56-51: A modified technique for device implantation using axillary subpectoral approach

EP Europace, Jun 2016

Introduction: Axillary subpectoral approach for device implantation is considered in patients with standard technique is not available. This study describes the feasibility of the modified subpectoral implantation technique.

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56-51: A modified technique for device implantation using axillary subpectoral approach

Mauro Biffi 0 11 Endrj Menardi 0 10 Gemma Pelargonio 0 9 Ernesto Ammendola 0 16 Quintino Parisi 0 15 Matteo Iori 0 14 Concetto La Rosa 0 13 Francesco Zanon 0 18 Matteo Bertini 0 17 Fabio Lissoni 0 12 Valeria Carinci 0 7 Gennaro Miracapillo 0 8 Attilio Del Rosso 0 5 Carlo D' Agostino 0 6 Gianfranco Ciaramitaro 0 3 Gianluca Zingarini 0 4 Maurizio Malacrida 0 1 Paolo De Filippo 0 2 Young Choi 0 11 Kim Ju Youn 0 11 Sung-Hwan Kim 0 11 Bommie Seo 0 11 Sang Tae Ahn 0 11 Yeong Su Yi 0 11 In Geol Song 0 11 Yoo Ri Kim 0 11 Kim Tae-Seok 0 10 Kim Ji-Hoon 0 11 Jang Sung-Won 0 11 Lee Man-Young 0 11 Rho Tai- Ho 0 11 Yong-Seog Oh 0 11 Lisbon, Portugal 0 Joa ̃o Mesquita , Diogo Cavaco, Nicodemus Lopes, Pedro Galva ̃ o Santos, Maria Salome ́ De Carvalho, Francisco Costa, Pedro Carmo, Francisco Morgado, Pedro Adraga ̃o, and Miguel Mendes 1 Boston Scientific Italia , Milan , Italy 2 Azienda Ospedaliera Papa Giovanni XXIII , Bergamo , Italy 3 Policlinico "Paolo Giaccone" , Palermo , Italy 4 Ospedale S. Maria della Misericordia , Perugia , Italy 5 Ospedale S. Giuseppe , Empoli , Italy 6 Ospedale Di Venere , Bari , Italy 7 Hospital Maggiore , Bologna , Italy 8 Ospedale della Misericordia , Grosseto , Italy 9 Catholic University of the Sacred Heart , Rome , Italy 10 Daejeon , South Korea , Republic of Korea 11 Seoul , Republic of Korea 12 Ospedale Maggiore , Lodi , Italy 13 Clinic Villa Verde , Taranto , Italy 14 Hospital S. Maria Nuova , Reggio Emilia , Italy 15 Catholic University of the Sacred Heart , Campobasso , Italy 16 Second University of Naples, A.O. Monaldi , Naples , Italy 17 S. Anna Hospital, University of Ferrara , Ferrara , Italy 18 Ospedale S. Maria della Misericordia , Rovigo , Italy - Purpose: Assess the efficacy and safety outcomes of subcutaneous implantable cardioverter defibrillators (SICD). Method: Single center prospective study which included 48 consecutive patients (mean age 40 + 17 years old, 85% males) who underwent S-ICD implantation between November/2009-October/2015. Safety outcome accounted for the delivery of inappropriate shocks and the efficacy outcome was defined as the prevention of sudden cardiac death (SCD). Tiered-therapy ICD was defined as having at least 2 programmed zones, determined by the longest RR interval in each zone. Results: Thirty-four patients (71%) had a primary prevention indication. Eight patients (17%) underwent previous ICD replacement with S-ICD due to infection or lead fracture. The most frequent indications for S-ICD were: Brugada Syndrome (15%), hypertrophic cardiomyopathy (15%), ischemic and dilated cardiomyopathies with left ventricle ejection fraction ,35% (both 15%, respectively) and left ventricular non-compaction cardiomyopathy (13%) (Table 1). During a mean follow-up of 2.8 + 1.7 years, 6 patients (13%) died, none due to SCD. Eight patients (17%) were delivered inappropriate shocks: 5 (10%) without tiered-therapy vs 3 (6%) with previously programmed tiered-therapy ( p ¼ 0.002). T wave oversensing was the most common cause for inappropriate shock delivery (50%), followed by supraventricular tachycardia (25%), atrial fibrillation with rapid ventricular response (12.5%) and QRS double counting (12.5%). Seven patients (15%) had appropriate shocks delivered, mostly due to ventricular tachycardia (75%). Table 1:Indications for S-ICD implantation: Indication for implantation Brugada syndrome Hypertrophic cardiomyopathy Ischemic cardiomyopathy (LVEF , 35%) Dilated cardiomyopathy (LVEF , 35%) Left ventricular non-compaction cardiomyopathy Arrhythmogenic right ventricular cardiomyopathy Adult congenital heart disease Idiopathic ventricular tachycardia Other causes Total Number of patients Percent (%) Conclusions: In this selected population of patients, S-ICD implantation proved effective in preventing sudden cardiac death, with a low rate of complications. S-ICD tiered-therapy programming (at least 2 zones) was associated with a lower rate of inappropriate shocks delivery. Conflict of interest: none DOES ICD LONGEVITY VARY BY MANUFACTURER? Introduction: Implantable cardioverter defibrillator (ICD) implantation rates have significantly increased in the last decade. The cost of these devices is significant. Generator replacement is an invasive procedure with a significant risk of complications including infection. Extending the longevity of a high voltage device to prolong the interval between generator replacements would have significant benefits for the healthcare system and individual patients. Previous studies have suggested a difference in device longevity between manufacturers. Method: All patients receiving an ICD or CRT-D between 2008 and 2011 at a high volume tertiary centre were identified. Data were obtained from retrospective review of hospital records. The longevity of each device was ascertained as the interval to box change. The impact of device manufacturer and device type on device longevity were assessed. Results: 1489 high energy devices were im (...truncated)


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Choi, Young, Youn, Kim Ju, Kim, Sung-Hwan, Seo, Bommie, Ahn, Sang Tae, Yi, Yeong Su, Song, In Geol, Kim, Yoo Ri, Tae-Seok, Kim, Ji-Hoon, Kim, Sung-Won, Jang, Man-Young, Lee, Tai-Ho, Rho, Oh, Yong-Seog. 56-51: A modified technique for device implantation using axillary subpectoral approach, EP Europace, 2016, pp. i44, Volume 18, Issue suppl_1, DOI: 10.1093/europace/18.suppl_1.i44c