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. 2022 Apr 15;13(4):4947-4953.
doi: 10.19102/icrm.2022.130407. eCollection 2022 Apr.

Subcutaneous Implantable Cardioverter-defibrillator Explantation-A Single Tertiary Center Experience

Naga Venkata K Pothineni  1 , Tharian Cherian  1 , Neel Patel  1 , Jeffrey Smietana  1 , David S Frankel  1 , Rajat Deo  1 , Andrew E Epstein  1 , Francis E Marchlinski  1 , Robert D Schaller  1
Affiliations

Subcutaneous Implantable Cardioverter-defibrillator Explantation-A Single Tertiary Center Experience

Naga Venkata K Pothineni et al. J Innov Card Rhythm Manag. .

Abstract

The subcutaneous implantable cardioverter-defibrillator (S-ICD) is an appealing alternative to transvenous ICD systems. However, data on indications for S-ICD explantations are sparse. The objective of this study was to assess the incidence and indications for S-ICD explantation at a large tertiary referral center. We conducted a retrospective study of all S-ICD explantations performed from 2014-2020. Data on demographics, comorbidities, implantation characteristics, and indications for explantation were collected. A total of 64 patients underwent S-ICD explantation during the study period. During that time, there were 410 S-ICD implantations at our institution, of which 53 (12.9%) were explanted with a mean duration from implant to explant of 19.7 ± 20.1 months. The mean age of the patients at explantation was 44.8 ± 15.3 years, and 42% (n = 27) were women. The indication for S-ICD implantation was primary prevention in 58% and secondary prevention in 42% of patients, respectively. The most common reason for explantation was infection (32.8%), followed by abnormal sensing (25%) and the need for pacing (18.8%). Those who underwent S-ICD explantation for pacing indications were significantly older (55.7 ± 13.6 vs. 42.3 ± 14.6 years, P = 0.005) with a wider QRS duration (111 ± 19 vs. 98 ± 19 ms, P = 0.03) at device implantation compared to patients who underwent explantation for other indications. The incidence of S-ICD explantation in a large tertiary practice was 12.9%. While infection was the indication for one-third of the explantations, a significant number of explantations were due to sensing abnormalities and the need for pacing. These data may have implications for patient selection for S-ICD implantation.

Keywords: Explantation; extraction; infection; pacing; subcutaneous implantable cardioverter-defibrillator.

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Conflict of interest statement

The authors report no conflicts of interest for the published content. This study was funded in part by the Mark Marchlinski EP Research & Education Fund.

Figures

Figure 1:
Figure 1:
Subcutaneous implantable cardioverter-defibrillator explantations over time arranged by explant indication.
Figure 2:
Figure 2:
Indications for explantation arranged by generation of subcutaneous implantable cardioverter-defibrillator.
See this image and copyright information in PMC

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