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Leadless ICD

Elif Kaya, Reza Wakili, Tienush Rassaf
The subcutaneous implantable cardioverter-defibrillator (S-ICD®, Boston Scientific, Marlborough, MA, USA, previously Cameron Health, San Clemente, CA, USA) represents an important milestone in ICD therapy for prevention of sudden cardiac death (SCD). Since the introduction of the S‑ICD in 2010, the device has undergone further development. Based on the unique feature of an entirely extracardiac implantation, the S‑ICD is able to reduce the common perioperative and long-term complications of the usual endovascular implanted ICD systems...
May 14, 2018: Herzschrittmachertherapie & Elektrophysiologie
Fleur V Y Tjong, Tom F Brouwer, Brendan Koop, Brian Soltis, Allan Shuros, Brian Schmidt, Bryan Swackhamer, Anne-Floor E B Quast, Arthur A M Wilde, Martin C Burke, Reinoud E Knops
OBJECTIVES: The primary objective was to assess the acute and 3-month performance of the modular antitachycardia pacing (ATP)-enabled leadless pacemaker (LP) and subcutaneous implantable cardioverter-defibrillator (S-ICD) system, particularly device-device communication and ATP delivery. BACKGROUND: Transvenous pacemakers and implantable cardioverter-defibrillators (ICDs) have considerable rates of lead complications. We examined the next step in multicomponent leadless cardiac rhythm management: feasibility of pacing (including ATP) by a LP, commanded by an implanted S-ICD through wireless, intrabody, device-device communication...
December 26, 2017: JACC. Clinical Electrophysiology
Anne-Floor B E Quast, Fleur V Y Tjong, Brendan E Koop, Arthur A M Wilde, Reinoud E Knops, Martin C Burke
Aims: The development of communicating modular cardiac rhythm management systems relies on effective intrabody communication between a subcutaneous implantable cardioverter-defibrillator (S-ICD) and a leadless pacemaker (LP), using conducted communication. Communication success is affected by the LP and S-ICD orientation. This study is designed to evaluate the orientation of the LP and S-ICD in canine subjects and measure success and threshold of intrabody communication. To gain more human insights, we will explore device orientation in LP and S-ICD patients...
February 14, 2018: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Lovkesh Arora, Chakradhari Inampudi
PURPOSE OF REVIEW: Patients with cardiac implantable electronic devices (CIEDs) frequently undergo various surgical procedures and in the past perioperative management involved only placing magnet over the device. New programming features, development of implantable cardiac defibrillator (ICD), cardiac resynchronization therapy, and increasing complexity of the operating room equipment have led to new sources of electromagnetic interference (EMI). A comprehensive understanding of the CIED is necessary to provide a timely and optimal care to the patients...
December 2017: Current Opinion in Anaesthesiology
Fozia Zahir Ahmed, Colin Cunnington, Manish Motwani, Amir Masood Zaidi
Subcutaneous implantable cardioverter defibrillators (S-ICDs) provide effective defibrillation, while also reducing the risk of long-term lead problems. However, S-ICDs do not offer bradycardia or antitachycardia pacing and therefore use has been limited. Combined implantation of an S-ICD with a leadless pacemaker (LP) has been proposed to overcome this limitation. Although a handful of combined S-ICD/LP implantations have been reported for Nanostim (St Jude Medical, St Paul, MN) as well as Micra LP (Medtronic, Minneapolis, MN) systems, none have documented delivery of appropriate shock therapies for spontaneous ventricular tachycardia...
August 2017: Canadian Journal of Cardiology
Kristin Ellison, Parikshit S Sharma, Richard Trohman
There have been many evolutionary milestones in cardiac implantable electronic device (CIED) therapy over the past few decades. These advancements have created new  challenges. Right ventricular pacing was the original (late 1950s) breakthrough, however the risk of pacing induced dyssynchrony has become evident. Biventricular pacing provided a viable way to mitigate dyssynchrony, but only benefits certain patients (primarily left bundle branch block and QRS duration ≥150 ms with depressed left ventricular (LV) function)...
June 2017: Expert Review of Cardiovascular Therapy
Riccardo Cappato, Hussam Ali
The implantable cardioverter-defibrillator (ICD) has shown its superiority to anti-arrhythmic drugs in the prevention of sudden cardiac death. However, the conventional transvenous ICDs are still associated with substantial risks and comorbidities mainly related to the transvenous leads. The recent advent of an entirely sub-cutaneous ICD (S-ICD) represents an important progress in the defibrillation technology towards a less invasive approach. Clinical data are growing regarding the safety and efficacy of S-ICD in prevention of sudden cardiac death in selected patients without pacing indications...
