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

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• 作者：Tom F. Brouwer ; MD^a ; ^{t.f.brouwer@amc.uva.nl" class="auth_mail" title="E-mail the corresponding author} ; Antoine H.G. Driessen ; MD^b ; Louise R.A. Olde Nordkamp ; MD ; PhD^a ; Kirsten M. Kooiman ; CCDS^a ; Joris R. de Groot ; MD ; PhD^a ; Arthur A.M. Wilde ; MD ; PhD^a ; Reinoud E. Knops ; MD^a
• 关键词：complication ; erosion ; ICD ; infection ; S-ICD
• 刊名：JACC: Clinical Electrophysiology
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：2
• 期：1
• 页码：89-96
• 全文大小：1311 K

文摘

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.

<h4 id="absSec_2">Backgroundh4>

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.

<h4 id="absSec_3">Methodsh4>

In the largest single-center cohort available to date, S-ICD patients implanted between 2009 and 2015 were included.

<h4 id="absSec_4">Resultsh4>

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.

<h4 id="absSec_5">Conclusionsh4>

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.