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Review
. 2025 Aug;68(5):1131-1139.
doi: 10.1007/s10840-022-01312-y. Epub 2022 Aug 5.

"Shift and cover technique": conservative management of complications for the rescue of S-ICD subcutaneous implantable defibrillator systems

Andrea Droghetti  1 , Domenico Pecora  2 , Stefano Maffè  3 , Sandra Badolati  4 , Patrizia Pepi  5 , Daniele Nicolis  5 , Pierpaolo Lupo  6 , Mariolina Lovecchio  7 , Sergio Valsecchi  7 , Luca Ottaviano  8
Affiliations
Review

"Shift and cover technique": conservative management of complications for the rescue of S-ICD subcutaneous implantable defibrillator systems

Andrea Droghetti et al. J Interv Card Electrophysiol. 2025 Aug.

Abstract

Background: The risk of complications has been shown to be lower with subcutaneous implantable defibrillator (S-ICD) than with conventional ICDs. Given the low frequency of complications, experience of how to manage them is limited. In this paper, we describe generator- and lead-related complications recorded in a series of S-ICD patients, and we propose our conservative approach to managing them.

Methods: The study cohort consisted of S-ICD patients who were referred to our institution owing to generator- or lead-related complications requiring surgical intervention. With our "shift and cover" approach, the system component involved is moved from its original position to an alternative, more protected location. In the case of the generator, this involves moving it to an intermuscular pocket. In the case of infections at the parasternal scar, the electrode sleeve is moved away from its original location, stitched, and then covered with the muscular fascia.

Results: Fourteen S-ICD patients were referred to our institution owing to system-related complications. Complications involved the generator in 7 cases (deep pocket infections with erosion, extrusion, or pain), the lead in 5 cases (parasternal infections at the xyphoid incision site), and both the generator and the lead in 2 cases. Complications were managed without completely removing the device and resolved in a single surgical session with no intraoperative complications. During defibrillation testing, the first shock at 65 J was effective in all patients. The shock impedance after revision was significantly lower than that measured during first implantation (59 ± 10 Ohm versus 86 ± 24 Ohm, P = 0.013). In all cases, the cosmetic result was satisfactory. No complications or recurrent infections were reported at the 12-month follow-up visit.

Conclusions: The proposed conservative approach was successful in managing S-ICD complications. The revision procedure allowed to optimize the system configuration in terms of the defibrillation vector, resulting in lower shock impedance values and better device positioning.

Keywords: Complication; Infection; Intermuscular technique; Replacement; Subcutaneous defibrillator.

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Conflict of interest statement

Declarations. Competing interests: Dr. Andrea Droghetti and Dr. Luca Ottaviano are consultants for Boston Scientific. The other authors report no conflicts. Informed consent: Before the procedure, each patient signed an informed consent form approved by the institutional review board.

References

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