Background: The subcutaneous implantable cardioverter defibrillator (S-ICD) is a relatively novel alternative to the transvenous ICD (T-ICD) for the treatment of life-threatening ventricular arrhythmias and is currently adopted in the clinical practice of several centers. Patients undergoing T-ICD explantation may be eligible for reimplantation with an S-ICD. Purpose: The aim of this analysis was to describe current Italian practice associated with S-ICD use after T-ICD explantation. Methods: We analyzed all consecutive patients who underwent transvenous extraction of a T-ICD and subsequent reimplantation of an S-ICD or a single-chamber T-ICD at 13 Italian centers from 2011 to 2017. Results: Data from 219 patients were analyzed. 83 patients received an S-ICD and 136 a single-chamber T-ICD. The utilization of S-ICD increased from 9% in 2011 to 83% in 2017 (p<0.001). S-ICD patients were younger than patients who received T-ICD (54±13 vs. 60±18 years, p=0.011), more frequently were male (90% vs. 74%, p=0.006) and showed a trend toward higher BMI (26±4 vs. 25±4, p=0.088). However, the underlying cardiomyopathy, the systolic function and the rate of comorbidities (diabetes, chronic renal disease) were comparable between groups. Venous thrombosis or obstruction was the reason for previous T-ICD extraction only in 4% of patients reimplanted with S-ICD. While, the reason was infection in 76% of patients reimplanted with S-ICD and in 53% of patients who received a new T-ICD (p<0.001). The proportion of patients previously implanted with a multi-lead (dual-chamber or biventricular) T-ICD and reimplanted with S-ICD or single-chamber T-ICD increased from 16% in 2011 to 71% in 2017 (p<0.001). Overall, a multi-lead T-ICD was previously implanted in 50% of patients reimplanted with S-ICD and 35% of those who received a single-chamber T-ICD (p=0.025). Conclusions: Our analysis demonstrated a trend to wider use of S-ICD after T-ICD explantation over the years. Also in this group of patients, the S-ICD is preferably adopted for specific patients (younger, male). The S-ICD is used not only in case of limited vascular access, but became the preferred option in case of infection. Increased consideration seemed to be given to the reappraisal of the actual need for pacing therapies, since multi-lead T-ICDs were not reimplanted in many patients, and an S-ICD was more frequently preferred.
Use of Subcutaneous ICD after transvenous ICD extraction: an analysis of Italian clinical practice
L. Segreti;G. Luzzi;R. Rordorf;MG. Bongiorni
2018-01-01
Abstract
Background: The subcutaneous implantable cardioverter defibrillator (S-ICD) is a relatively novel alternative to the transvenous ICD (T-ICD) for the treatment of life-threatening ventricular arrhythmias and is currently adopted in the clinical practice of several centers. Patients undergoing T-ICD explantation may be eligible for reimplantation with an S-ICD. Purpose: The aim of this analysis was to describe current Italian practice associated with S-ICD use after T-ICD explantation. Methods: We analyzed all consecutive patients who underwent transvenous extraction of a T-ICD and subsequent reimplantation of an S-ICD or a single-chamber T-ICD at 13 Italian centers from 2011 to 2017. Results: Data from 219 patients were analyzed. 83 patients received an S-ICD and 136 a single-chamber T-ICD. The utilization of S-ICD increased from 9% in 2011 to 83% in 2017 (p<0.001). S-ICD patients were younger than patients who received T-ICD (54±13 vs. 60±18 years, p=0.011), more frequently were male (90% vs. 74%, p=0.006) and showed a trend toward higher BMI (26±4 vs. 25±4, p=0.088). However, the underlying cardiomyopathy, the systolic function and the rate of comorbidities (diabetes, chronic renal disease) were comparable between groups. Venous thrombosis or obstruction was the reason for previous T-ICD extraction only in 4% of patients reimplanted with S-ICD. While, the reason was infection in 76% of patients reimplanted with S-ICD and in 53% of patients who received a new T-ICD (p<0.001). The proportion of patients previously implanted with a multi-lead (dual-chamber or biventricular) T-ICD and reimplanted with S-ICD or single-chamber T-ICD increased from 16% in 2011 to 71% in 2017 (p<0.001). Overall, a multi-lead T-ICD was previously implanted in 50% of patients reimplanted with S-ICD and 35% of those who received a single-chamber T-ICD (p=0.025). Conclusions: Our analysis demonstrated a trend to wider use of S-ICD after T-ICD explantation over the years. Also in this group of patients, the S-ICD is preferably adopted for specific patients (younger, male). The S-ICD is used not only in case of limited vascular access, but became the preferred option in case of infection. Increased consideration seemed to be given to the reappraisal of the actual need for pacing therapies, since multi-lead T-ICDs were not reimplanted in many patients, and an S-ICD was more frequently preferred.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
