Postoperative ergometry-guided programming does not prevent T-wave oversensing and inappropriate shocks in S-ICD patients.

BACKGROUND: T-wave oversensing (TWOS) is a feared complication after subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation, potentially leading to inappropriate shocks (IS) with tremendous impact on quality of life. HYPOTHESIS: Postoperative ergometry facilitates primary and secondary prevention of TWOS or other potential causes of IS and optimizes S-ICD programming. METHODS: We analyze the impact of ergometry guided-programming (EMGP) on primary and secondary prevention of TWOS/IS in S-ICD patients, we screened 146 patients implanted in our center (2010-2016) for the incidence of TWOS/IS during postoperative ergometry. Furthermore, to evaluate the outcome in 123 eligible patients complete follow-up (FU) of at least 6 months up to 2 years was retrospectively analyzed. RESULTS: (1) Primary prevention: TWOS could only be provoked postoperatively in 3.7% of patients (n = 3/82). FU analyses did not reveal significant differences compared to our control group (Ctrl: n = 6/61, 9.8% vs EMGP: n = 5/62, 8.1%; P = 0.731). Further subgroup analyses of patients with postoperative ergometry in the close postoperative period (< 7 days; n = 3/45, 6.7%; P = 0.563) did not yield any significant difference. (2) Secondary prevention: We found various causes of TWOS/IS. In patients who underwent reprogramming due to previous TWOS/IS events we observed a 66.7% (n = 6/9) reduction of TWOS/IS using EMGP. CONCLUSION: TWOS/IS has various causes while not all cases are exercise-associated. Postoperative ergometry does not seem to be useful for primary prevention. Further trials need to investigate the potential benefit of EMGP for secondary prevention of TWOS/IS.

[Management of inappropriate shocks/T-wave-oversensing in S-ICD®-patients]. / Management von inadäquaten Schocks/T-Wellen-Oversensing bei S-ICD®-Patienten.

Inappropriate shocks are a feared complication after implantable cardioverter-defibrillator (ICD) implantation and have a tremendous impact on quality of life. Inappropriate shocks in patients with subcutaneous ICD (S-ICD®, Boston Scientific, Marlborough, MA, USA) have various underlying causes. This review summarizes the current literature on this topic and lists possible treatment options.

[Surgical therapy of end-stage heart failure. State of the art 2006]. / Chirurgische Therapie der Herzinsuffizienz : State of the Art 2006.

Cardiac transplantation still remains the gold standard despite recent success in organ-preserving therapy. However, organ shortage forces to process alternative therapies. Cardiac resynchronization therapy and cardiac contractility modulation are new and promising therapies, which are able either to delay or even prevent the need for cardiac transplantation. High-risk cardiac revascularization and valve replacement is another important therapy in especially evaluated patients. With newer organ-protective procedures and novel treatment options like the off-pump bypass surgery, end-stage heart failure could be treated successfully. The volume reduction surgery, the so-called Batista procedure, has its indication only in special selected patients with dilated cardiomyopathy. A modified procedure, the surgical ventricular restoration (SVR) therapy, however, has a definitive potential and is evaluated in a multicenter trial (RESTORE). Mechanical cardiac assist devices have still a high impact in the therapy of acute or chronic end-stage heart failure. By means of smaller devices with axial rotary blades, the high rates of thromboembolic events, infections and mechanical device complications were significantly reduced. Survival to transplant with mechanical assist device support is nowadays around 80%. New centrifugal pumps are tested in clinical trials right now. Passive cardiac support devices and the total artificial heart are limited to special indications. The organ shortage could be overcome with the xenotransplantation. However, the problem of hyperacute rejection and the risk of transfection of animal diseases limit the clinical use considerably. The cell therapy has probably the highest potential for the future. Still unsolved are problems with the potential trigger of arrhythmias and ethical preconceptions regarding embryonic stem cells. In summary, cardiac transplantation still remains the gold standard in the therapy of end-stage heart failure with 10-year survival rates of 50%. With increasing donor shortage a potential combination therapy of organ-preserving cardiac surgery and cell transplantation might be the future for the 21st century.