Use of pulsed electron avalanche knife (PEAK) PlasmaBlade™ in patients undergoing implantation of subcutaneous implantable cardioverter-defibrillator. (September 2019)

• Record Type: Journal Article
• Authors: Kaya, Elif; Siebermair, Johannes; Azizy, Obayda; Dobrev, Dobromir; Rassaf, Tienush; Wakili, Reza
• Is Part Of: IJC heart & vasculature. Volume 24(2019)
• Publication Date: 2019-09
• Subjects: CAD Coronary artery disease -- CIED Cardiac implantable electronic device -- DOAC Direct oral anticoagulant -- INR International normalized ratio -- ASA American Society of Anesthesiologists -- AST Automated screening tool -- DFT Defibrillation threshold -- ICD Implantable cardioverter-defibrillator -- IVF Idiopathic ventricular fibrillation -- J Joule -- M Musculus -- SCD Sudden cardiac death -- S-ICD Subcutaneous implantable cardioverter-defibrillator -- VF Ventricular fibrillation -- VKA Vitamin K antagonist; PEAK PlasmaBlade™ -- S-ICD -- Intermuscular technique -- Bleeding complication -- Anticoagulation; Cardiovascular system -- Diseases -- Periodicals; Cardiovascular system -- Pathophysiology -- Periodicals; 616.1005
• DOI: 10.1016/j.ijcha.2019.100390
• Languages: English
• ISSNs: 2352-9067

Abstract

Abstract: Introduction: Surgical implantation of subcutaneous implantable cardioverter-defibrillators (S-ICD) requires preparation of a deeper and larger pocket. Infection and bleeding complications are reported, particularly in patients requiring antiplatelet therapy (APT) or being on oral anticoagulation (OAC), with rates up to 25%. The pulsed electron avalanche knife (PEAK) PlasmaBlade™ has been reported to reduce bleeding complications. The purpose of this study was to evaluate the safety and feasibility of a PEAK guided S-ICD implantation with respect to perioperative complications. Methods and results: We enrolled 36 consecutive patients (75% male; mean age 52.1 ± 14.4 years) undergoing S-ICD implantation. Periprocedural safety endpoints comprised major complications including pocket hematomas, wound infections, bleeding (BARC ≥2) or events requiring interventions. Patients were divided into three groups according to management of their anticoagulation: i.) APT, n = 15 (41.7%); ii.) OAC, n = 10 patients (27.8%); iii.) none (neither OAC nor APT), n = 11 (30.6%). Mean procedure duration was 33.1 ± 13.4 min. Mean length of hospital stay was 3.3 ± 2.1 days. Overall analysis showed no differences between the 3 groups with respect to major complications, major bleeding episodes or other procedural parameters, beside a trend towards more minor hematomas in the OAC group (OAC: 22.2% vs. APT: 11.4% vs. none: 9.1%; p = 0.15). Conclusion: The results of our pilot study suggest that intermuscular S-ICD implantation using PEAK is safe and potentially beneficial in patients receiving OAC or APT with respect to prevention of bleeding complications. These results support the rationale for large prospective controlled trials evaluating a beneficial effect of PEAK use in S-ICD implantation procedures.