June 15, 2017: International Journal of Cardiology
Benedict M Wiles, Paul R Roberts
Implantable cardiac devices have an increasingly important role. Pacemakers remain the only effective treatment for symptomatic bradycardia; cardiac resynchronisation therapy is a proven treatment for heart failure; and implantable cardioverter defibrillators (ICD) are superior to medical therapy in prevention of sudden cardiac death. Our ageing population has led to a rising number of device implants. Physicians in all specialties increasingly encounter patients with cardiac devices and require an understanding of their capabilities and functions...
February 2017: Clinical Medicine: Journal of the Royal College of Physicians of London
Sana M Al-Khatib, Paul Friedman, Kenneth A Ellenbogen
Advances in the field of defibrillation have brought to practice different types of devices that include the transvenous implantable cardioverter-defibrillator (ICD) with or without cardiac resynchronization therapy, the subcutaneous ICD (S-ICD), and the wearable cardioverter-defibrillator. To ensure optimal use of these devices and to achieve best patient outcomes, clinicians need to understand how these devices work, learn the characteristics of patients who qualify them for one type of device versus another, and recognize the remaining gaps in knowledge surrounding these devices...
November 1, 2016: Circulation
Yusuke Kondo, Marehiko Ueda, Yoshio Kobayashi, Joerg O Schwab
There has been a significant increase in the number of patients receiving cardiovascular implantable electronic devices (CIED) over the last two decades. CIED infection represents a serious complication after CIED implantation and is associated with significant morbidity and mortality. Recently, newly advanced technologies have offered attractive and suitable therapeutic alternatives. Notably, the leadless pacemaker and anti-bacterial envelope decrease the potential risk of CIED infection and the resulting mortality, when it does occur...
August 2016: Journal of Arrhythmia
F V Y Tjong, T F Brouwer, L Smeding, K M Kooiman, J R de Groot, D Ligon, R Sanghera, M J Schalij, A A M Wilde, R E Knops
AIMS: The subcutaneous implantable cardioverter-defibrillator (S-ICD) and leadless pacemaker (LP) are evolving technologies that do not require intracardiac leads. However, interactions between these two devices are unexplored. We investigated the feasibility, safety, and performance of combined LP and S-ICD therapy, considering (i) simultaneous device-programmer communication, (ii) S-ICD rhythm discrimination during LP communication and pacing, and (iii) post-shock LP performance. METHODS AND RESULTS: The study consists of two parts...
November 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Jeffrey Arkles, Joshua Cooper
The role of leadless devices to treat cardiac rhythm disorders and heart failure is emerging. Subcutaneous defibrillator (S-ICD) and leadless pacemakers were developed to ameliorate the risks associated with chronic transvenous leads. Potential benefits of leadless pacemakers and S-ICD include more favorable infection profile, less risk of venous stenosis or occlusion, and less risk of tricuspid valve insufficiency. Novel implantable leadless monitors for heart failure represent a novel diagnostic tool that can guide therapy for CHF...
February 2016: Current Treatment Options in Cardiovascular Medicine
Chu-Pak Lau, Chung-Wah Siu, Kai-Hang Yiu, Kathy Lai-Fun Lee, Yap-Hang Chan, Hung-Fat Tse
Nearly one out of five strokes is associated with atrial fibrillation (AF). Atrial fibrillation is often intermittent and asymptomatic. Detection of AF after cryptogenic stroke will likely change therapy from antiplatelet to oral anticoagulation agents for secondary stroke prevention. A critical step is to convert 'covert' AF into electrocardiogram documented AF. External rhythm recording devices have registered a high incidence of AF to occur after a cryptogenic stroke, but are limited by short duration of continuous recordings...
October 2015: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Hussam Ali, Pierpaolo Lupo, Riccardo Cappato
Although conventional implantable cardioverter-defibrillators (ICDs) have proved effective in the prevention of sudden cardiac death (SCD), they still appear to be limited by non-trivial acute and long-term complications. The recent advent of an entirely subcutaneous ICD (S-ICD) represents a further step in the evolution of defibrillation technology towards a less-invasive approach. This review highlights some historical and current issues concerning the S-ICD that may offer a viable therapeutic option in selected patients at high risk of SCD and in whom pacing is not required...
