How to minimize peri-procedural complications during subcutaneous defibrillator implant?. (2nd July 2020)

• Record Type: Journal Article
• Authors: Afzal, Muhammad R.; Okabe, Toshimasa; Hsu, Kevin; Cook, Schuyler; Koppert, Tanner; Weiss, Raul
• Is Part Of: Expert review of cardiovascular therapy. Volume 18:Number 7(2020)
• Page Start: 427
• Page End: 434
• Publication Date: 2020-07-02
• Subjects: Perioperative complications -- subcutaneous defibrillator -- sudden cardiac death -- device infection -- intra-operative; Cardiovascular agents -- Research -- Periodicals; 616.12061
• DOI: 10.1080/14779072.2020.1784006
• Languages: English
• ISSNs: 1477-9072

Abstract

ABSTRACT: Introduction: Subcutaneous defibrillator (S-ICD) is the latest development in the clinically available devices for sudden cardiac death prevention. Experience from pivotal trials and post-marketing studies has proven the feasibility and safety of S-ICD. Extra-cardiac location of S-ICD obviates the need for transvenous leads which translates into lower incidence of lead-related complications and systemic infections. This is a review on peri-procedural interventions to minimize complications associated with S-ICD during implant and follow-up. Areas covered: This paper will highlight the results of pertinent studies related to perioperative management of S-ICD and review the approaches to minimize the risk of complications such as hematoma at the pulse generator location, unsuccessful defibrillation due to suboptimal S-ICD lead and generator position, postoperative pain, inappropriate shocks due to T wave oversensing and interaction with concomitant cardiac implantable devices. An extensive literature search was performed to identify the relevant articles. Expert commentary: The use of S-ICD is expanding, and the published results suggest a preferential use of such devices for younger patients and those with a potential risk of infection from intravascular devices. The perioperative management of S-ICD has significantly evolved during a decade of experience. Contemporary experience suggests that these procedures are associated with minimal complications.