P12 SUBCUTANEOUS IMPLANTABLE CARDIOVERTER–DEFIBRILLATOR AFTER TRANSVENOUS LEAD EXTRACTION: SAFETY, EFFICACY AND OUTCOME. (18th May 2022)

• Record Type: Journal Article
• Authors: Migliore, F; Giacomin, E; Pittorru, R; Falzone, P; Dall'Aglio, P; Vianello, R; De Lazzari, M; Bertaglia, E; Iliceto, S
• Is Part Of: European heart journal supplements. Volume 24(2022)Supplement C
• Publication Date: 2022-05-18
• Subjects: Cardiology -- Periodicals; Cardiology -- Europe -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/suac012.010
• Languages: English
• ISSNs: 1520-765X

Abstract

Abstract: Background: Subcutaneous implantable cardioverter defibrillator (S–ICD) is a suitable alternative for trans–venous–ICD (TV–ICD) patients underwent transvenous lead extraction (TLE) for any reason, but limited data are available about outcome of s–ICD patients implanted after TLE. Methods: Thirty–six consecutive patients underwent TLE of TV–ICD and subsequent S–ICD implantation in our center were included in this prospective single–center observational study (72.2% male, median age 52 years–old). Results: During a median follow-up of 31 months, 3 patients (8.3%) experienced appropriate therapy and 7 patients (19.4%) experienced complications including innapropriate therapy (IAT) (n = 4; 11.1%), pulse generator decubitus with no evidence of infection (n = 2; 5.5%) and ineffective therapy (n = 1; 2.7%). Reasons of IAT were: T–wave oversensing in one patient and extracardiac signals in the remaining 3 patients. Of note, 2 patients who experienced IAT had a left–ventricular assist device (LVAD) for refractory heart failure (HF). Premature device explantation and TV–ICD re–implantation occurred in 4 patients (11%) for pulse generator decubitus despite surgical pocket revisions (n = 2), for recurrent IAT despite reprogramming (n = 1) and ineffective therapy during arrhythmic storm (n = 1). Eight patients (22.2%) died, 3 patients (9%) underwent LVAD implantation due refractory HF during follow‐up. Six patients died because of refractory HF, 1 patient died due to intracerebral hemorrhage and 1 due to sarcoidosis. There were no documented deaths associated with the procedure or the S–ICD system itself. No patient had the device removed because of a perceived need for antitachycardia pacing (ATP) or the necessity of pacing or cardiac resynchronization therapy despite 9 patients (25%) after TLE of a two–chamber ICD and one patient (3%) after TLE of a CRT–D. Univariate predictors of death included hypertension (HR 22.72; p = 0.02), diabetes (HR 10.64; p = 0.001), ischemic heart disease (HR 5.92; p = 0.01) and NYHA class > = II (p = 0.04). We did not observed any predictors for complications including IATs and device‐related complications requiring surgical revision. Conclusions: S–ICD implantaion after TLE of TV–ICD is safy and effective. Baseline clinical characterisctics including ischemic heart disease, diabetes, hypertension and NYHA class > = II are associated with worse survival.