August 2015: Arrhythmia & Electrophysiology Review
Pierre Bordachar, Christelle Marquié, Thomas Pospiech, Jean-Luc Pasquié, Zakaria Jalal, Michel Haissaguerre, Jean-Benoit Thambo
The demonstration of severe complications in patients implanted with a transvenous implantable cardioverter defibrillator (ICD) has led to the development of devices equipped with a subcutaneous lead. This new technique offers numerous advantages but also certain disadvantages. Various studies or anecdotal clinical cases have specifically been conducted with this subcutaneous defibrillation system in children and/or patients with congenital heart disease. Results of these studies suggest: 1) a high feasibility despite being limited by a selection process that excludes patients requiring permanent pacing and patients declared ineligible during pre-screening; 2) good efficacy of electrical shocks in reducing induced or spontaneous ventricular arrhythmias; 3) in this specific subset of patients, 2 types of complications have been particularly described: a risk of device exteriorization and infection, and a large number of inappropriate therapies primarily related to T-wave oversensing...
January 15, 2016: International Journal of Cardiology
Jean-Claude Daubert, Albin Behaghel, Christophe Leclercq, Philippe Mabo
Major improvements in implantable electrical cardiac devices have been made during the last two decades, notably with the advent of automatic internal defibrillation (ICD) to prevent sudden arrhythmic death, and cardiac resynchronisation (CRT) to treat the discoordinated failing heart. They now constitute a major therapeutic option and may eventually supersede drug therapy. The coming era will be marked by a technological revolution, with improvements in treatment delivery, safety and efficacy, and an expansion of clinical indications...
March 2014: Bulletin de L'Académie Nationale de Médecine
Kiran Haresh Kumar Patel, Pier D Lambiase
The subcutaneous implantable cardioverter-defibrillator (S-ICD) represents an exciting development in ICD technology. It has relative advantages over traditional transvenous systems, particularly for young patients in whom the lifetime risk of device-related complications may be deemed to be unacceptably high. While data relating to device longevity and long term safety profile is yet to be accrued, several recent studies have demonstrated good clinical efficacy comparable to transvenous ICDs. Indeed, new techniques have also been developed to simplify the S-ICD implantation procedure and attempts have been made to address challenges pertaining to T-wave oversensing to reduce the delivery of inappropriate shocks...
December 2014: Cardiovascular Diagnosis and Therapy
Angelo Auricchio, Peter-Paul Delnoy, Christian Butter, Johannes Brachmann, Lieselot Van Erven, Stefan Spitzer, Tiziano Moccetti, Martin Seifert, Thanasie Markou, Karolyi Laszo, François Regoli
AIMS: Left ventricular (LV) endocardial pacing may address the limitations in the selection of an LV pacing site and provide improvements in cardiac resynchronization therapy (CRT) effectiveness. We report on the feasibility, the safety, and the short-term outcome of a leadless ultrasound-based technology for LV endocardial resynchronization in heart failure (HF) patients enroled into the Wireless Stimulation Endocardially for CRT (WiSE-CRT) study. METHODS AND RESULTS: Seventeen HF patients were enroled and categorized as: (i) patients in whom attempted coronary sinus lead implantation for CRT had failed (n = 7); (ii) patients with a previously implanted CRT device, not responding to CRT (n = 2); and (iii) patients with previously implanted pacemakers or implantable cardioverter-defibrillator and meeting the standard indications for CRT (n = 8)...
May 2014: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
S Jacob, A S Bharadwaj, S S Panaich, A Mathew, L Afonso
Despite the clear cut indications for cardiac resynchronization therapy (CRT) laid down by guideline forming bodies, there are numerous unresolved issues. This review article primarily focuses on the current trends in CRT and the challenges encountered in patient selection, procedure related and postimplantation patient management issues. The high rate of non-response to CRT warrants a critical appraisal of the patient selection criteria, with the role of QRS duration and use of imaging to quantify ventricular dyssynchrony being the major points of discussion...
December 2010: Minerva Cardioangiologica
Kevin A Michael, Brett J Peterson, Arthur M Yue, Ryan D Wilson, Li Wang, Kevin Ousdigian, Bruce Wilkoff, Laurence Sterns, John M Morgan et al.
BACKGROUND: A surface electrocardiogram (SECG) for pacing threshold measurements during routine implantable cardioverter-defibrillator (ICD) follow-up can be cumbersome. This study evaluated the use of an intrathoracic far-field electrogram (EGM) derived between the Can and superior vena cava (SVC) electrode -- the Leadless electrocardiogram (LLECG), in dual chamber ICDs in performing pacing threshold tests. METHODS: The LLECG was evaluated prospectively during atrial and ventricular pacing threshold testing as a substudy of the Comparison of Empiric to Physician-Tailored Programming of Implantable Cardioverter-Defibrillators trial (EMPIRIC) in which dual chamber ICDs were implanted in 888 patients...
December 2007: Pacing and Clinical Electrophysiology: PACE
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