TY - JOUR
T1 - Long-term follow-up of the two-incision implantation technique for the subcutaneous implantable cardioverter-defibrillator
AU - van der Stuijt, Willeke
AU - Baalman, Sarah W. E.
AU - Brouwer, Tom F.
AU - Quast, Anne-Floor B. E.
AU - de Groot, Joris R.
AU - Knops, Reinoud E.
PY - 2020/12
Y1 - 2020/12
N2 - Introduction: The two-incision implantation technique of the subcutaneous implantable cardioverter-defibrillator (S-ICD) was introduced as an alternative to the standard three-incision approach by omitting the superior parasternal incision. Thereby, complications may be prevented. Short-term follow-up demonstrated the safety and efficacy of the two-incision technique. However, long-term results are lacking. Methods: This retrospective study included patients implanted between February 2009 and June 2020. Patients were divided into a group of patients who were implanted with the standard three-incision technique and a group who were implanted with the two-incision technique. Outcomes were defibrillation impedance and efficacy and complications requiring intervention. Results: A total of 268 patients were included (age 42.4 ± 16.6 years, 35.4% female, BMI 25.1 ± 4.5 kg/m2). Thirty-one patients underwent S-ICD implantation with the three-incision technique and 237 patients with the two-incision technique. First shock efficacy during defibrillation testing was 93% in the three-incision group versus 94% in the two-incision group (P =.69), and shock impedance was 85 versus 68 ohms (P =.04). First shock success was 75% versus 76% for spontaneous episodes (P = 1.00). Complication-free survival at 5-year follow-up in the three-incision group was estimated at 0.96 (95% CI 0.90-1.00) versus 0.98 (95% CI 0.96-1.00) in the two-incision group (P =.20) and for inappropriate shocks at 5-year 0.77 (95% CI 0.63-0.94) versus 0.83 (95% CI 0.77-0.89, P =.30), respectively. Conclusion: Five-year follow-up in this S-ICD cohort showed similar complication rates and effectiveness of two-incision technique compared to the three-incision technique. This technique offers physicians a less invasive and more simplified implantation procedure for the S-ICD, with a better cosmetic result.
AB - Introduction: The two-incision implantation technique of the subcutaneous implantable cardioverter-defibrillator (S-ICD) was introduced as an alternative to the standard three-incision approach by omitting the superior parasternal incision. Thereby, complications may be prevented. Short-term follow-up demonstrated the safety and efficacy of the two-incision technique. However, long-term results are lacking. Methods: This retrospective study included patients implanted between February 2009 and June 2020. Patients were divided into a group of patients who were implanted with the standard three-incision technique and a group who were implanted with the two-incision technique. Outcomes were defibrillation impedance and efficacy and complications requiring intervention. Results: A total of 268 patients were included (age 42.4 ± 16.6 years, 35.4% female, BMI 25.1 ± 4.5 kg/m2). Thirty-one patients underwent S-ICD implantation with the three-incision technique and 237 patients with the two-incision technique. First shock efficacy during defibrillation testing was 93% in the three-incision group versus 94% in the two-incision group (P =.69), and shock impedance was 85 versus 68 ohms (P =.04). First shock success was 75% versus 76% for spontaneous episodes (P = 1.00). Complication-free survival at 5-year follow-up in the three-incision group was estimated at 0.96 (95% CI 0.90-1.00) versus 0.98 (95% CI 0.96-1.00) in the two-incision group (P =.20) and for inappropriate shocks at 5-year 0.77 (95% CI 0.63-0.94) versus 0.83 (95% CI 0.77-0.89, P =.30), respectively. Conclusion: Five-year follow-up in this S-ICD cohort showed similar complication rates and effectiveness of two-incision technique compared to the three-incision technique. This technique offers physicians a less invasive and more simplified implantation procedure for the S-ICD, with a better cosmetic result.
KW - implantable cardioverter-defibrillator
KW - implantation technique
KW - subcutaneous implantable cardioverter-defibrillator
UR - http://www.scopus.com/inward/record.url?scp=85089159901&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/pace.14022
DO - https://doi.org/10.1111/pace.14022
M3 - Article
C2 - 32720398
SN - 0147-8389
VL - 43
SP - 1476
EP - 1480
JO - Pacing and clinical electrophysiology
JF - Pacing and clinical electrophysiology
IS - 12
ER -