Subcutaneous Implantable Cardioverter‐Defibrillator in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia: A Transatlantic Experience
Background Despite growing use of the subcutaneous implantable cardioverter‐defibrillator (S‐ICD), its clinical role in arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) patients remains undefined. We aim to elucidate the cardiac phenotype, implant characteristics, and long‐term eff...
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| Format: | Article |
| Language: | English |
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Wiley
2018-11-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.118.008782 |
| _version_ | 1811334130437193728 |
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| author | Gabriela M. Orgeron Aditya Bhonsale Federico Migliore Cynthia A. James Crystal Tichnell Brittney Murray Emanuele Bertaglia Julia Cadrin‐Tourigny Pietro De Franceschi Jane Crosson Harikrishna Tandri Domenico Corrado Hugh Calkins |
| author_facet | Gabriela M. Orgeron Aditya Bhonsale Federico Migliore Cynthia A. James Crystal Tichnell Brittney Murray Emanuele Bertaglia Julia Cadrin‐Tourigny Pietro De Franceschi Jane Crosson Harikrishna Tandri Domenico Corrado Hugh Calkins |
| author_sort | Gabriela M. Orgeron |
| collection | DOAJ |
| description | Background Despite growing use of the subcutaneous implantable cardioverter‐defibrillator (S‐ICD), its clinical role in arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) patients remains undefined. We aim to elucidate the cardiac phenotype, implant characteristics, and long‐term efficacy regarding appropriate therapy and complications in ARVC/D patients with an S‐ICD implant. Methods and Results A transatlantic cohort of ARVC/D patients who underwent S‐ICD implantation was analyzed for clinical characteristics, S‐ICD therapy, and long‐term outcome including device‐related complications. The cohort included 29 patients (52% male, 76% probands, 59% with ARVC/D‐associated mutation, 59% primary prevention [no prior sustained ventricular arrhythmias], and 45% first‐generation S‐ICD devices). At implant, all inducible patients (27/29) had conversion of induced ventricular fibrillation. Two patients (7%) had superficial infections of the incision site that were treated conservatively. Over a median follow‐up of 3.16 years (interquartile range: 2.21–4.51 years), all episodes (6 patients, 4% per year) of sustained ventricular arrhythmias were appropriately detected and treated. Six patients (21%) experienced 39 inappropriate shocks, with 3 requiring device explantation. Oversensing of noncardiac signal (n=4; especially myopotentials) and cardiac signal (n=4) was the most frequent etiology. No lead or device dislodgement, infection, skin erosion, or explantation related to need for antitachycardia pacing was noted. Conclusions S‐ICD can effectively treat both induced and spontaneous ventricular arrhythmias in patients with ARVC/D. The rate of inappropriate shocks, although considerable, is comparable to that in ARVC/D patients treated with transvenous ICDs. When they occurred, inappropriate shocks were primarily due to cardiac and, uniquely, noncardiac oversensing. We suggest potential strategies for minimizing inappropriate therapy. |
| first_indexed | 2024-04-13T17:03:14Z |
| format | Article |
| id | doaj.art-60b59eb1fe334f93b49ff497fed2b17a |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T17:03:14Z |
| publishDate | 2018-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-60b59eb1fe334f93b49ff497fed2b17a2022-12-22T02:38:34ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802018-11-0172110.1161/JAHA.118.008782Subcutaneous Implantable Cardioverter‐Defibrillator in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia: A Transatlantic ExperienceGabriela M. Orgeron0Aditya Bhonsale1Federico Migliore2Cynthia A. James3Crystal Tichnell4Brittney Murray5Emanuele Bertaglia6Julia Cadrin‐Tourigny7Pietro De Franceschi8Jane Crosson9Harikrishna Tandri10Domenico Corrado11Hugh Calkins12Division of Cardiology Department of Medicine Johns Hopkins Hospital Baltimore MDDivision of Cardiology Department of Medicine Johns Hopkins Hospital Baltimore MDDivision of Cardiology Department of Cardiac Thoracic and Vascular Sciences University of Padova ItalyDivision of Cardiology Department of Medicine Johns Hopkins Hospital Baltimore MDDivision of Cardiology Department of Medicine Johns Hopkins Hospital Baltimore MDDivision of Cardiology Department of Medicine Johns Hopkins Hospital Baltimore MDDivision