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Non-transvenous ICD therapy: current status and beyond

Therapie mit nicht-transvenösen implantierbaren Defibrillatoren: Aktueller Stand und darüber hinaus

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Abstract

Subcutaneous implantable cardioverter/defibrillators (S-ICDs) have been developed to offer ICD treatment to patients without venous access to the heart and to overcome complications associated with transvenous leads, particularly lead fracture/insulation defects and endocarditis. Several studies and registries have demonstrated the feasibility and safety of S‑ICD in different groups of patients. Further developments in S‑ICD technology involve the combination with devices that can provide anti-bradycardia and anti-tachycardia pacing if needed. The extravascular ICD (EV-ICD) is a new system that similarly offers ICD therapy without a transvenous lead but uses a substernal instead of a subcutaneous lead to facilitate detection of ventricular fibrillation and to provide anti-tachycardia and also temporary anti-bradycardia pacing. The first animal but also clinical data on EV-ICDs have been published. This review discusses the current state, potential advantages and limitations, and future research of both S‑ICD and EV-ICD.

Zusammenfassung

Der subkutane implantierbare Kardioverter/Defibrillator (S-ICD) wurde entwickelt, um eine ICD-Therapie auch Patienten ohne venösen Zugang zum Herzen zu ermöglichen und um Komplikationen, die mit der Implantation transvenöser Elektroden assoziiert sind, zu vermeiden, insbesondere Elektrodenbrüche/Isolierungsdefekte und Endokarditis. Mehrere Studien und Register haben die Machbarkeit und Sicherheit des S‑ICD-Einsatzes bei verschiedenen Patientengruppen gezeigt. Weiterentwicklungen der S‑ICD-Technologie zielen auf eine Kombination mit Geräten zur antibradykarden und antitachykarden Stimulation ab. Der extravaskuläre ICD (EV-ICD) stellt ein neues System dar, das in ähnlicher Weise eine ICD-Therapie ohne transvenöse Elektrode erlaubt und stattdessen eine substernale Elektrode verwendet, um die Detektion von Kammerflimmern zu vereinfachen und eine antitachykarde sowie temporäre antibradykarde Stimulation zu ermöglichen. Erste experimentelle und klinische Ergebnisse zum EV-ICD wurden bereits veröffentlicht. In der vorliegenden Übersicht werden der aktuelle Stand, mögliche Vorteile und Limitationen sowie die weitere Forschung zu beiden Systemen, S‑ICD und EV-ICD, diskutiert.

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Authors and Affiliations

  1. Department of Cardiology, St Antonius Hospital, Koekoekslaan 1, 3435, CM Nieuwegein, The Netherlands

    Vincent F. van Dijk MD PhD & Lucas V. A. Boersma MD PhD

  2. Heart Centre, Department of Clinical and Experimental Cardiology, Amsterdam University Medical Center, Amsterdam, The Netherlands

    Lucas V. A. Boersma MD PhD

Authors
  1. Vincent F. van Dijk MD PhD
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  2. Lucas V. A. Boersma MD PhD
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Correspondence to Lucas V. A. Boersma MD PhD.

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Conflict of interest

L.V. Boersma is a consultant for Boston Scientific and Medtronic. V.F. van Dijk is a consultant for Boston scientific.

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

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van Dijk, V.F., Boersma, L.V.A. Non-transvenous ICD therapy: current status and beyond. Herz 46, 520–525 (2021). https://doi.org/10.1007/s00059-021-05077-4

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