- •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.
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.
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.
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.
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.
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Published online: April 12, 2023
Accepted: April 11, 2023
Received in revised form: April 7, 2023
Received: March 13, 2023
☆All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
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