Procedure, management, and outcome of subcutaneous implantable cardioverter-defibrillator extraction in clinical practice

被引:9
作者
De Filippo, Paolo [1 ]
Migliore, Federico [2 ]
Palmisano, Pietro [3 ]
Nigro, Gerardo [4 ]
Ziacchi, Matteo [5 ]
Rordorf, Roberto [6 ]
Pieragnoli, Paolo [7 ]
Di Grazia, Angelo [8 ]
Ottaviano, Luca [9 ]
Francia, Pietro [10 ]
Pisano, Ennio [11 ]
Tola, Gianfranco [12 ]
Giammaria, Massimo [13 ]
D'Onofrio, Antonio [14 ]
Botto, Giovanni Luca [15 ]
Zucchelli, Giulio [16 ]
Ferrari, Paola [1 ]
Lovecchio, Mariolina [17 ]
Valsecchi, Sergio [17 ]
Viani, Stefano [16 ]
机构
[1] ASST Papa Giovanni XXIII, Cardiac Electrophysiol & Pacing Unit, Piazza OMS 1, I-24127 Bergamo, Italy
[2] Univ Padua, Dept Cardiac Thorac Vasc Sci & Publ Hlth, Padua, Italy
[3] Card G Panico Hosp, Cardiol Unit, Tricase, Le, Italy
[4] Univ Campania Luigi Vanvitelli, Monaldi Hosp, Dept Translat Med Sci, Naples, Italy
[5] Univ Bologna, Inst Cardiol, Dept Expt Diagnost & Specialty Med, Policlin S Orsola Malpighi, Bologna, Italy
[6] IRCCS Fdn Policlin S Matteo, Arrhythmia & Electrophysiol Unit, Pavia, Italy
[7] Univ Hosp Florence, Inst Internal Med & Cardiol, Florence, Italy
[8] Policlin G Rodol San Marco, Cardiol Dept, Catania, Italy
[9] IRCCS Galeazzi S Ambrogio, Cardiothorac Dept, Arrhythmia & Electrophysiol Unit, Milan, Italy
[10] Univ Sapienza, St Andrea Hosp, Dept Clin & Mol Med, Cardiol, Rome, Italy
[11] Vito Fazzi Hosp, Cardiol Div, UOSVD Cardiac Electrophysiol, Lecce, Italy
[12] AO Brotzu, Cardiol Div, Cagliari, Italy
[13] M Vittoria Hosp, Turin, Italy
[14] Monaldi Hosp, Unita Operat Elettrofisiol Studio & Terapia Aritm, Naples, Italy
[15] ASST Rhodense, Dept Clin cardiol & Electrophysiol, Rho Garbagnate Milanese, MI, Italy
[16] Univ Hosp Pisa, Cardio Thorac & Vasc Dept, Cardiol Div 2, Pisa, Italy
[17] Boston Sci, Rhythm Management Div, Milan, Italy
来源
EUROPACE | 2023年 / 25卷 / 06期
关键词
Implantable defibrillator; Subcutaneous; Extraction; Infection; TRANSVENOUS LEAD EXTRACTION; MORTALITY; REGISTRY; IMPACT; ICD;
D O I
10.1093/europace/euad158
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims Subcutaneous implantable cardioverter-defibrillator (S-ICD) therapy is expanding rapidly. However, there are few data on the S-ICD extraction procedure and subsequent patient management. The aim of this analysis was to describe the procedure, management, and outcome of S-ICD extractions in clinical practice. Methods and results We enrolled consecutive patients who required complete S-ICD extraction at 66 Italian centres. From 2013 to 2022, 2718 patients undergoing de novo implantation of an S-ICD were enrolled. Of these, 71 required complete S-ICD system extraction (17 owing to infection). The S-ICD system was successfully extracted in all patients, and no complications were reported; the median procedure duration was 40 (25th-75th percentile: 20-55) min. Simple manual traction was sufficient to remove the lead in 59 (84%) patients, in whom lead-dwelling time was shorter [20 (9-32) months vs. 30 (22-41) months; P = 0.032]. Hospitalization time was short in the case of both non-infectious [2 (1-2) days] and infectious indications [3 (1-6) days]. In the case of infection, no patients required post-extraction intravenous antibiotics, the median duration of any antibiotic therapy was 10 (10-14) days, and the re-implantation was performed during the same procedure in 29% of cases. No complications arose over a median of 21 months. Conclusion The S-ICD extraction was safe and easy to perform, with no complications. Simple traction of the lead was successful in most patients, but specific tools could be needed for systems implanted for a longer time. The peri- and post-procedural management of S-ICD extraction was free from complications and not burdensome for patients and healthcare system. [GRAPHICS] .
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