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Amy Wharmby1, Charles Butcher2, Shohreh Honarbakhsh1
1Barts NHS Trust, St. Bartholomew's Hospital, West Smithfield, London, UK.
Insights
Subcutaneous implantable cardioverter defibrillator (S-ICD) electrode displacement can go undetected. Comparing S-ICD electrograms during follow-up can prevent this issue.
Area of Science:
- Cardiology
- Medical Devices
- Electrophysiology
Background:
- Secondary prevention with subcutaneous implantable cardioverter defibrillators (S-ICDs) is crucial for managing sudden cardiac death risk.
- Ensuring the proper function and placement of S-ICD electrodes is vital for device efficacy.
Observation:
- Two cases of S-ICD implantation experienced undetected electrode displacement.
- Displacement was identified through a routine chest X-ray and an unmonitored event via remote monitoring.
- Neither patient's initial presentation immediately indicated the electrode displacement.
Findings:
- Comparing current subcutaneous electrograms (S-ECGs) with those recorded at the time of S-ICD implantation can reveal electrode displacement.
- This comparison is a simple yet effective strategy for early detection of displacement.
- Undetected displacement poses a risk to patient safety and device performance.
Implications:
- Routine comparison of S-ECGs during follow-up appointments is recommended for all S-ICD patients.
- Implementing this strategy can improve patient outcomes and device reliability.
- This highlights the importance of vigilant monitoring and standardized follow-up protocols for S-ICD systems.
Abstract:
We describe two cases of secondary prevention subcutaneous implantable cardioverter defibrillator (S-ICD) implantation and subsequent S-ICD electrode displacement which initially went undetected. One presentation was a result of a coincidental chest x-ray for respiratory exacerbation and another with an untreated episode highlighted via remote monitoring, both patients were booked to clinic for further investigation. Our findings highlighted had there been a comparison of the existing subcutaneous electrogram (S-ECG) to captured S-ECGs at time of implant the electrode displacement would have been detected beforehand. This underpins the importance of introducing the simple management strategy into routine follow-up.