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Eligibility of cardiac resynchronization therapy patients for subcutaneous implantable cardioverter defibrillators

  • Massimo GiammariaEmail author
  • Maria Teresa Lucciola
  • Claudia Amellone
  • Fabrizio Orlando
  • Giuseppe Mazzone
  • Sara Chiarenza
  • Mariolina Lovecchio
  • Sergio Valsecchi
Article
  • 83 Downloads

Abstract

Background

Before subcutaneous implantable cardioverter defibrillator (S-ICD) implantation, the adequacy of sensing is required to be verified through surface ECG screening. Our objective was to determine whether S-ICD can be considered as a supplementary therapy in patients who are receiving biventricular (BIV) pacing.

Methods

We evaluated 48 patients with BIV devices to determine S-ICD candidacy during BIV, left ventricular (LV), right ventricular (RV) pacing, and intrinsic conduction (left bundle branch block—LBBB) by using an automated screening tool. Eligibility was defined by the presence of at least one appropriate vector in the supine and standing positions.

Results

Eligibility was verified during BIV pacing in 34 (71%) patients. In patients screened-out, QRS duration was longer (p = 0.035) and ischemic cardiomyopathy was more frequent (p = 0.027). LV-only pacing was associated with a lower passing rate (46%) (p < 0.001 versus BIV). The LBBB QRS morphology during inhibited ventricular pacing was acceptable in 51% of patients. The QRS generated by RV pacing was acceptable in 25% of patients. In patients who passed the screening test during BIV, the QRS was not acceptable in 76% during RV pacing (i.e., accidental loss of LV capture). The concomitant adequacy during inhibited ventricular pacing (i.e., possible intrinsic conduction) was not assessed in 40% of patients.

Conclusions

S-ICD may be a supplemental therapy in the majority of CRT patients. Standard BIV pacing should be preferred to the LV-only pacing mode, as it is more frequently associated with adequacy of S-ICD sensing. Spontaneous LBBB and RV-paced QRS morphologies are frequently inadequate. Therefore, in patients selected for concomitant S-ICD and CRT implantation, accidental loss of LV capture or possible intrinsic conduction must be prevented.

Keywords

ICD Subcutaneous Screening CRT Sudden death 

Abbreviations

ICD

Implantable cardioverter-defibrillators

S-ICD

Subcutaneous ICD

CRT

Cardiac resynchronization therapy

ECG

Electrocardiogram

Notes

Compliance with ethical standards

All patients provided written informed consent for data storage and analysis, as approved by the Institutional Review Board.

Conflict of interest

M. Lovecchio, S. Chiarenza and S. Valsecchi are employees of Boston Scientific, Inc. No other conflicts of interest exist.

Ethical approval

The study was approved by the Local Ethics Committee.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Massimo Giammaria
    • 1
    Email author
  • Maria Teresa Lucciola
    • 1
  • Claudia Amellone
    • 1
  • Fabrizio Orlando
    • 1
  • Giuseppe Mazzone
    • 1
  • Sara Chiarenza
    • 2
  • Mariolina Lovecchio
    • 2
  • Sergio Valsecchi
    • 2
  1. 1.Maria Vittoria HospitalTurinItaly
  2. 2.Boston Scientific ItalyMilanItaly

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