of Cardiology Department of Cardiac Thoracic and Vascular Sciences University of Padova ItalyDivision of Cardiology Department of Medicine Johns Hopkins Hospital Baltimore MDDivision of Cardiology Department of Cardiac Thoracic and Vascular Sciences University of Padova ItalyDivision of Cardiology Department of Medicine Johns Hopkins Hospital Baltimore MDDivision of Cardiology Department of Medicine Johns Hopkins Hospital Baltimore MDDivision of Cardiology Department of Cardiac Thoracic and Vascular Sciences University of Padova ItalyDivision of Cardiology Department of Medicine Johns Hopkins Hospital Baltimore MDBackground Despite growing use of the subcutaneous implantable cardioverter‐defibrillator (S‐ICD), its clinical role in arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) patients remains undefined. We aim to elucidate the cardiac phenotype, implant characteristics, and long‐term efficacy regarding appropriate therapy and complications in ARVC/D patients with an S‐ICD implant. Methods and Results A transatlantic cohort of ARVC/D patients who underwent S‐ICD implantation was analyzed for clinical characteristics, S‐ICD therapy, and long‐term outcome including device‐related complications. The cohort included 29 patients (52% male, 76% probands, 59% with ARVC/D‐associated mutation, 59% primary prevention [no prior sustained ventricular arrhythmias], and 45% first‐generation S‐ICD devices). At implant, all inducible patients (27/29) had conversion of induced ventricular fibrillation. Two patients (7%) had superficial infections of the incision site that were treated conservatively. Over a median follow‐up of 3.16 years (interquartile range: 2.21–4.51 years), all episodes (6 patients, 4% per year) of sustained ventricular arrhythmias were appropriately detected and treated. Six patients (21%) experienced 39 inappropriate shocks, with 3 requiring device explantation. Oversensing of noncardiac signal (n=4; especially myopotentials) and cardiac signal (n=4) was the most frequent etiology. No lead or device dislodgement, infection, skin erosion, or explantation related to need for antitachycardia pacing was noted. Conclusions S‐ICD can effectively treat both induced and spontaneous ventricular arrhythmias in patients with ARVC/D. The rate of inappropriate shocks, although considerable, is comparable to that in ARVC/D patients treated with transvenous ICDs. When they occurred, inappropriate shocks were primarily due to cardiac and, uniquely, noncardiac oversensing. We suggest potential strategies for minimizing inappropriate therapy.https://www.ahajournals.org/doi/10.1161/JAHA.118.008782arrhythmogenic right ventricular cardiomyopathyimplanted cardioverter defibrillatorlong‐term follow‐upventricular tachycardia |
| spellingShingle | Gabriela M. Orgeron Aditya Bhonsale Federico Migliore Cynthia A. James Crystal Tichnell Brittney Murray Emanuele Bertaglia Julia Cadrin‐Tourigny Pietro De Franceschi Jane Crosson Harikrishna Tandri Domenico Corrado Hugh Calkins Subcutaneous Implantable Cardioverter‐Defibrillator in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia: A Transatlantic Experience Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease arrhythmogenic right ventricular cardiomyopathy implanted cardioverter defibrillator long‐term follow‐up ventricular tachycardia |
| title | Subcutaneous Implantable Cardioverter‐Defibrillator in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia: A Transatlantic Experience |
| title_full | Subcutaneous Implantable Cardioverter‐Defibrillator in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia: A Transatlantic Experience |
| title_fullStr | Subcutaneous Implantable Cardioverter‐Defibrillator in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia: A Transatlantic Experience |
| title_full_unstemmed | Subcutaneous Implantable Cardioverter‐Defibrillator in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia: A Transatlantic Experience |
| title_short | Subcutaneous Implantable Cardioverter‐Defibrillator in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia: A Transatlantic Experience |
| title_sort | subcutaneous implantable cardioverter defibrillator in patients with arrhythmogenic right ventricular cardiomyopathy dysplasia a transatlantic experience |
| topic | arrhythmogenic right ventricular cardiomyopathy implanted cardioverter defibrillator long‐term follow‐up ventricular tachycardia |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.118.008782 |
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