Pitfalls of the S-ICD therapy: experiences from a large tertiary centre
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ORIGINAL PAPER
Pitfalls of the S‑ICD therapy: experiences from a large tertiary centre Kevin Willy1 · Florian Reinke1 · Benjamin Rath1 · Christian Ellermann1 · Julian Wolfes1 · Nils Bögeholz1 · Julia Köbe1 · Lars Eckardt1 · Gerrit Frommeyer1 Received: 26 August 2020 / Accepted: 15 October 2020 © The Author(s) 2020
Abstract Aim The subcutaneous ICD (S-ICD) has evolved to a potential first option for many patients who have to be protected from sudden cardiac death. Many trials have underlined a similar performance regarding its effectiveness in relation to transvenous ICDs and have shown the expected benefits concerning infective endocarditis and lead failure. However, there have also been problems due to the peculiarities of the device, such as oversensing and myopotentials. In this study, we present patients from a large tertiary centre suffering from complications with an S-ICD and propose possible solutions. Methods and results All S-ICD patients who experienced complications related to the device (n = 40) of our large-scale single-centre S-ICD registry (n = 351 patients) were included in this study. Baseline characteristics, complications occurring and solutions to these problems were documented over a mean follow-up of 50 months. In most cases (n = 23), patients suffered from oversensing (18 cases with T wave or P wave oversensing, 5 due to myopotentials). Re-programming successfully prevented further oversensing episode in 13/23 patients. In 9 patients, generator or lead-related complications, mostly due to infectious reasons (5/9), occurred. Further problems consisted of ineffective shocks in one patient and need for antibradycardia stimulation in 2 patients and indication for CRT in 2 other patients. In total, the S-ICD had to be extracted in 10 patients. 7 of them received a tv-ICD subsequently, 3 patients refused re-implantation of any ICD. One other patient kept the ICD but had antitachycardic therapy deactivated due to inappropriate shocks for myopotential oversensing. Conclusion The S-ICD is a valuable option for many patients for the prevention of sudden cardiac death. Nonetheless, certain problems are immanent to the S-ICD (limited re-programming options, size of the generator) and should be addressed in future generations of the S-ICD. Graphic abstract
Oversensing Infecon Without complicaons
n=311
n=40
With complicaons
Myopotenals Need for pacing Haematoma Others
Keywords Subcutaneous ICD · S-ICD · Pitfalls · Troubleshooting · ICD · Lead dysfunction · Ventricular arrhythmia * Kevin Willy [email protected] 1
Clinic for Cardiology II: Electrophysiology, University Hospital Münster, Albert‑Schweitzer‑Campus 1, 48149 Munster, Germany
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Introduction The subcutaneous ICD (S-ICD) (Boston Scientific, Natick, Massachusetts) is widely accepted as a valuable alternative to transvenous ICDs in a variety of clinical constellations requiring ICD therapy [1–5]. Due to positive experiences, the spectrum of indications has been constantly broadened so that the S-
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