Use and outcomes of subcutaneous implantable cardioverter-defibrillator (ICD) after transvenous ICD extraction: An analysis of current clinical practice and a comparison with transvenous ICD reimplantation

Stefano Viani, Federico Migliore, Gianfranco Tola, Ennio C L Pisanò, Antonio Dello Russo, Giovanni Luzzi, Paolo Sartori, Agostino Piro, Roberto Rordorf, Giovanni Battista Forleo, Anna Rago, Luca Segreti, Emanuele Bertaglia, Mauro Biffi, Mariolina Lovecchio, Sergio Valsecchi, Igor Diemberger, Maria Grazia Bongiorni

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The subcutaneous implantable cardioverter-defibrillator (S-ICD) does not require the insertion of any leads into the cardiovascular system.

OBJECTIVE: The aims of the study were to describe current practice and to measure outcomes associated with S-ICD or standard single-chamber transvenous ICD (TV-ICD) use after TV-ICD explantation.

METHODS: We analyzed all consecutive patients who underwent transvenous extraction of an ICD and subsequent implantation of an S-ICD or a single-chamber TV-ICD at 12 Italian centers from 2011 to 2017.

RESULTS: A total of 229 patients were extracted and subsequently reimplanted with an S-ICD (90; 39%) or a single-chamber TV-ICD (139; 61%). S-ICD implantation increased from 9% in 2011 to 85% in 2017 (P < .001). Patients reimplanted with an S-ICD were younger (53 ± 13 years vs 60 ± 18 years; P = .011) and more frequently had undergone extraction owing to infection (73% vs 52%; P < .001). The rates of complications at follow-up were comparable between groups (hazard ratio 0.97; 95% confidence interval 0.49-1.92; P = .940). No lead failures, systemic infections, or system-related deaths occurred in the S-ICD group. In the TV-ICD group, 1 lead fracture occurred and 2 systemic infections were reported, resulting in death in 1 case. In the S-ICD group, the rate of complications was lower when the generator was positioned in a sub- or intermuscular pocket (hazard ratio 0.21; 95% confidence interval 0.05-0.87; P = .048).

CONCLUSION: Our results show an increasing use of S-ICD over the years in patients undergoing TV-ICD explantation. An S-ICD is preferably adopted in young patients, mostly in the case of infection. The complication rate was comparable between groups and decreased when a sub- or intermuscular S-ICD generator position was adopted.

Original languageEnglish
JournalHeart Rhythm
DOIs
Publication statusE-pub ahead of print - Oct 24 2018

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Implantable Defibrillators
Replantation
Infection
Confidence Intervals
Cardiovascular System

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Use and outcomes of subcutaneous implantable cardioverter-defibrillator (ICD) after transvenous ICD extraction : An analysis of current clinical practice and a comparison with transvenous ICD reimplantation. / Viani, Stefano; Migliore, Federico; Tola, Gianfranco; Pisanò, Ennio C L; Russo, Antonio Dello; Luzzi, Giovanni; Sartori, Paolo; Piro, Agostino; Rordorf, Roberto; Forleo, Giovanni Battista; Rago, Anna; Segreti, Luca; Bertaglia, Emanuele; Biffi, Mauro; Lovecchio, Mariolina; Valsecchi, Sergio; Diemberger, Igor; Bongiorni, Maria Grazia.

In: Heart Rhythm, 24.10.2018.

