Surgical Management of Implantation-Related Complications oftheSubcutaneous Implantable Cardioverter-Defibrillator.

Abstract

This study assessed outcomes in patients in whom subcutaneous implantable cardioverter-defibrillator (S-ICD) therapy was continued after implantation-related complications, in order to avoid conversion to transvenous ICD therapy. Patients at risk for sudden cardiac death benefit from ICD therapy, despite a significant risk for complications. S-ICD has a similar complication rate as transvenous ICD therapy, but the absence of transvenous leads may hold long-term benefits, especially in young ICD patients. In the largest single-center cohort available to date, S-ICD patients implanted between 2009 and 2015 were included. There were 123 patients at a median age of 40 years. During a median follow-up of 2years, 10 patients (9.4%) suffered implant-related complications. There were 5 infections, 3 erosions, and 2 implant failures for which 21 surgical procedures were needed. In 9 of 10 patients, S-ICD therapy could be continued after intervention. In 6 patients, the period between extraction and reimplantation of the S-ICD system was bridged with a wearable cardioverter-defibrillator (WCD). The pulse generator was reimplanted at the original site in 5 patients and in 3underneath the serratus anterior muscle. One patient was not reimplanted following extraction due to recurrent infections. Conversion to a transvenous ICD was not needed in any patient. In most patients with a complication, S-ICD therapy could be continued after intervention, avoiding theneed to convert to a transvenous system. Bridging to recovery with a WCD and submuscular implantation of the pulsegenerator are effective treatment strategies to manage S-ICD complications.