The Subcutaneous ICD: A Review of the UNTOUCHED and PRAETORIAN Trials

The ICD is an important part of the treatment and prevention of sudden cardiac death in many high-risk populations. Traditional transvenous ICDs (TV-ICDs) are associated with certain short- and long- term risks. The subcutaneous ICD (S-ICD) was developed in order to avoid these risks and complications. However, this system is associated with its own set of limitations and complications. First, patient selection is important, as S-ICDs do not provide pacing therapy currently. Second, pre-procedural screening is important to minimise T wave and myopotential oversensing. Finally, until recently, the S-ICD was primarily used in younger patients with fewer co-morbidities and less structural heart disease, limiting the general applicability of the device. S-ICDs achieve excellent rates of arrhythmia conversion and have demonstrated noninferiority to TV-ICDs in terms of complication rates in real-world studies. The objective of this review is to discuss the latest literature, including the UNTOUCHED and PRAETORIAN trials, and to address the risk of inappropriate shocks.

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Abstract 16273: Safety of Subcutaneous ICD Implantation in Patients With Prior Sternotomy

Circulation ◽

10.1161/circ.142.suppl_3.16273 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Mejalli AlKofahi ◽

Moghniuddin Mohammed ◽

Madhu Reddy ◽

Raghuveer Dendi ◽

Rhea C Pimentel ◽

...

Keyword(s):

Median Time ◽

Complication Rates ◽

Inappropriate Shock ◽

Multicenter Studies ◽

Icd Implantation ◽

Subcutaneous Icd ◽

Inappropriate Shocks ◽

Increased Risk ◽

Incision Technique

Introduction: Subcutaneous ICD (S-ICD) implantation is a viable alternative to transvenous ICD implantation in patients without a pacing indication. The S-ICD lead is placed near the sternum. The safety of S-ICD implantation and risk for inappropriate shocks is uncertain in patients with prior sternotomy. Methods: This single-center retrospective cohort study included patients that had implantation of an S-ICD between February 2014 - May 2020. The 30-day complication rates and long-term risks of inappropriate shocks were compared between patients with and without prior sternotomy. Results: Ninety-eight patients (52 ± 15 years old, 43% men, BMI 29 ± 6, 72% primary prevention, 28% ischemic cardiomyopathy, median LVEF 30% (IQR 25-45%)) underwent S-ICD implantation, among whom 19 (19.4%) had a prior sternotomy. The median time between sternotomy and S-ICD implantation was 96 (IQR 4.1-306) months. The sternal coil was primarily implanted left of the sternum (n=17/19, 89%). A two-incision technique was used in 79% of patients with prior sternotomy vs. 65% without sternotomy (p=0.23). The 30-day complication rate was similar between those with and without prior sternotomy (n=1/19 vs. n=10/79, 5% vs. 13%, p=0.36). The only 30-day complication in patients with prior sternotomy was a hematoma without intervention. The 30-day complications in patients without prior sternotomy included: superficial site infection resolving with brief antibiotics (n=4), inappropriate shock (n=3), lead migration requiring revision (n=2), and a hematoma without intervention (n=1). Over a median follow-up of 17.1 (IQR 3.4-29.1) months, the frequency of inappropriate shocks was similar between patients with and without prior sternotomy (n=1/19 and n=6/79, 5% vs. 8%, p=0.72). The median time to inappropriate shock from S-ICD implantation was 1.1 (IQR 0.1-19.8) months. The mechanisms of inappropriate shocks were T-wave oversensing or other oversensing (n=5/7, 72%), air in the pocket (n=1/7, 14%), and atrial tachycardia (n=1/7, 14%). Conclusions: Implantation of S-ICD in patients with prior sternotomy was not associated with an increased risk of 30-day complications or inappropriate shocks. These outcomes need to be confirmed in larger, multicenter studies.

