Third-generation subcutaneous implantable cardioverter defibrillator and intermuscular two-incision implantation technique in patients with Arrhythmogenic cardiomyopathy: 3-year follow-up

https://doi.org/10.1016/j.ijcard.2023.04.018Get rights and content
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Highlights

  • Preliminary studies demonstrated that subcutaneous implantable cardioverter defibrillator (S-ICD) can effectively treat ventricular arrythmias in patients with arrhythmogenic cardiomyopathy (ACM) despite relatively high inappropriate shocks (IS) mostly due to T-wave oversensing (TWOS) and device-related complications.

  • Data on the potential advantages of combining the third-generation S-ICD with modern software upgrade and the intermuscular (IM) two-incision implantation technique in ACM with different phenotypic variants are lacking.

  • According to our findings, although the third-generation S-ICD implanted with the IM two-incision technique appears to be associated with a low risk of device-related complications and IS due to TWOS, the risk of IS due to myopotential should be considered.

Abstract

Background

Long-term data on the potential advantages of combining the third-generation subcutaneous implantable cardioverter defibrillator (S-ICD) with modern software upgrade including the “SMART Pass”, modern programming strategies and the intermuscular (IM) two-incision implantation technique in arrhythmogenic cardiomyopathy (ACM) with different phenotypic variants are lacking. In this study we evaluated the long-term outcome of patients with ACM who underwent third-generation S-ICD (Emblem, Boston Scientific) and IM two-incision technique.

Methods

The study population included 23 consecutive patients [70% male, median age 31 (24–46) years] diagnosed with ACM with different phenotypic variants who received third-generation S-ICD implantation with the IM two-incision technique.

Results

During a median follow-up of 45.5 months [16–65], 4 patients (17.4%) received a at least one inappropriate shock (IS), with median annual event rate of 4.5%. Extra-cardiac oversensing (myopotential) during effort represented the only cause of IS. No IS due to T-wave oversensing (TWOS) were recorded. Only one patient (4.3%) experienced device-related complication consisting of premature cell battery depletion requiring device replacement. No device explantation because of need for anti-tachycardia pacing or ineffective therapy occurred. There was no significant difference between patients who did and did not experienced IS with regard to baseline clinical, ECG and technical characteristics. Five patients (21.7%) received appropriate shocks on ventricular arrythmias.

Conclusions

According to our findings, although the third-generation S-ICD implanted with the IM two-incision technique appears to be associated with a low risk of complications and IS due to cardiac oversensing, the risk of IS due to myopotential mainly during effort should be considered.

Keywords

Arrhythmogenic cardiomyopathy
Cardiomyopathies
Implantable cardioverter defibrillator
Subcutaneous implantable cardioverter defibrillator
Sudden death

Data Availability

Data available on request from the authors.

Cited by (0)

All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

1

These authors contributed equally as first author to this study.

2

Boston Scientific, Cardiac Rhythm Management, Diegem, Belgium.