Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2023 Feb;46(2):100-107.
doi: 10.1111/pace.14615. Epub 2022 Nov 21.

Multicenter assessment of the outcomes of subcutaneous ICD implantation in patients with prior or future sternotomy

Mejalli Al-Kofahi  1 , Oluwaseun G Adeola  2 , Jason Payne  3 , Moghniuddin Mohammed  1 , Y Madhu Reddy  1 , Raghuveer Dendi  1 , Rhea Pimentel  1 , Loren Berenbom  1 , Martin Emert  1 , Rigoberto Ramirez  1 , Amit Noheria  1 , Jay A Montgomery  2 , Seth H Sheldon  1
Affiliations
Multicenter Study

Multicenter assessment of the outcomes of subcutaneous ICD implantation in patients with prior or future sternotomy

Mejalli Al-Kofahi et al. Pacing Clin Electrophysiol. 2023 Feb.

Abstract

Background: The subcutaneous ICD (S-ICD) is a viable alternative to transvenous ICD and avoids intravascular complications in patients without a pacing indication. The outcomes of S-ICD implantation are uncertain in patients with prior sternotomy.

Objective: We aim to compare the implant techniques and outcomes with S-ICD implantation in patients with and without prior sternotomy.

Methods: Multicenter retrospective cohort study including adult patients with an S-ICD implanted between January 2014 and June 2020. Outcomes were compared between patients with and without prior sternotomy.

Results: Among the 212 patients (49 ± 15 years old, 43% women, BMI 30 ± 8 kg/m2 , 68% primary prevention, 30% ischemic cardiomyopathy, LVEF median 30% IQR 25%-45%) who underwent S-ICD implantation, 47 (22%) had a prior sternotomy. There was no difference in the sensing vector (57% vs. 53% primary, p = 0.55), laterality of the S-ICD lead to the sternum (94% vs. 96% leftward, p = 0.54), or the defibrillation threshold (65 ± 1.4 J vs. 65 ± 0.8 J, p = 0.76) with versus without prior sternotomy. The frequency of 30-day complications was similar with and without prior sternotomy (n = 3/47 vs. n = 15/165, 6% vs. 9%, p = 0.56). Over a median follow-up of 28 months (IQR 10-49 months), the frequency of inappropriate shocks was similar between those with and without prior sternotomy (n = 3/47 and n = 16/165, 6% vs. 10%, p = 0.58).

Conclusion: Implantation of an S-ICD in patients with prior sternotomy is safe with a similar risk of 30-day complications and inappropriate ICD shocks as patients without prior sternotomy.

Keywords: implantable cardioverter-defibrillator; inappropriate; sternotomy; subcutaneous.

PubMed Disclaimer

References

REFERENCES

    1. Kuriachan VP, Sumner GL, Mitchell LB. Sudden cardiac death. Curr Probl Cardiol. 2015;40:133-200. doi:10.1016/j.cpcardiol.2015.01.002
    1. Moss AJ, Zareba W, Hall WJ, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002;346:877-883. doi:10.1056/NEJMoa013474
    1. Moss AJ, Hall WJ, Cannom DS, et al. Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. N Engl J Med. 1996;335:1933-1940. doi:10.1056/NEJM199612263352601
    1. Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: executive summary. 2018;138. doi:10.1161/CIR.0000000000000548
    1. Van Rees JB, De Bie MK, Thijssen J, Borleffs CJW, Schalij MJ, Van Erven L. Implantation-related complications of implantable cardioverter- defibrillators and cardiac resynchronization therapy devices: a systematic review of randomized clinical trials. J Am Coll Cardiol. 2011;58:995-1000. doi:10.1016/j.jacc.2011.06.007

Publication types

LinkOut - more resources