Abstract 14688: Submuscular is Superior to Subcutaneous Implantation for Subcutaneous Implantable Cardioverter Defibrillator
Objectives: The incidence of electrode problems in the subcutaneous ICD (S-ICD) system appears to be rare but an improvement upon conventional transvenous systems. Recent publications of subcutaneous placement have highlighted pocket complications due to the size of the device especially in young and physically active. We have developed a sub-muscular approach to avoid these issues which provides a better cosmetic outcome.
Methods: Our technique differs in that the pulse generator is placed postero laterally between the anterior surface of serratus anterior and the posterior surface of latissmus dorsi. The pocket is created by blunt dissection between these two muscles. This area is generally free from blood vessels. The long thoracic nerve is not within this plane but deep to the thoracic wall. The majority of the pulse generator is placed behind latissmus dorsi. The posterior placement provides an improved vector towards the shocking coil capturing more of the left ventricle. The electrode is implanted in the same manner as for subcutaneous placement.
Results: We implanted the S-ICD with our submuscular approach in 81 pts with mean +/- standard deviation (SD) aged of 48 +/- 18 years, (range 13 - 81 years), between August 2010 and May 2013. Indications for implantation were ischemic cardiomyopathy, dilated cardiomyopathy, ion channelopathies, idiopathic ventricular fibrillation and congenital heart disease in 28, 24,16, 7 and 6 pts respectively. Mean + /- SD left ventricular ejection fraction was 36 +/- 15%, (range 10-55%). Implantation was for primary and secondary prevention in 49 pts and 32 pts respectively. Intra-operatively, all patients, except 3 (LV thrombus), were induced into ventricular fibrillation and successfully converted with a 65 Joule sub-maximal energy shock. Our mean +/- SD follow-up time was 448 +/- 290 (range 15 - 1001) days. Three patients progressed to heart transplantation and the entire system was simply explanted. Our consecutive series of 81 patients implanted by a single operator had no pocket complications.
Conclusion: The submuscular S-ICD implantation is a safe and feasible alternative to the standard subcutaneous placement. It provides a good shocking vector and excellent cosmetic outcome especially in the thin and young pts.
- © 2013 by American Heart Association, Inc.