Growing experience with subcutaneous and extravascular implantable cardioverter-defibrillators: results from an implantation center

    Authors

    Keywords

    implantable cardioverter-defibrillator, sudden cardiac death

    DOI

    https://doi.org/10.15836/ccar2024.406

    Full Text

    **Introduction**: Implantable cardioverter-defibrillators (ICDs) are the gold standard for preventing sudden cardiac death (SCD). Subcutaneous ICDs (S-ICDs) offer an alternative to traditional transvenous devices (TV-ICDs), reducing the risk of lead complications and systemic infections and offering safe and effective therapy in case of anatomic constraints. (1, 2) The new extravascular ICD (EV-ICD) is being developed as an option that addresses some limitations of both TV-ICDs and S-ICDs. However, adopting these technologies involves increased costs and a learning curve for new implantation centres. **Patients and Methods**: We analysed data on all non-TV-ICDs implanted at University Hospital Centre Zagreb since their introduction in December 2021. **Results**: A total of 19 patients (68% male) were included, with a median age of 49 years (range 10-73). Eighteen patients received S-ICDs for primary SCD prevention, while one 10-year-old patient received an EV-ICD for secondary prevention after a failed TV-ICD implantation due to ischemic cardiomyopathy (ICM). The indications for S-ICD use included ICM (6 cases), hypertrophic cardiomyopathy (5 cases), and non-ischemic cardiomyopathy (7 cases). Various reasons for choosing S-ICD over TV-ICD were noted: 8 patients had severe kidney failure (3 with chronic dialysis catheters), 5 were young and preferred S-ICD, 4 had anatomical constraints preventing TV-ICD placement, and one had a prior TV-ICD infection. The first 6 implants were conducted with the assistance of an experienced proctor. In one S-ICD case, the defibrillation test was unsuccessful requiring lead repositioning during revision procedure. One patient experienced inappropriate S-ICD activation one day post-implantation, but no other periprocedural complications occurred. During follow-up, 5 patients had appropriate device activations; 2 patients died of congestive heart failure and chronic renal insufficiency, and 2 received heart transplants (one being a combined heart-kidney transplant). **Conclusion**: Non-TV-ICDs have been successfully integrated into our practice over the past three years. Increasing expertise with these newer technologies is crucial to meet the rising demand for SCD prevention in specialised patient populations. However, broader adoption remains challenged by reimbursement issues.

    Literature

    1. Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA, et al. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J. 2022 October 21;43(40):3997–4126. https://doi.org/10.1093/eurheartj/ehac262
    2. Friedman P, Murgatroyd F, Boersma LVA, Manlucu J, O’Donnell D, Knight BP, et al. Efficacy and Safety of an Extravascular Implantable Cardioverter-Defibrillator. N Engl J Med. 2022 October 6;387(14):1292–302. https://doi.org/10.1056/NEJMoa2206485
    Cardiologia Croatica
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    Growing experience with subcutaneous and extravascular implantable cardioverter-defibrillators: results from an implantation center

    Extended Abstract
    Issue11-12
    Published
    Pages406
    PDF via DOIhttps://doi.org/10.15836/ccar2024.406
    implantable cardioverter-defibrillator
    sudden cardiac death

    Authors

    Ivan Prepolec*ORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Miroslav KrpanORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Andrija NekićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Vedran PašaraORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Richard MatasićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Borka Pezo-NikolićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Mislav PuljevićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Martina Lovrić-BenčićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Davor PuljevićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Davor MiličićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Vedran VelagićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia

    *Correspondence email: iprepolec@gmail.com

    Full Text

    Introduction: Implantable cardioverter-defibrillators (ICDs) are the gold standard for preventing sudden cardiac death (SCD). Subcutaneous ICDs (S-ICDs) offer an alternative to traditional transvenous devices (TV-ICDs), reducing the risk of lead complications and systemic infections and offering safe and effective therapy in case of anatomic constraints. (1, 2) The new extravascular ICD (EV-ICD) is being developed as an option that addresses some limitations of both TV-ICDs and S-ICDs. However, adopting these technologies involves increased costs and a learning curve for new implantation centres.

    Patients and Methods: We analysed data on all non-TV-ICDs implanted at University Hospital Centre Zagreb since their introduction in December 2021.

    Results: A total of 19 patients (68% male) were included, with a median age of 49 years (range 10-73). Eighteen patients received S-ICDs for primary SCD prevention, while one 10-year-old patient received an EV-ICD for secondary prevention after a failed TV-ICD implantation due to ischemic cardiomyopathy (ICM). The indications for S-ICD use included ICM (6 cases), hypertrophic cardiomyopathy (5 cases), and non-ischemic cardiomyopathy (7 cases). Various reasons for choosing S-ICD over TV-ICD were noted: 8 patients had severe kidney failure (3 with chronic dialysis catheters), 5 were young and preferred S-ICD, 4 had anatomical constraints preventing TV-ICD placement, and one had a prior TV-ICD infection. The first 6 implants were conducted with the assistance of an experienced proctor. In one S-ICD case, the defibrillation test was unsuccessful requiring lead repositioning during revision procedure. One patient experienced inappropriate S-ICD activation one day post-implantation, but no other periprocedural complications occurred. During follow-up, 5 patients had appropriate device activations; 2 patients died of congestive heart failure and chronic renal insufficiency, and 2 received heart transplants (one being a combined heart-kidney transplant).

    Conclusion: Non-TV-ICDs have been successfully integrated into our practice over the past three years. Increasing expertise with these newer technologies is crucial to meet the rising demand for SCD prevention in specialised patient populations. However, broader adoption remains challenged by reimbursement issues.

    Literature

    1. 1.
      Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA, et al. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J. 2022 October 21;43(40):3997–4126.DOI
    2. 2.
      Friedman P, Murgatroyd F, Boersma LVA, Manlucu J, O’Donnell D, Knight BP, et al. Efficacy and Safety of an Extravascular Implantable Cardioverter-Defibrillator. N Engl J Med. 2022 October 6;387(14):1292–302.DOI