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Safety of Permanent Pacemaker Implantation: A Prospective Study

Journal of Clinical Medicine ◽

10.3390/jcm8010035 ◽

2019 ◽

Vol 8 (1) ◽

pp. 35 ◽

Cited By ~ 6

Author(s):

Mª Reyes Carrión-Camacho ◽

Ignacio Marín-León ◽

José Manuel Molina-Doñoro ◽

José Rafael González-López

Keyword(s):

Antithrombotic Therapy ◽

Pacemaker Implantation ◽

Complication Rates ◽

Minor Complication ◽

Permanent Pacing ◽

Short And Long Term ◽

A Prospective Study ◽

Technical Failures ◽

Lead Dislodgement

Although pacemaker implantation is considered to be low risk, it is not exempt from complications and technical failures during the procedure, both in the short and long term, and the complications that such patients may present remain unknown. The aim has been to analyze the complication rates associated with permanent pacing and to identify if these differ between patients with or without previous antithrombotic therapy. We used a prospective, single center, observational study of 310 adult patients with indications of permanent pacing. They were hospitalized from 1 January to 31 December 2014 and followed up for 6 months after the pacemaker implant. The participants were distributed into two groups according to the antithrombotic therapy prior to the implant. The most frequent major complications were pneumothorax (3.87%) and lead dislodgement (8.39%), while superficial phlebitis (12.90%) and uncomplicated hematomas (22.58%) were presented as the most recurrent minor complications. Hematomas were the most frequent minor complication in the antithrombotic therapy cohort, and shoulder pain was reported as the most recurrent minor complication in the non-exposed group. Finding out about complications in pacemaker implants enables a complete view of the process, and hence the prioritization of actions aimed at improving safety and reducing associated risks.

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Abstract 15748: Failure of Subcutaneous Implantable Cardioverter Defibrillator in a Patient With Arrhythmogenic Right Ventricular Cardiomyopathy

Circulation ◽

10.1161/circ.142.suppl_3.15748 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Anish K Desai ◽

Annie Glover ◽

Angela Krebsbach ◽

Charles Henrikson

Keyword(s):

Arrhythmogenic Right Ventricular Cardiomyopathy ◽

Ventricular Cardiomyopathy ◽

Subcutaneous Icd ◽

Inappropriate Shocks ◽

Lead Fracture ◽

Lead Placement ◽

Icd Leads ◽

Attractive Option ◽

Myopotential Oversensing

Introduction: The subcutaneous ICD is an attractive option in ARVC patients as they rarely require pacing, it preserves vascular access, and it avoids the long-term morbidity related to intravascular lead placement. However, the limitations of the S ICD have not been fully demarcated by clinical trials. Case: After her father presented with a cardiac arrest, a 16-year-old female was diagnosed with ARVC on MRI after initially presenting with palpitations. This was corroborated via genetic testing, and an S ICD was placed after she passed pre-implant screening. Initially she did well, but she suffered inappropriate shocks approximately seven months after implant, in the setting of “hugging her boyfriend”. Interrogation revealed apparent noise, which was felt to be most likely due to lead fracture or possibly generator malfunction. At reoperation, first her lead was replaced, but continued noise was demonstrated intra-operatively, and thus her generator was also replaced. However, she was found again to have noise in each vector causing recurrent inappropriate shocks. Further testing ultimately determined that the noise was due to myopotentials, which were present in all vectors and unable to be programmed around. Ultimately, the S ICD was removed and replaced with a transvenous device. Discussion: While the S ICD is an attractive option in ARVC patients, the limitations of the technology must be acknowledged. The far-field nature of the sensing algorithm in the S ICD leads to a risk of myopotential oversensing. If this occurs, sometimes the system cannot be salvaged and the patient must be converted to a transvenous system. Recognizing this at the initial presentation with inappropriate shocks can avoid unsuccessful attempts at S ICD system modification and morbidity from future inappropriate shock events.

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In-Stent Thrombosis and Stenosis After Neck-Remodeling Device-Assisted Coil Embolization of Intracranial Aneurysms

Neurosurgery ◽

10.1227/neu.0b013e3181f8d194 ◽

2010 ◽

Vol 67 (6) ◽

pp. 1523-1533 ◽

Cited By ~ 44

Author(s):

Hilal Kanaan ◽

Brian Jankowitz ◽

Aitziber Aleu ◽

Dean Kostov ◽

Ridwan Lin ◽

...

Keyword(s):

