B-PO02-064 SUB-SERRATUS IMPLANTATION OF THE SUBCUTANEOUS IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR: A SINGLE-CENTER EXPERIENCE

Abstract

Subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation techniques have moved towards an inter-muscular strategy. To evaluate the efficacy and safety of a sub-muscular (sub-serratus) S-ICD technique. The study consists of 20 patients who underwent S-ICD generator placement between the serratus anterior muscle and thoracic rib cage. The generator was secured with two-point fixation. DFT testing was performed and patients followed prospectively. All 20 patients (70% male, age 39 ± 15.7 years) underwent successful implantation with no complications. Six patients (30%) underwent concomitant transvenous device extraction. S-ICD indications included 15 (75%) primary and 5 (25%) secondary prevention. Defibrillation testing was successful in 18 patients (90%) with a single 65 J shock. In 2 patients (10%) sustained VF could not be induced and a synchronized commanded 10 J shock was delivered instead. Mean impedance was 66.3 ± 16.3 ohms. Mean follow-up duration was 176 days (range 11-503). One patient (5%) received an appropriate therapy for PMVT (single successful shock, impedance 50 ohms). One patient (5%) received an inappropriate shock for AF with aberration requiring re-programming. No patients experienced any other complications and there were no episodes of non-physiologic noise. The sub-serratus S-ICD technique is safe and effective and can be readily performed by an electrophysiologist. It may offer improved device efficacy by way of low shock impedances and proximity of the generator to the heart as well as enhanced cosmesis by maximizing overlying tissue.