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Subcutaneous implantable cardioverter defibrillator implantation: An analysis of Italian clinical practice and its evolution

2018; Elsevier BV; Volume: 272; Linguagem: Inglês

10.1016/j.ijcard.2018.07.139

1874-1754

Antonio D’Onofrio, Paolo Pieragnoli, Mauro Biffi, Gerardo Nigro, Federico Migliore, Pietro Francia, Paolo De Filippo, Alessandro Capucci, Giovanni Luca Botto, Massimo Giammaria, Pietro Palmisano, Ennio Pisanò, Giovanni Bisignani, Carmelo La Greca, Berardo Sarubbi, Simone Sala, Miguel Viscusi, Maurizio Landolina, Mariolina Lovecchio, Sergio Valsecchi, Maria Grazia Bongiorni,

Cardiac electrophysiology and arrhythmias

The subcutaneous implantable cardioverter defibrillator (S-ICD) is a relatively novel alternative to the transvenous ICD for the treatment of life-threatening ventricular arrhythmias, and is currently used in the clinical practice of several centers. The aim of this analysis was to describe current Italian practice regarding S-ICD implantation and its evolution over the years.We analyzed 607 consecutive patients (78% male, 48 ± 16 years) who underwent S-ICD implantation in 39 Italian centers from 2013 to 2017.Structural cardiomyopathy was present in 78% of patients and 30% of patients received their device for secondary prevention. The proportion of patients with dilated cardiomyopathy and with left ventricular ejection fraction ≤35% increased from ≤2014 to 2017 (from 38% to 58%, from 33% to 53%, respectively; both p < 0.05). Almost all procedures (97%) were performed in electrophysiology laboratories. Over the last 4 years, the 2-incision implantation technique has been widely adopted, with sub- or inter-muscular positioning of the generator, under local anesthesia or deep sedation (≤2014 versus 2017: all p < 0.001). Defibrillation testing was performed in 81% of patients. Shock energy of ≤65 J was successful in 93.9% of patients and the overall cardioversion success rate at ≤80 J was 99.8%.Our analysis confirmed that the S-ICD continues to be preferentially used in specific patients (younger, less frequently with dilated cardiomyopathy and low ejection fraction.). Nonetheless, we noted a trend toward the wider use of S-ICD in patients with dilated cardiomyopathy and systolic dysfunction over the years. Novel approaches have been adopted while the acute efficacy of the system has remained stably high.