Coil Embolization ◽

Intracranial Aneurysms ◽

Anterior Communicating Artery ◽

Complication Rates ◽

Stent Patency ◽

Unruptured Aneurysms ◽

Short And Long Term ◽

Stent Complications

Abstract BACKGROUND: Intrinsic thrombosis and stenosis are complications associated with the use of neck-remodeling devices in the treatment of intracranial aneurysms. OBJECTIVE: To examine the technical and anatomic factors that predict short- and long-term stent patency. METHODS: We undertook a retrospective review of 161 patients who underwent coil embolization of 168 ruptured and unruptured aneurysms assisted by the use of a neck-remodeling device. One hundred twenty-seven patients had catheter-based angiographic follow-up to evaluate 133 stent-coil constructs (mean, 15.4 months; median, 12.7 months). The technique of microcatheter jailing was used in a majority of patients; nonstandard stent configurations were also used. RESULTS: Clinical follow-up for all patients who had catheter-based angiograms demonstrated that among 133 stent constructs, a total of 9 (6.8%) had an in-stent event: 6 acute or subacute thrombosis (4.5%) and 3 delayed stenosis or occlusion (2.3%). Seven of these constructs were associated with a symptomatic event (5.3%). A significantly higher rate of in-stent events was seen with the use of constructs to treat anterior communicating artery aneurysms. When all patients are considered, including those who did not receive catheter-based follow-up imaging, 2 of 168 procedures (1.2%) resulted in the death of a patient, and procedural morbidity was 14.9%. CONCLUSION: From these results and those in the published literature, in-stent complication rates are low in carefully selected patients. The use of dual antiplatelet therapy, sensitivity assays, and glycoprotein IIb/IIIa inhibitors may decrease the rate of acute and chronic in-stent complications.

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Cones and sleeves present good survival and clinical outcome in revision total knee arthroplasty: a meta-analysis

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-021-06670-0 ◽

2021 ◽

Author(s):

Laura Theresa Fischer ◽

Markus Heinecke ◽

Eric Röhner ◽

Peter Schlattmann ◽

Georg Matziolis

Keyword(s):

Aseptic Loosening ◽

Meta Analysis ◽

Fixation Method ◽

Good Survival ◽

Complication Rates ◽

Long Term Follow Up ◽

Total Knee ◽

Short And Long Term

Abstract Purpose The fixation of revision total knee arthroplasties (rTKA) tends to be difficult, leading to a reduction in implant survival. One option for achieving a more stable anchorage is to use metaphyseal cones and sleeves. The objective of the present paper is to provide a current comparative meta-analysis on survival and clinical results of cones vs. sleeves, with a differentiation between the short- and long-term outcome. Methods A search of the literature was conducted systematically to include original papers from 2010 to June 2021. The following parameters were taken into account: revision for aseptic loosening, revision for any reason, periprosthetic joint infections (PJI), KSS as well as KSFS. Studies with a mean follow-up of at least 60 months were defined to be long-term follow-up studies (LT). All other studies were included in the short-term (ST) study analysis. A pooled incidence was used as a summary statistic using a random intercept logistic regression model. Results The present meta-analysis included 43 publications with 3008 rTKA. Of these, 23 publications with 1911 cases were allocated to the sleeve group (SG) and 20 papers with 1097 cases to the cone group (CG). CG showed overall numerically higher complication rates in short- and long-term follow-up, compared with SG. Aseptic loosening occurred at a rate of 0.4% in SG (LT) and 4.1% in CG (LT) (p = 0.09). Periprosthetic joint infection (PJI) was more frequent in the cone group (7% in ST and 11.7% in LT) than in the sleeve group (3.4% in ST and 4.9% in LT, p = 0.02 both). The total revision rate was 5.5% in SG (LT) and 14.4% in CG (LT) (p = 0.12). The clinical scores were also comparable between the two groups. Hinged prothesis were used more frequent in the cone group (ST p < 0.001; LT p = 0.10), whereas CC type protheses were used more frequently in the sleeve group (ST p < 0.001; LT p < 0.11). Conclusions This meta-analysis takes into account the longest follow-up periods covered to date. Both cones and sleeves represent a reliable fixation method in the case of severe bone loss in rTKA, although the higher rate of PJI after cone fixation remains a source of concern. A metaphyseal fixation of hinged implants should be taken into account. Level of evidence II (meta-analysis).

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Retrospective analysis of intracranial aneurysms after flow diverter treatment including color-coded imaging (syngo iFlow) as a predictor of aneurysm occlusion

Interventional Neuroradiology ◽

10.1177/15910199211024056 ◽

2021 ◽

pp. 159101992110240

Author(s):

Andreas Simgen ◽

Christine Mayer ◽

Michael Kettner ◽

Ruben Mühl-Benninghaus ◽

Wolfgang Reith ◽

...