Research output: Contribution to journalArticle

Viani, Stefano ; Migliore, Federico ; Tola, Gianfranco ; Pisanò, Ennio C L ; Russo, Antonio Dello ; Luzzi, Giovanni ; Sartori, Paolo ; Piro, Agostino ; Rordorf, Roberto ; Forleo, Giovanni Battista ; Rago, Anna ; Segreti, Luca ; Bertaglia, Emanuele ; Biffi, Mauro ; Lovecchio, Mariolina ; Valsecchi, Sergio ; Diemberger, Igor ; Bongiorni, Maria Grazia. / Use and outcomes of subcutaneous implantable cardioverter-defibrillator (ICD) after transvenous ICD extraction : An analysis of current clinical practice and a comparison with transvenous ICD reimplantation. In: Heart Rhythm. 2018.
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title = "Use and outcomes of subcutaneous implantable cardioverter-defibrillator (ICD) after transvenous ICD extraction: An analysis of current clinical practice and a comparison with transvenous ICD reimplantation",
abstract = "BACKGROUND: The subcutaneous implantable cardioverter-defibrillator (S-ICD) does not require the insertion of any leads into the cardiovascular system.OBJECTIVE: The aims of the study were to describe current practice and to measure outcomes associated with S-ICD or standard single-chamber transvenous ICD (TV-ICD) use after TV-ICD explantation.METHODS: We analyzed all consecutive patients who underwent transvenous extraction of an ICD and subsequent implantation of an S-ICD or a single-chamber TV-ICD at 12 Italian centers from 2011 to 2017.RESULTS: A total of 229 patients were extracted and subsequently reimplanted with an S-ICD (90; 39{\%}) or a single-chamber TV-ICD (139; 61{\%}). S-ICD implantation increased from 9{\%} in 2011 to 85{\%} in 2017 (P < .001). Patients reimplanted with an S-ICD were younger (53 ± 13 years vs 60 ± 18 years; P = .011) and more frequently had undergone extraction owing to infection (73{\%} vs 52{\%}; P < .001). The rates of complications at follow-up were comparable between groups (hazard ratio 0.97; 95{\%} confidence interval 0.49-1.92; P = .940). No lead failures, systemic infections, or system-related deaths occurred in the S-ICD group. In the TV-ICD group, 1 lead fracture occurred and 2 systemic infections were reported, resulting in death in 1 case. In the S-ICD group, the rate of complications was lower when the generator was positioned in a sub- or intermuscular pocket (hazard ratio 0.21; 95{\%} confidence interval 0.05-0.87; P = .048).CONCLUSION: Our results show an increasing use of S-ICD over the years in patients undergoing TV-ICD explantation. An S-ICD is preferably adopted in young patients, mostly in the case of infection. The complication rate was comparable between groups and decreased when a sub- or intermuscular S-ICD generator position was adopted.",
author = "Stefano Viani and Federico Migliore and Gianfranco Tola and Pisan{\`o}, {Ennio C L} and Russo, {Antonio Dello} and Giovanni Luzzi and Paolo Sartori and Agostino Piro and Roberto Rordorf and Forleo, {Giovanni Battista} and Anna Rago and Luca Segreti and Emanuele Bertaglia and Mauro Biffi and Mariolina Lovecchio and Sergio Valsecchi and Igor Diemberger and Bongiorni, {Maria Grazia}",
note = "Copyright {\circledC} 2018 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.",
year = "2018",
month = "10",
day = "24",
doi = "10.1016/j.hrthm.2018.10.026",
language = "English",
journal = "Heart Rhythm",
issn = "1547-5271",
publisher = "Elsevier",

}

TY - JOUR

T1 - Use and outcomes of subcutaneous implantable cardioverter-defibrillator (ICD) after transvenous ICD extraction

T2 - An analysis of current clinical practice and a comparison with transvenous ICD reimplantation

