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Research Article| Volume 382, P33-39, July 01, 2023

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

  • Author Footnotes
    1 These authors contributed equally as first author to this study.
    Federico Migliore
    Correspondence
    Corresponding author at: Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35121, Padua,Italy.
    Footnotes
    1 These authors contributed equally as first author to this study.
    Affiliations
    Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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  • Author Footnotes
    1 These authors contributed equally as first author to this study.
    Raimondo Pittorru
    Footnotes
    1 These authors contributed equally as first author to this study.
    Affiliations
    Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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  • Manuel De Lazzari
    Affiliations
    Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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  • Alberto Cipriani
    Affiliations
    Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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  • Barbara Bauce
    Affiliations
    Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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  • Martina Perazzolo Marra
    Affiliations
    Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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  • Enrico Giacomin
    Affiliations
    Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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  • Pietro Bernardo Dall'Aglio
    Affiliations
    Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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  • Author Footnotes
    2 Boston Scientific, Cardiac Rhythm Management, Diegem, Belgium.
    Stefano Accinelli
    Footnotes
    2 Boston Scientific, Cardiac Rhythm Management, Diegem, Belgium.
    Affiliations
    Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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  • Sabino Iliceto
    Affiliations
    Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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  • Domenico Corrado
    Affiliations
    Division of Cardiology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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  • Author Footnotes
    1 These authors contributed equally as first author to this study.
    2 Boston Scientific, Cardiac Rhythm Management, Diegem, Belgium.
Published:April 12, 2023DOI:https://doi.org/10.1016/j.ijcard.2023.04.018
Third-generation subcutaneous implantable cardioverter defibrillator and intermuscular two-incision implantation technique in patients with Arrhythmogenic cardiomyopathy: 3-year follow-up
Previous ArticleTemporal changes in incidence, treatment strategies and 1-year re-admission rates in patients with atrial fibrillation/flutter under 65 years of age: A Danish nationwide study
Next ArticleSafety of benzodiazepines in patients with acute heart failure: A propensity score-matching study