Keyword(s):

Cerebral Aneurysms ◽

Flow Diverter ◽

Complication Rates ◽

Long Term Follow Up ◽

Aneurysm Growth ◽

Short And Long Term ◽

Aneurysm Occlusion ◽

Unruptured Cerebral Aneurysms

Purpose Flow Diverters (FD) have immensely extended the treatment of cerebral aneurysms in the past years. Complete aneurysm occlusion is a process that often takes a certain amount of time and is usually difficult to predict. Our aim was to investigate different syngo iFlow parameters in order to predict aneurysm occlusion. Methods Between 2014 and 2018 patients with unruptured cerebral aneurysms treated with a FD were reviewed. Aneurysm occlusion and complication rates have been assessed. In addition, various quantitative criteria were assessed using syngo iFlow before, after the intervention, and after short and long-term digital subtraction angiography (DSA). Results A total of 66 patients hosting 66 cerebral aneurysms were included in this study. 87.9% (n = 58) aneurysms in the anterior and 12.1% (n = 8) in the posterior circulation were treated. Adequate aneurysm occlusion at long-term follow-up (19.05 ± 15.1 months) was achieved in 90.9% (n = 60). Adequately occluded aneurysm revealed a significantly greater peak intensity delay (PI-D, p = 0.008) and intensity decrease ratio (ID-R, p < 0.001) compared to insufficiently occluded aneurysms. Increased intra-aneurysmal contrast agent intensity (>100%) after FD implantation resulted in an ID-R < 1, which was associated with aneurysm growth during follow-up DSA. Retreatment with another FD due to foreshortening and/or aneurysm growth was performed in 10.6% (n = 7). Overall morbidity and mortality rates were 1.5% (n = 1) and 0%. Conclusion The applied syngo iFlow parameters were found to be useful in predicting adequate aneurysm occlusion and foresee aneurysm growth, which might indicate the implantation of another FD.

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Chikungunya and the Heart

Cardiology ◽

10.1159/000514206 ◽

2021 ◽

pp. 1-11

Author(s):

Juan I. Cotella ◽

Ana L. Sauce ◽

Clara I. Saldarriaga ◽

Gonzalo E. Perez ◽

Juan M. Farina ◽

...

Keyword(s):

Neglected Tropical Diseases ◽

Healthcare Providers ◽

Tropical Diseases ◽

Atypical Presentation ◽

Treatment And Prevention ◽

Prisma Statement ◽

Short And Long Term ◽

Meta Analyses ◽

Improve Patient

Introduction: Neglected tropical diseases are a group of communicable diseases that occur in tropical and subtropical conditions and are closely related to poverty and inadequate sanitation conditions. Among these entities, chikungunya remains one of the most widely spread diseases. Although the main symptoms are related to a febrile syndrome, cardiovascular (CV) involvement has been reported, with short- and long-term implications. As part of the “Neglected Tropical Diseases and other Infectious Diseases involving the Heart” (NET-Heart) Project, the aim of this review is to compile all the information available regarding CV involvement of this disease, to help healthcare providers gain knowledge in this field, and contribute to improving early diagnosis, treatment, and prevention strategies. Methods: We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement in conducting and reporting this systematic review. The search was conducted using MEDLINE/PubMed, SciELO, and LILACS databases to identify any relevant studies or reviews detailing an association between chikungunya and cardiac involvement published from January 1972 to May 31, 2020. Results: Despite its mechanism not being fully understood, CV involvement has been described as the most frequent atypical presentation of chikungunya (54.2%). Myocarditis is the most prevalent CV complication. Different rhythm disturbances have been reported in 52% of cases, whereas heart failure was reported in 15% of cases, pericarditis in 5%, and acute myocardial infarction in 2%. Overall estimated CV mortality is 10%, although in patients with other comorbidities, it may increase up to 20%. In the proper clinical setting, the presence of fever, polyarthralgia, and new-onset arrhythmia suggests chikungunya virus-related myocarditis. Conclusion: Although most cases are rarely fatal, CV involvement in chikungunya infection remains the most frequent atypical presentation of this disease and may have severe manifestations. Timely diagnosis and appropriate management are necessary to improve patient outcomes.

