ABSTRACT
INTRODUCTION: The implantable cardioverter defibrillator had been increasing the survival of patients at high risk for sudden cardiac death. The subcutaneous implantable cardioverter defibrillator was developed to mitigate the complications inherent to lead placement into cardiovascular system. OBJECTIVE: To report the initial experience of 18 consecutive cases of subcutaneous implantable cardioverter defibrillator implantation showing the indications, potential pitfalls and perioperative complications. METHODS: Between September 2016 and March 2017, 18 patients with indication for primary and secondary prevention of sudden cardiac death, with no concomitant indication for artificial cardiac pacing, were included. RESULTS: The implantation of the subcutaneous implantable cardioverter defibrillator successfully performed in 18 patients. It was difficult to place the subcutaneous lead at the parasternal line in two patients. One patient returned a week after the procedure complaining about an increase in pain intensity at pulse generator pocket site, which was associated with edema, temperature rising and hyperemia. Two patients took antialgic medication for five days after surgery. A reintervention was necessary in one patient to replace the lead in order to correct inappropriate shocks caused by myopotential oversensing. CONCLUSION: In our initial experience, although the subcutaneous implantable cardioverter defibrillator implantation is a less-invasive, simple-accomplishment procedure, it resulted in a bloodier surgery perhaps requiring an operative care different from the conventional. Inappropriate shock by oversensing is a reality in this system, which should be overcame in order not to become a limiting issue for its indication.
Subject(s)
Cardiac Pacing, Artificial/methods , Death, Sudden, Cardiac/prevention & control , Defibrillators, Implantable , Electric Countershock/instrumentation , Secondary Prevention/instrumentation , Ventricular Fibrillation/therapy , Death, Sudden, Cardiac/etiology , Defibrillators, Implantable/adverse effects , Electric Countershock/adverse effects , Female , Humans , Male , Middle Aged , Pacemaker, Artificial , Treatment Outcome , Ventricular Fibrillation/complicationsABSTRACT
Abstract Introduction: The implantable cardioverter defibrillator had been increasing the survival of patients at high risk for sudden cardiac death. The subcutaneous implantable cardioverter defibrillator was developed to mitigate the complications inherent to lead placement into cardiovascular system. Objective: To report the initial experience of 18 consecutive cases of subcutaneous implantable cardioverter defibrillator implantation showing the indications, potential pitfalls and perioperative complications. Methods: Between September 2016 and March 2017, 18 patients with indication for primary and secondary prevention of sudden cardiac death, with no concomitant indication for artificial cardiac pacing, were included. Results: The implantation of the subcutaneous implantable cardioverter defibrillator successfully performed in 18 patients. It was difficult to place the subcutaneous lead at the parasternal line in two patients. One patient returned a week after the procedure complaining about an increase in pain intensity at pulse generator pocket site, which was associated with edema, temperature rising and hyperemia. Two patients took antialgic medication for five days after surgery. A reintervention was necessary in one patient to replace the lead in order to correct inappropriate shocks caused by myopotential oversensing. Conclusion: In our initial experience, although the subcutaneous implantable cardioverter defibrillator implantation is a less-invasive, simple-accomplishment procedure, it resulted in a bloodier surgery perhaps requiring an operative care different from the conventional. Inappropriate shock by oversensing is a reality in this system, which should be overcame in order not to become a limiting issue for its indication.
Subject(s)
Humans , Male , Female , Middle Aged , Ventricular Fibrillation/therapy , Electric Countershock/instrumentation , Cardiac Pacing, Artificial/methods , Death, Sudden, Cardiac/prevention & control , Defibrillators, Implantable/adverse effects , Secondary Prevention/instrumentation , Pacemaker, Artificial , Ventricular Fibrillation/complications , Electric Countershock/adverse effects , Treatment Outcome , Death, Sudden, Cardiac/etiologyABSTRACT
Introdução: Este trabalho teve por objetivo avaliar a taxa de sucesso de implante de cabo-eletrodo ventricular em região lateral sem uso de venografia. Método: Foram analisados 100 casos de implante de cabo-eletrodo ventricular esquerdo ao longo de 30 meses, em um único centro, quanto a sua localização e calculada a taxa de implantes em parede lateral (ântero-lateral, lateral e póstero-lateral). Todos os procedimentos foram realizados sem uso de bainha e sem realização de venografia, por meio de técnica de cateterização do seio coronário baseada no componente atrial do eletrograma endocavitário. Resultados: Em 83% dos casos foi conseguido implante em parede lateral, predominantemente em paredes póstero-lateral e lateral, com tempo de radioscopia médio de 5,97 minutos. Em 10% houve insucesso, com necessidade de implante de cabo-eletrodo epicárdico. Conclusão: O implante de cabo-eletrodo ventricular esquerdo em região lateral sem uso de venografia baseado no componente atrial do eletrograma endocavitário constitui técnica segura e eficaz, apresentando ainda redução do tempo de radioscopia
Background: This study was aimed at evaluating left ventricular pacing implant success rate in the lateral region without the use of venography. Method: We analyzed 100 cases of left ventricular lead implants over 30 months in a single center as to the location of the left ventricular lead and calculated the rate of implants in the lateral wall (anterolateral, lateral and posterolateral). All procedures were carried out without the use of a sheath and without performing venography using the coronary sinus catheter technique based on the atrial endocardial electrogram component. Results: In 83% of cases it was successfully implanted in the lateral wall, predominantly in the posterolateral and lateral walls, with a mean radioscopy time of 5.97 minutes. It failed in 10% of the cases and we had to use an epicardial lead. Conclusion: Left ventricular lead implantation in the lateral region without venography based on atrial component of the endocavitary electrogram is a safe and effective technique, which also reduces radioscopy time
