Implantation of Submammary Implantable Cardioverter Defibrillators (original) (raw)
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Aesthetic Subpectoral Placement of Implantable Cardioverter Defibrillators
Annals of Plastic Surgery, 2014
The implantable cardioverter defibrillator (ICD) is the treatment of choice for life-threatening arrhythmias. Usually, the device is placed, by a subclavian access, on the upper portion of the pectoralis major muscle. As a result, the visibility of the device and the wide subclavian scar create an important aesthetic deformity, especially in young women, evolving in a relevant psychosocial distress. The authors report their experience with subpectoral ICD implantation. Between January 2001 and December 2011, approximately30 consecutive female patients underwent submuscular ICD implantation or substitution, performed in collaboration with the cardiology team. No significant complications, except 1 case of wound dehiscence and 2 cases of caudal dislocation of the device, were observed. At 6 and 12 months' follow-up, no significant difference between preoperative and postoperative breast symmetry and volume was noticed. The combined approach aims at reducing the visible signs of the procedure and improving the psychological outcomes.
Pacing and Clinical Electrophysiology, 1999
Pectoral Cardioverter Defibrillators: Comparison of Prepectoral and Submuscular Implantation Techniques ANTONIS S. MANOLIS. JOHN CHILADAKIS, VASSILIS VASSiLIKOS, THEMOS MAOUNIS. and DENNIS V. COKKINOS From Patras University. Rio. Patras.Vnd Onassis Cardiac Surgery Center. Athens/Greece) MANOLIS A.S., vrr AI..: Pectoral Cardioverter Deiibrillators: Comparison of Prepectoral and Submuscular Implantation Techniques. The purpose of this study was to compare the two techniques of pectorai ICD implantation, prepectoral and submuscular. performed by an electrophysiohgist in the catheterization laboratoty with use of general or local anesthesia in 45 consecutive patients. Over a period of 30 months, we implanted pectoral tnuisvenous [CDs in 4'.i men and 2 women, aged 59 ± 12 years, with use of general (n = 20) or local (n = 25) anesthesia in the catheterization laboratory. Patients had coronary (n = 30} or valvular (n -4) disease, cardiomyopathy (n ~ 10) or no organic disease (n = 1), a mean left ventricular ejection fraction of 31 %, and presented with ventricular tachycardia (n = 40) or fibrillation (n = 5). One-lead IGD systems (t8 Endotak, iO Transvene/8 Sprint, 2 EnGuard) were used in 38 patients, 2-lead (5 Transvene. 1 EnCuard) systems in 6 patients, and 1 atrioventrirular lead IGD system in 1 patient. The prepectoral technique was employed in 29 patients with adequate subcutaneous tissue, while the submuscular technique was used in 16 patients who had a thin layer of subcutaneous tissue. The defibrillation threshold averaged 9-10 } in both groups and th(n-e were no differences in pace/sense thresholds. All implants were entirely transvenous with no subcutaneous patch. Biphasic IGD devices were employed in all patients. Active or hot can devices were u.'ied in 39 patients. There were no complications, operative deaths, or infections. Patients were discharged at a mean of 3 days. All devices functioned well at predischarge testing. Over 14 ± 8 months, 20 patients received appropriate device therapy {antitachycardia pacing or shocks). No late complications occurred. One patient died at 3 months of pump failure: there were no suddfm deaths. In conclusion, for exclusive pectoral implantation of transvenous ICDs. electrophysiologists should master both prepectoral and submuscular techniques. One can thus avoid potential skin erosion or need for abdominal implantation in patients with a thin layer of subcutaneous tissue. Finally, there are no differences in pacing or defibrillation thresholds hetween the two techniques-XPAGE 1999; 22:469-478) -ĉ ardioverter defibrillators, ventricular tachyarrhythmias, sudden death, pectoral implantation techniques
The subcutaneous implantable cardioverter-defibrillator: A tertiary center experience
Cardiology Journal
Background: The aim of the study was to evaluate subcutaneous implantable cardioverterdefibrillator (S-ICD) patients with regard to underlying etiology, peri-procedural outcome, appropriate/inappropriate shocks, and complications during follow-up. Methods: All patients who underwent S-ICD implantation from February 2013 to March 2017 at an academic hospital in Vienna were included. Medical records were examined and follow-up interrogations of devices were conducted. Results: A total of 79 S-ICD patients (58.2% males) with a mean age of 44.5 ± 17.2 years were followed for a mean duration of 12.8 ± 13.7 months. A majority of patients (58.2%) had S-ICD for primary prevention of sudden cardiac death. The most common of the 16 underlying etiologies were ischemic cardiomyopathy, non-ischemic cardiomyopathy, and idiopathic ventricular fibrillation. The lead was implanted to the left sternal border in 96.2% of cases, between muscular layers in 72.2%. Mean implant time was 45 min, 3 patients were induced, and all patients except one were programmed to two zones. Six (7.6%) patients experienced at least one appropriate therapy for ventricular arrhythmias and the time to first event ranged from 1 to 52 months. Seven patients experienced inappropriate shocks due to Twave oversensing, atrial tachycardia with rapid atrioventricular conduction, external electromagnetic interference, and/or baseline oversensing due to lead movement. Four patients underwent revision for lead repositioning (n = 1), loose device suture (n = 1), and infection (n = 2). Conclusions: While S-ICDs are a feasible and effective treatment, issues remain with inappropriate shock and infection.
