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Subcutaneous Implantable Cardioverter-Defibrillator in Patients With Arrhythmogenic Right Ventricular

Gabriela M Orgeron1, Aditya Bhonsale1, Federico Migliore2

  • 11 Division of Cardiology Department of Medicine Johns Hopkins Hospital Baltimore MD.

Journal of the American Heart Association
|January 5, 2019
PubMed

Insights

The subcutaneous implantable cardioverter-defibrillator (S-ICD) effectively treats ventricular arrhythmias in arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) patients. Inappropriate shocks occurred but were comparable to transvenous ICDs, mainly due to oversensing.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • The clinical role of the subcutaneous implantable cardioverter-defibrillator (S-ICD) in arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) patients is not well-defined.
  • Growing use of S-ICD necessitates understanding its efficacy and safety in this specific patient population.

Purpose of the Study:

  • To evaluate the cardiac phenotype, implant characteristics, and long-term efficacy of S-ICD therapy in ARVC/D patients.
  • To identify the incidence and causes of appropriate and inappropriate S-ICD therapy and device-related complications in ARVC/D patients.

Main Methods:

  • Analysis of a transatlantic cohort of ARVC/D patients who underwent S-ICD implantation.
  • Evaluation of clinical characteristics, S-ICD therapy (appropriate and inappropriate), and long-term outcomes, including device-related complications.

Main Results:

  • S-ICD effectively converted induced ventricular fibrillation in 27/29 patients.
  • Over a median follow-up of 3.16 years, all sustained ventricular arrhythmias were appropriately detected and treated (4% per year).
  • Inappropriate shocks occurred in 21% of patients, primarily due to cardiac and noncardiac oversensing, with 3 requiring device explantation.

Conclusions:

  • S-ICD is effective in treating induced and spontaneous ventricular arrhythmias in ARVC/D patients.
  • The rate of inappropriate shocks is comparable to transvenous ICDs, with oversensing being the main cause.
  • Potential strategies to minimize inappropriate therapy in ARVC/D patients receiving S-ICDs should be considered.

Keywords:
arrhythmogenic right ventricular cardiomyopathyimplanted cardioverter defibrillatorlong‐term follow‐upventricular tachycardia

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