Usefulness of subcutaneous implantable cardioverter-defibrillator therapy in patients with Brugada syndrome
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ORIGINAL ARTICLE
Usefulness of subcutaneous implantable cardioverter‑defibrillator therapy in patients with Brugada syndrome Tetsuji Shinohara1 · Ichitaro Abe1 · Kei Hirota1 · Hidekazu Kondo1 · Akira Fukui1 · Hidefumi Akioka1 · Yasushi Teshima1 · Kunio Yufu1 · Mikiko Nakagawa1 · Naohiko Takahashi1 Received: 8 May 2020 / Accepted: 14 August 2020 © Springer Japan KK, part of Springer Nature 2020
Abstract Implantable cardioverter-defibrillators (ICDs) are the main therapy to prevent sudden cardiac death in patients with Brugada syndrome (BrS). The subcutaneous ICD (S-ICD) can eliminate lead-associated complications compared with transvenous ICD (TV-ICD). However, S-ICD is susceptible to T-wave oversensing (TWOS) and may result in more frequent inappropriate shocks in patients with BrS. This study aimed to compare inappropriate shocks between TV-ICD and S-ICD in patients with BrS. We enrolled 32 patients with BrS (including one woman; mean age 52 ± 18 years) who were implanted with ICD (23 TV-ICDs and 9 S-ICDs) between January 2002 and November 2018 in Oita University Hospital. We carried out a standard surface electrocardiogram (ECG) screening tests in both supine and standing positions prior to S-ICD implantation. The patients received routine clinical review every month and device monitoring every 4 months. The period of follow-up was 129 ± 51 months. Six patients with BrS and TV-ICDs experienced inappropriate shocks (26%) with their ICD therapy. In contrast, two patients with BrS and S-ICDs experienced inappropriate shocks (22%). There was no significant difference between the two groups (P = 0.82). Although one case in the S-ICD group experienced TWOS-induced inappropriate shock, SMART Pass (new high-pass filter) prevented the subsequent recurrence of inappropriate shocks during ICD therapy. Our results suggest that S-ICD is not inferior to TV-ICD in the incidence of inappropriate shocks. SMART Pass may be a useful tool to prevent inappropriate ICD shocks by TWOS in patients with BrS. Keywords Brugada syndrome · Inappropriate shock · SMART pass · Subcutaneous implantable cardioverter-defibrillator · T-wave oversensing
Introduction Implantable cardioverter-defibrillators (ICDs) are the main therapy to prevent sudden cardiac death in patients with Brugada syndrome (BrS) [1]. The subcutaneous ICD (S-ICD) is a novel treatment modality to prevent sudden cardiac death that does not require lead implantation and can eliminate lead-associated complications compared with transvenous ICD (TV-ICD) [2]. Patients with BrS are usually young and active, do not require pacing, and are likely to benefit greatly from this system. Similarly, it may be used in patients with a
* Tetsuji Shinohara shinohar@oita‑u.ac.jp 1
Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1‑1 Idaigaoka, Hasama‑machi, Yufu 879‑5593, Japan
history of ventricular fibrillation (VF) due to coronary spasm or hypertrophic cardiomyopathy [3, 4]. However, S-ICD treatment is susceptible to T- wave oversensing (TWOS)
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