Incidence of ineffective safety margin testing (<10 J) and efficacy of routine subcutaneous array insertion during implantable cardioverter defibrillator implantation
The purpose of this study was to assess (1) the incidence of safety margin testing <10 J (SMT) and (2) the efficacy/safety of routinely adding a subcutaneous array (SQA) (Medtronic 6996SQ) for these patients. Patients with SMT smaller than a 10-J safety margin from maximum output were considered...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2016-03-01
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| Series: | Indian Pacing and Electrophysiology Journal |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S0972629215300115 |
| _version_ | 1811331007089999872 |
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| author | Marc-Alexander Ohlow Marcus Roos Bernward Lauer J. Christoph Geller |
| author_facet | Marc-Alexander Ohlow Marcus Roos Bernward Lauer J. Christoph Geller |
| author_sort | Marc-Alexander Ohlow |
| collection | DOAJ |
| description | The purpose of this study was to assess (1) the incidence of safety margin testing <10 J (SMT) and (2) the efficacy/safety of routinely adding a subcutaneous array (SQA) (Medtronic 6996SQ) for these patients.
Patients with SMT smaller than a 10-J safety margin from maximum output were considered to have very high readings and underwent SQA insertion. These patients were compared with the rest of the patients who had acceptable SMT (≥10 J).
A total of 616 patients underwent ICD implantation during the analysis period. Of those, 16 (2.6%) had SMT <10 J. By univariate analysis, younger age, and non-ischemic cardiomyopathy, were all significant predictors of SMT <10 J (p < 0.05). In all 16 cases, other methods to improve SMT prior to array insertion were attempted but failed for all patients: reversing shock polarity (n = 15), removing the superior vena cava coil (n = 14), reprogramming shock waveform (n = 9), and repositioning right ventricular lead (n = 9). Addition of the SQA successfully increased SMT to within safety margin for all patients (32 ± 2 versus 21 ± 3 J; p < 0.001). Follow-up (mean 48.1 ± 21 months) was available for all patients with SQA, only 2 cases with inappropriate shocks due to atrial fibrillation had to be noted. None of the patients experienced complications due to SQA implantation.
SMT <10 J occur in about 2.6% of patients undergoing ICD implantation. SQA insertion corrects this problem without procedural/mid-term complications. |
| first_indexed | 2024-04-13T16:12:22Z |
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| id | doaj.art-01ce8d908fff4edc93b07de6991a8eee |
| institution | Directory Open Access Journal |
| issn | 0972-6292 |
| language | English |
| last_indexed | 2024-04-13T16:12:22Z |
| publishDate | 2016-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Indian Pacing and Electrophysiology Journal |
| spelling | doaj.art-01ce8d908fff4edc93b07de6991a8eee2022-12-22T02:40:09ZengElsevierIndian Pacing and Electrophysiology Journal0972-62922016-03-01162475210.1016/j.ipej.2016.02.011Incidence of ineffective safety margin testing (<10 J) and efficacy of routine subcutaneous array insertion during implantable cardioverter defibrillator implantationMarc-Alexander Ohlow0Marcus Roos1Bernward Lauer2J. Christoph Geller3Department of Cardiology, Zentralklinik, Robert-Koch-Allee 9, 99437 Bad Berka, GermanyClinic for Electrophysiology, Heart Center, Salzburger Leite 1, 67616 Bad Neustadt, GermanyDepartment of Cardiology, Zentralklinik, Robert-Koch-Allee 9, 99437 Bad Berka, GermanyDepartment of Invasive Electrophysiology, Zentralklinik, Robert-Koch-Allee 9, 99437 Bad Berka, GermanyThe purpose of this study was to assess (1) the incidence of safety margin testing <10 J (SMT) and (2) the efficacy/safety of routinely adding a subcutaneous array (SQA) (Medtronic 6996SQ) for these patients. Patients with SMT smaller than a 10-J safety margin from maximum output were considered to have very high readings and underwent SQA insertion. These patients were compared with the rest of the patients who had acceptable SMT (≥10 J). A total of 616 patients underwent ICD implantation during the analysis period. Of those, 16 (2.6%) had SMT <10 J. By univariate analysis, younger age, and non-ischemic cardiomyopathy, were all significant predictors of SMT <10 J (p < 0.05). In all 16 cases, other methods to improve SMT prior to array insertion were attempted but failed for all patients: reversing shock polarity (n = 15), removing the superior vena cava coil (n = 14), reprogramming shock waveform (n = 9), and repositioning right ventricular lead (n = 9). Addition of the SQA successfully increased SMT to within safety margin for all patients (32 ± 2 versus 21 ± 3 J; p < 0.001). Follow-up (mean 48.1 ± 21 months) was available for all patients with SQA, only 2 cases with inappropriate shocks due to atrial fibrillation had to be noted. None of the patients experienced complications due to SQA implantation. SMT <10 J occur in about 2.6% of patients undergoing ICD implantation. SQA insertion corrects this problem without procedural/mid-term complications.http://www.sciencedirect.com/science/article/pii/S0972629215300115Subcutaneous arraySafety margin testingImplantable cardioverter-defibrillatorRisk factors |
| spellingShingle | Marc-Alexander Ohlow Marcus Roos Bernward Lauer J. Christoph Geller Incidence of ineffective safety margin testing (<10 J) and efficacy of routine subcutaneous array insertion during implantable cardioverter defibrillator implantation Indian Pacing and Electrophysiology Journal Subcutaneous array Safety margin testing Implantable cardioverter-defibrillator Risk factors |
| title | Incidence of ineffective safety margin testing (<10 J) and efficacy of routine subcutaneous array insertion during implantable cardioverter defibrillator implantation |
| title_full | Incidence of ineffective safety margin testing (<10 J) and efficacy of routine subcutaneous array insertion during implantable cardioverter defibrillator implantation |
| title_fullStr | Incidence of ineffective safety margin testing (<10 J) and efficacy of routine subcutaneous array insertion during implantable cardioverter defibrillator implantation |
| title_full_unstemmed | Incidence of ineffective safety margin testing (<10 J) and efficacy of routine subcutaneous array insertion during implantable cardioverter defibrillator implantation |
| title_short | Incidence of ineffective safety margin testing (<10 J) and efficacy of routine subcutaneous array insertion during implantable cardioverter defibrillator implantation |
| title_sort | incidence of ineffective safety margin testing 10 j and efficacy of routine subcutaneous array insertion during implantable cardioverter defibrillator implantation |
| topic | Subcutaneous array Safety margin testing Implantable cardioverter-defibrillator Risk factors |
| url | http://www.sciencedirect.com/science/article/pii/S0972629215300115 |
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