Subcutaneous implantable cardioverter defibrillator: early experience

Abstract Introduction: The implantable cardioverter defibrillator had been increasing the survival of patients at high risk for sudden cardiac death. The subcutaneous implantable cardioverter defibrillator was developed to mitigate the complications inherent to lead placement into cardiovascular system. Objective: To report the initial experience of 18 consecutive cases of subcutaneous implantable cardioverter defibrillator implantation showing the indications, potential pitfalls and perioperative complications. Methods: Between September 2016 and March 2017, 18 patients with indication for primary and secondary prevention of sudden cardiac death, with no concomitant indication for artificial cardiac pacing, were included. Results: The implantation of the subcutaneous implantable cardioverter defibrillator successfully performed in 18 patients. It was difficult to place the subcutaneous lead at the parasternal line in two patients. One patient returned a week after the procedure complaining about an increase in pain intensity at pulse generator pocket site, which was associated with edema, temperature rising and hyperemia. Two patients took antialgic medication for five days after surgery. A reintervention was necessary in one patient to replace the lead in order to correct inappropriate shocks caused by myopotential oversensing. Conclusion: In our initial experience, although the subcutaneous implantable cardioverter defibrillator implantation is a less-invasive, simple-accomplishment procedure, it resulted in a bloodier surgery perhaps requiring an operative care different from the conventional. Inappropriate shock by oversensing is a reality in this system, which should be overcame in order not to become a limiting issue for its indication.

Implante de cardioversor-desfibrilador subcutâneo: relato de caso de paciente com taquicardia ventricular induzida por esforço / Subcutaneous cardioverter defibrillator implantation: case report of a patient with stress-induced ventricular tachycardia

As complicações relacionadas ao cardioversor-desfibrilador implantável em geral estão relacionadas a implante de cabo-eletrodo transvenoso, fratura do condutor ou ruptura do isolamento de silicone, além de infecções. Essas complicações podem ser evitadas com o implante do sistema de cardioversor-desfibrilador implantável totalmente subcutâneo. Relatamos o caso de um paciente de 60 anos de idade, assintomático, com antecedentes de morte súbita cardíaca na família, submetido ao primeiro implante de cardioversor-desfibrilador implantável subcutâneo no Brasil

Complications related to the use of implantable cardioverter-defibrillator are often related to transvenous lead implant, conductor fracture or insulation disruption in addition to infections. These complications may be avoided by implanting a totally subcutaneous implantable cardioverter-defibrillator system. We report the case of a 60-year old, asymptomatic patient with a family history of cardiac sudden death, undergoing the first subcutaneous implantable cardioverter-defibrillator implant in Brazil