      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

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      References

        • Corrado D.
        • Perazzolo Marra M.
        • et al.
        Diagnosis of arrhythmogenic cardiomyopathy: the Padua criteria.
        Int. J. Cardiol. 2020; 319: 106-114
        View in Article
        • Corrado D.
        • Zorzi A.
        • Cipriani A.
        • et al.
        Evolving diagnostic criteria for Arrhythmogenic cardiomyopathy.
        J. Am. Heart Assoc. 2021; 10e021987
        View in Article
        • Corrado D.
        • Wichter T.
        • Link M.S.
        • et al.
        Treatment of Arrhythmogenic right ventricular cardiomyopathy/dysplasia: an international task force consensus statement.
        Circulation. 2015; 132: 441-453
        View in Article
        • Link M.S.
        • Laidlaw D.
        • Polonsky B.
        • et al.
        Ventricular arrhythmias in the north American multidisciplinary study of ARVC: predictors, characteristics, and treatment.
        J. Am. Coll. Cardiol. 2014; 64: 119-125
        View in Article
        • Migliore F.
        • Mattesi G.
        • Zorzi A.
        • et al.
        Arrhythmogenic cardiomyopathy-current treatment and future options.
        J. Clin. Med. 2021; 10: 2750
        View in Article
        • Corrado D.
        • Leoni L.
        • Link M.S.
        • et al.
        Implantable cardioverter defibrillator therapy for prevention of sudden death in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia.
        Circulation. 2003; 108: 3084-3091
        View in Article
        • Cadrin-Tourigny J.
        • Bosman L.P.
        • Nozza A.
        • et al.
        A new prediction model for ventricular arrhythmias in arrhythmogenic right ventricular cardiomyopathy.
        Eur. Heart J. 2019; 40: 1850-1858
        View in Article
        • Corrado D.
        • Calkins H.
        • Link M.S.
        • et al.
        Prophylactic implantable defibrillator in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia and no prior ventricular fibrillation or sustained ventricular tachycardia.
        Circulation. 2010; 122: 1144-1152
        View in Article
        • Olde Nordkamp L.R.
        • Postema P.G.
        • Knops R.E.
        • et al.
        Implantable cardioverter-defibrillator harm in young patients with inherited arrhythmia syndromes: a systematic review and meta-analysis of inappropriate shocks and complications.
        Heart Rhythm. 2016; 13: 443-454
        View in Article
        • Migliore F.
        • Silvano M.
        • Zorzi A.
        • et al.
        Implantable cardioverter defibrillator therapy in young patients with cardiomyopathies and channelopathies: a single Italian Centre experience.
        J. Cardiovasc. Med. (Hagerstown). 2016; 17: 485-493
        View in Article
        • Knops R.E.
        • Olde Nordkamp L.R.A.
        • Delnoy P.H.M.
        • et al.
        Subcutaneous or transvenous defibrillator therapy.
        N. Engl. J. Med. 2020; 383: 526-536
        View in Article
        • Gold M.R.
        • Lambiase P.D.
        • El-Chami M.F.
        • et al.
        Primary results from the understanding outcomes with the S-ICD in primary prevention patients with low ejection fraction (UNTOUCHED) trial.
        Circulation. 2021; 143: 7-17
        View in Article
        • Migliore F.
        • Allocca G.
        • Calzolari V.
        • et al.
        Intermuscular two-incision technique for subcutaneous implantable cardioverter defibrillator implantation: results from a multicenter registry.
        Pacing Clin. Electrophysiol. 2017; 40: 278-285
        View in Article
        • Winter J.
        • Siekiera M.
        • Shin D.I.
        • et al.
        Intermuscular technique for implantation of the subcutaneous implantable cardioverter defibrillator: long-term performance and complications.
        Europace. 2017; 19: 2036-2041
        View in Article
        • Francia P.
        • Biffi M.
        • Adduci C.
        • et al.
        Implantation technique and optimal subcutaneous defibrillator chest position: a PRAETORIAN score-based study.
        Europace. 2020; 22: 1822-1829
        View in Article
        • Migliore F.
        • Mattesi G.
        • De Franceschi P.
        • et al.
        Multicentre experience with the second-generation subcutaneous implantable cardioverter defibrillator and the intermuscular two-incision implantation technique.
        J. Cardiovasc. Electrophysiol. 2019; 30: 854-864
        View in Article
        • Migliore F.
        • Corrado D.
        Implantable defibrillator in patients with inherited arrhythmogenic diseases: are inapproppriate shocks preventable?.
        Int. J. Cardiol. 2022; 360: 36-38
        View in Article
        • Orgeron G.M.
        • Bhonsale A.
        • Migliore F.
        • et al.
        Subcutaneous implantable cardioverter-defibrillator in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia: a transatlantic experience.
        J. Am. Heart Assoc. 2018; 7e008782
        View in Article
        • Migliore F.
        • Viani S.
        • Bongiorni M.G.
        • et al.
        Subcutaneous implantable cardioverter defibrillator in patients with arrhythmogenic right ventricular cardiomyopathy: results from an Italian multicenter registry.
        Int. J. Cardiol. 2019; 280: 74-79
        View in Article
        • Wang W.
        • Gasperetti A.
        • Sears S.F.
        • et al.
        Subcutaneous and transvenous defibrillators in arrhythmogenic right ventricular cardiomyopathy: a comparison of clinical and quality-of-life outcomes.
        JACC Clin. Electrophysiol. 2023; 9 (S2405-500X(22)00846-5): 394-402
        View in Article
        • Migliore F.
        • De Franceschi P.
        • De Lazzari M.
        • et al.
        Ultrasound-guided serratus anterior plane block for subcutaneous implantable cardioverter defibrillator implantation using the intermuscular two-incision technique.
        J. Interv. Card. Electrophysiol. 2020; 57: 303-309
        View in Article
        • Quast A.-F.B.E.
        • Baalman S.W.E.
        • Brouwer T.F.
        • et al.
        A novel tool to evaluate the implant position and predict defibrillation success of the subcutaneous implantable defibrillator: the PRAETORIAN score.
        Heart Rhythm. 2019; 16: 403-410
        View in Article
        • Viani S.
        • Migliore F.
        • Ottaviano L.
        • et al.
        Longevity of model 3501 subcutaneous implantable cardioverter-defibrillator leads in clinical practice.
        Heart Rhythm. 2022; S1547-5271: 00225-00229
        View in Article
        • Gulletta S.
        • Gasperetti A.
        • Schiavone M.
        • et al.
        Age-related differences and associated mid-term outcomes of subcutaneous implantable cardioverter-defibrillators: a propensity-matched analysis from a multicenter European registry.
        Heart Rhythm. 2022; S1547-5271 (00214–4)
        View in Article
        • Theuns D.A.M.J.
        • Brouwer T.F.
        • Jones P.W.
        • et al.
        Prospective blinded evaluation of a novel sensing methodology designed to reduce inappropriate shocks by the subcutaneous implantable cardioverter defibrillator.
        Heart Rhythm. 2018; 15: 1515-1522
        View in Article
        • Migliore F.
        • Pittorru R.
        • Giacomin E.
        • et al.
        Intermuscular two-incision technique for implantation of the subcutaneous implantable cardioverter defibrillator: a 3-year follow-up.
        J. Interv. Card. Electrophysiol. 2023 Jan 20; (Epub ahead of print PMID: 36662384)https://doi.org/10.1007/s10840-023-01478-z
        View in Article
        • Tsutsui K.
        • Kato R.
        • Asano S.
        • et al.
        Myopotential Oversensing is a major cause of inappropriate shock in subcutaneous implantable defibrillator in Japan.
        Int. Heart J. 2020; 61: 913-921
        View in Article
        • Orgeron G.M.
        • James C.A.
        • Te Riele A.
        • Tichnell C.
        • Murray B.
        • Bhonsale A.
        • Kamel I.R.
        • Zimmerman S.L.
        • Judge D.P.
        • Crosson J.
        • Tandri H.
        • Calkins H.
        Implantable cardioverter-defibrillator therapy in arrhythmogenic right ventricular dysplasia/cardiomyopathy: predictors of appropriate therapy, outcomes, and complications.
        J. Am. Heart Assoc. 2017; 6e006242
        View in Article
        • van den Bruck J.H.
        • Sultan A.
        • Plenge T.
        • et al.
        Incidence of myopotential induction in subcutaneous implantable cardioverter-defibrillator patients: is the oversensing issue really solved?.
        Heart Rhythm. 2019; 16: 1523-1530
        View in Article

      Article info

      Publication history

      Published online: April 12, 2023
      Accepted: April 11, 2023
      Received in revised form: April 7, 2023
      Received: March 13, 2023

      Footnotes

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

      Identification

      DOI: https://doi.org/10.1016/j.ijcard.2023.04.018

      Copyright

      © 2023 Elsevier B.V. All rights reserved.

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