Surgical Management of Implantation-Related Complications of the Subcutaneous Implantable Cardioverter-Defibrillator

Abstract Objectives This study assessed outcomes in patients in whom subcutaneous implantable cardioverter-defibrillator (S-ICD) therapy was continued after implantation-related complications, in order to avoid conversion to transvenous ICD therapy. Background Patients at risk for sudden cardiac dea...

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Bibliographic Details
Published in:JACC. Clinical electrophysiology 2016-02, Vol.2 (1), p.89-96
Main Authors: Brouwer, Tom F., MD, Driessen, Antoine H.G., MD, Olde Nordkamp, Louise R.A., MD, PhD, Kooiman, Kirsten M., CCDS, de Groot, Joris R., MD, PhD, Wilde, Arthur A.M., MD, PhD, Knops, Reinoud E., MD
Format: Article
Language:English
Subjects:
Cardiovascular
complication
erosion
ICD
infection
S-ICD
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Summary:Abstract Objectives This study assessed outcomes in patients in whom subcutaneous implantable cardioverter-defibrillator (S-ICD) therapy was continued after implantation-related complications, in order to avoid conversion to transvenous ICD therapy. Background Patients at risk for sudden cardiac death benefit from ICD therapy, despite a significant risk for complications. S-ICD has a similar complication rate as transvenous ICD therapy, but the absence of transvenous leads may hold long-term benefits, especially in young ICD patients. Methods In the largest single-center cohort available to date, S-ICD patients implanted between 2009 and 2015 were included. Results There were 123 patients at a median age of 40 years. During a median follow-up of 2 years, 10 patients (9.4%) suffered implant-related complications. There were 5 infections, 3 erosions, and 2 implant failures for which 21 surgical procedures were needed. In 9 of 10 patients, S-ICD therapy could be continued after intervention. In 6 patients, the period between extraction and reimplantation of the S-ICD system was bridged with a wearable cardioverter-defibrillator (WCD). The pulse generator was reimplanted at the original site in 5 patients and in 3 underneath the serratus anterior muscle. One patient was not reimplanted following extraction due to recurrent infections. Conversion to a transvenous ICD was not needed in any patient. Conclusions In most patients with a complication, S-ICD therapy could be continued after intervention, avoiding the need to convert to a transvenous system. Bridging to recovery with a WCD and submuscular implantation of the pulse generator are effective treatment strategies to manage S-ICD complications.
ISSN:2405-500X
2405-5018
DOI:10.1016/j.jacep.2015.09.011