the intermuscular 2-incision technique improve acute defibrillation efficacy compared to traditional techniques in patients undergoing S-ICD implantation?
Does the intermuscular 2-incision technique improve acute defibrillation efficacy compared to traditional techniques in patients undergoing S-ICD implantation?
The intermuscular 2-incision technique for S-ICD implantation is associated with lower shock impedance and a higher likelihood of successful acute defibrillation compared to traditional approaches.
May support 2-incision IM S-ICD technique for defibrillation; leaves open need for randomized confirmation.
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.
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Francia et al. (2021) studied this question.
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