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The heart remembers : observations of cardiac memory in the Dorper sheep heart

Onderstepoort Journal of Veterinary Research ◽

10.4102/ojvr.v70i4.294 ◽

2003 ◽

Vol 70 (4) ◽

Author(s):

J. Ker ◽

E.C. Webb ◽

J.A. Ker ◽

P.A. Bekker

Keyword(s):

Ventricular Myocytes ◽

Diverse Range ◽

Cardiac Memory ◽

T Wave ◽

Ventricular Activation ◽

Short And Long Term ◽

Dorper Sheep ◽

Mechanisms Of Memory ◽

Peculiar Phenomenon

Memory is a property common to a diverse range of tissues. Cardiac memory has been demonstrated in the human, dog, rat and rabbit. This is a peculiar phenomenon, reflected in the T wave of the electrocardiogram. The heart is able to remember periods of alterations in the sequence of ventricular activation and once there is a return to a normal sequence of ventricular activation the T waves may manifest memory. Cardiac memory is noted when the T wave during normal ventricular activation retains the vector of the previous abnormal QRS complex, caused by a period of altered ventricular activation. Possible mechanisms of memory in the heart are alterations of the transient outward potassium current (Ito) in ventricular myocytes and new protein synthesis inside myocytes. These two mechanisms operate in short- and long-term cardiac memory respectively. Currently, it is unknown whether memory may have adverse structural consequences in the heart. We were able to demonstrate memory in the hearts of Dorper wethers and this is the first report of cardiac memory in Dorper sheep.

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The short- and long-term outcomes of pancreatic resection for pancreatic adenocarcinoma in patients older than 75 years.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.470 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 470-470

Author(s):

Keisuke Kazama ◽

Toru Aoyama ◽

Yosuke Atsumi ◽

Masaaki Murakawa ◽

Manabu Shiozawa ◽

...

Keyword(s):

Elderly Patients ◽

Pancreatic Adenocarcinoma ◽

Pancreatic Resection ◽

The Elderly ◽

Complication Rates ◽

Long Term Outcomes ◽

Group A ◽

Short And Long Term ◽

Group B

470 Background: The short- and long-term outcomes of pancreatic resection for pancreatic adenocarcinoma have not been evaluated in elderly patients. Methods: This retrospective study selected patients who underwent curative surgery for pancreatic cancer at our institution. Patients were categorized into two groups; non-elderly patients(age <75 years: group A) and non-elderly patients (age ≥75 years: group B). The surgical morbidity, motality, overall survival (OS), and recurrence-free survival (RFS) rates in the two groups were compared. Results: A total of 221 patients were evaluated in the study. The overall complication rates are 44.8% in Group A and 52.6% in Group B. Surgical mortality was observed in 2 patients due to an abdominal abcess and cardiovascular disease in Group A (1.1%) and in 1 patient due to postoperative bleeding in Group B (2.6%). There were no significant differences (p=0.379 and p=0.456, respectively). Furthermore, the 5-year OS and RFS rates were similar between the elderly patients and non-elderly patients (18.55% vs. 20.2%, p=0.946 and 13.1% vs. 16.0%, p=0.829 respectively). Conclusions: The short-term outcomes and long-term outcomes survival after pancreatic resection for pancreatic adenocarcinoma were almost equal in the elderly and the non-elderly patients in this study. Therefore, it is unnecessary to avoid pancreatic resection for pancreatic adenocarcinoma in elderly patients simply because of their age.

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Unilateral or single-session bilateral surgery for correction of medial patellar luxation in small dogs: short and long-term outcomes

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-14-03-0035 ◽

2014 ◽

Vol 27 (06) ◽

pp. 484-490 ◽

Cited By ~ 7

Author(s):

L. Huneault ◽

J. Dupuis ◽

M. Moreau ◽

J. Auger ◽

P. Clerfond

Keyword(s):

Clinical Signs ◽

Complication Rates ◽

Single Session ◽

Term Function ◽

Significant Difference ◽

Duration Of Surgery ◽

Bilateral Surgery ◽

Short And Long Term ◽

Group B

SummaryObjective: To compare complication rates as well as the short and long-term function of surgical limbs in small dogs with bilateral medial patellar luxation (MPL) undergoing unilateral or single-session bilateral surgery.Methods: Dogs weighing less than 12 kg with bilateral MPL that underwent unilateral (group U) or single-session bilateral surgery (group B) were retrospectively analysed. Data analysed included signalment, grades of luxation, surgical procedures, duration of surgery and anaesthesia, use of antibiotic medications, hospitalization time, complications, function at short-term follow-up, bone healing, and long-term assessment of function by means of a questionnaire.Results: Twenty-four dogs were included in group U and 27 in group B. Groups were similar in signalment and procedures performed. No significant difference was found in overall, minor, and major complication rates between Group U and Group B, nor in the short and long-term function of surgical limbs. Nine out of 21 dogs developed clinical signs on the contralateral stifle in Group U, of which only three underwent corrective surgery.Clinical significance: Single-session bilateral surgery could be offered for dogs with bilateral MPL with complication rates and function of operated limbs similar to unilateral surgery.

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