AU - Viani, Stefano

AU - Migliore, Federico

AU - Tola, Gianfranco

AU - Pisanò, Ennio C L

AU - Russo, Antonio Dello

AU - Luzzi, Giovanni

AU - Sartori, Paolo

AU - Piro, Agostino

AU - Rordorf, Roberto

AU - Forleo, Giovanni Battista

AU - Rago, Anna

AU - Segreti, Luca

AU - Bertaglia, Emanuele

AU - Biffi, Mauro

AU - Lovecchio, Mariolina

AU - Valsecchi, Sergio

AU - Diemberger, Igor

AU - Bongiorni, Maria Grazia

N1 - Copyright © 2018 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

PY - 2018/10/24

Y1 - 2018/10/24

N2 - BACKGROUND: The subcutaneous implantable cardioverter-defibrillator (S-ICD) does not require the insertion of any leads into the cardiovascular system.OBJECTIVE: The aims of the study were to describe current practice and to measure outcomes associated with S-ICD or standard single-chamber transvenous ICD (TV-ICD) use after TV-ICD explantation.METHODS: We analyzed all consecutive patients who underwent transvenous extraction of an ICD and subsequent implantation of an S-ICD or a single-chamber TV-ICD at 12 Italian centers from 2011 to 2017.RESULTS: A total of 229 patients were extracted and subsequently reimplanted with an S-ICD (90; 39%) or a single-chamber TV-ICD (139; 61%). S-ICD implantation increased from 9% in 2011 to 85% in 2017 (P < .001). Patients reimplanted with an S-ICD were younger (53 ± 13 years vs 60 ± 18 years; P = .011) and more frequently had undergone extraction owing to infection (73% vs 52%; P < .001). The rates of complications at follow-up were comparable between groups (hazard ratio 0.97; 95% confidence interval 0.49-1.92; P = .940). No lead failures, systemic infections, or system-related deaths occurred in the S-ICD group. In the TV-ICD group, 1 lead fracture occurred and 2 systemic infections were reported, resulting in death in 1 case. In the S-ICD group, the rate of complications was lower when the generator was positioned in a sub- or intermuscular pocket (hazard ratio 0.21; 95% confidence interval 0.05-0.87; P = .048).CONCLUSION: Our results show an increasing use of S-ICD over the years in patients undergoing TV-ICD explantation. An S-ICD is preferably adopted in young patients, mostly in the case of infection. The complication rate was comparable between groups and decreased when a sub- or intermuscular S-ICD generator position was adopted.

AB - BACKGROUND: The subcutaneous implantable cardioverter-defibrillator (S-ICD) does not require the insertion of any leads into the cardiovascular system.OBJECTIVE: The aims of the study were to describe current practice and to measure outcomes associated with S-ICD or standard single-chamber transvenous ICD (TV-ICD) use after TV-ICD explantation.METHODS: We analyzed all consecutive patients who underwent transvenous extraction of an ICD and subsequent implantation of an S-ICD or a single-chamber TV-ICD at 12 Italian centers from 2011 to 2017.RESULTS: A total of 229 patients were extracted and subsequently reimplanted with an S-ICD (90; 39%) or a single-chamber TV-ICD (139; 61%). S-ICD implantation increased from 9% in 2011 to 85% in 2017 (P < .001). Patients reimplanted with an S-ICD were younger (53 ± 13 years vs 60 ± 18 years; P = .011) and more frequently had undergone extraction owing to infection (73% vs 52%; P < .001). The rates of complications at follow-up were comparable between groups (hazard ratio 0.97; 95% confidence interval 0.49-1.92; P = .940). No lead failures, systemic infections, or system-related deaths occurred in the S-ICD group. In the TV-ICD group, 1 lead fracture occurred and 2 systemic infections were reported, resulting in death in 1 case. In the S-ICD group, the rate of complications was lower when the generator was positioned in a sub- or intermuscular pocket (hazard ratio 0.21; 95% confidence interval 0.05-0.87; P = .048).CONCLUSION: Our results show an increasing use of S-ICD over the years in patients undergoing TV-ICD explantation. An S-ICD is preferably adopted in young patients, mostly in the case of infection. The complication rate was comparable between groups and decreased when a sub- or intermuscular S-ICD generator position was adopted.

U2 - 10.1016/j.hrthm.2018.10.026

DO - 10.1016/j.hrthm.2018.10.026

M3 - Article

C2 - 30366163

JO - Heart Rhythm

JF - Heart Rhythm

SN - 1547-5271

ER -