Journal of Clinical Anesthesia, 2016
Background: The recently approved subcutaneous implantable cardioverter/defibrillator (S-ICD) uses a single extrathoracic subcutaneous lead to treat life-threatening ventricular arrhythmias, such as ventricular tachycardia and ventricular fibrillation. This is different from conventional transvenous ICDs, which are typically implanted under sedation. Currently, there are no reports regarding the anesthetic management of patients undergoing S-ICD implantation. Study objectives: This study describes the anesthetic management and outcomes in patients undergoing S-ICD implantation and defibrillation threshold (DFT) testing. Methods: The study population consists of 73 patients who underwent S-ICD implantation. General anesthesia (n = 69, 95%) or conscious/deep sedation (n = 4, 5%) was used for device implantation. ☆ Disclosures: In the past, Dr Raul Weiss has received advisory and speaker honoraria from Cameron Health, Inc, San Clemente, CA (modest relationship). The Ohio State University Wexner Medical Center EP section receives funding for partial support of a single EP fellowship training grant from Boston scientific. Funding and resources for the execution of this project were provided by the
Left Retropectoral Axillary Implantation of Defibrillators in Young Women
The Annals of Thoracic Surgery, 2012
We propose a complete surgical approach by left retropectoral transaxillary implantation with no vein puncture to improve the aesthetic and psychological tolerance of the implantable cardioverter defibrillator and avoid the pneumothorax and the subclavian crush syndrome.
Subcutaneous implantable cardioverter-defibrillator: Initial experience
2014
BACKGROUND Implantable cardioverter-defibrillators (ICDs) are important tools in the prevention of sudden death, but implantation requires transvenous access, which is associated with complications. Subcutaneous implantable cardioverter-defibrillators (S-ICDs) may prevent some of these complications. AIM To evaluate the therapeutics and complications associated with S-ICD systems. METHODS S-ICD implantation was planned in 23 patients, for whom the indications were vascular access problems, increased risk of infection or young patients with long predicted follow-up. The population consisted of four patients with ischemic heart disease, three of them on hemodialysis (two with subclavian vein thrombosis), five with left ventricular noncompaction, four with Brugada syndrome, three with arrhythmogenic right ventricular cardiomyopathy, one with transposition of the great vessels, two with dilated cardiomyopathy and four with hypertrophic cardiomyopathy. RESULTS S-ICDs were implanted in 21...
Subcutaneous implantable cardioverter-defibrillator in a young woman
International Journal of Cardiology, 2014
Central venous stenosis is a common complication of the transvenous leads associated with an implantable cardioverter defibrillator (ICD). Although epicardial leads have been reported to bypass this complication, their placement is much more invasive than the subcutaneous ICDs (SICDs) and requires the services of a cardiothoracic surgeon. Recent data have demonstrated successful defibrillation using an SICD. In this report, we present 4 long-term hemodialysis patients treated successfully with an SICD. 3 patients received the device for primary prevention of sudden cardiac death (cardiomyopathy with low ejection fraction). The patient in the fourth case had a prolonged QT interval and received the device for secondary prevention. 3 patients had an arteriovenous fistula, whereas 1 patient was dialyzing with a tunneled dialysis catheter. Insertion of an SICD is a minimally invasive procedure. By virtue of leaving the venous system untouched, this approach might offer the advantage of reduced risk of central venous stenosis and infection over an endocardial ICD with transvenous leads. SICD is not experimental; it has been approved by the US Food and Drug Administration and is currently being used in the United States and Europe.
Aims: the aim of this study is to find out the effect of subpectoral implantation of unipolar active case Implantable Cardioverter Defibrillators (ICD), on defibrillation threshold (DFT), compared to the conventional subcutaneous approach. Methods: unipolar, active case ICDs were implanted subcutaneously in 7 patients (group I), and subpectoraly in another 7 patients (group II); all patients were diagnosed with ischemic cardiomyopathy. DFT, shock lead impedance, R wave amplitude, slew rate, pacing lead threshold and pacing lead impedance were compared between the two groups. Results: DFT was significantly lower in group II, 14.8±5.5 vs 7.29±5.1 J (P=0. 017) in groups I and II respectively. Other parameters were comparable in the two groups. One patient with high DFT on subcutaneous ICD implantation showed an acceptable reduction of DFT when the device was implanted subpectoraly. Conclusion: reduction in DFT with subpectoral implantation of ICDs is among the benefits of this approach, which is an easy and workable approach to high DFT patients. Keywords: Implantable Cardioverter Defibrillator, Subpectoral Pocket, Defibrillation Threshold, Shock Lead Impedance.