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Usefulness of subcutaneous implantable cardioverter-defibrillator therapy in patients with Brugada syndrome

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Abstract

Implantable cardioverter-defibrillators (ICDs) are the main therapy to prevent sudden cardiac death in patients with Brugada syndrome (BrS). The subcutaneous ICD (S-ICD) can eliminate lead-associated complications compared with transvenous ICD (TV-ICD). However, S-ICD is susceptible to T-wave oversensing (TWOS) and may result in more frequent inappropriate shocks in patients with BrS. This study aimed to compare inappropriate shocks between TV-ICD and S-ICD in patients with BrS. We enrolled 32 patients with BrS (including one woman; mean age 52 ± 18 years) who were implanted with ICD (23 TV-ICDs and 9 S-ICDs) between January 2002 and November 2018 in Oita University Hospital. We carried out a standard surface electrocardiogram (ECG) screening tests in both supine and standing positions prior to S-ICD implantation. The patients received routine clinical review every month and device monitoring every 4 months. The period of follow-up was 129 ± 51 months. Six patients with BrS and TV-ICDs experienced inappropriate shocks (26%) with their ICD therapy. In contrast, two patients with BrS and S-ICDs experienced inappropriate shocks (22%). There was no significant difference between the two groups (P = 0.82). Although one case in the S-ICD group experienced TWOS-induced inappropriate shock, SMART Pass (new high-pass filter) prevented the subsequent recurrence of inappropriate shocks during ICD therapy. Our results suggest that S-ICD is not inferior to TV-ICD in the incidence of inappropriate shocks. SMART Pass may be a useful tool to prevent inappropriate ICD shocks by TWOS in patients with BrS.

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Acknowledgement

The authors thank Masae Hayashi for her excellent secretarial assistance.

Funding

This study was supported in part by a Grant-in-Aid (grant number 18K06856 from the Japanese Ministry of Education, Science and Culture [T. Shinohara]).

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Authors and Affiliations

  1. Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, 879-5593, Japan

    Tetsuji Shinohara, Ichitaro Abe, Kei Hirota, Hidekazu Kondo, Akira Fukui, Hidefumi Akioka, Yasushi Teshima, Kunio Yufu, Mikiko Nakagawa & Naohiko Takahashi

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  1. Tetsuji Shinohara
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  2. Ichitaro Abe
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  3. Kei Hirota
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  4. Hidekazu Kondo
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  5. Akira Fukui
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  6. Hidefumi Akioka
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  7. Yasushi Teshima
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  9. Mikiko Nakagawa
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  10. Naohiko Takahashi
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Correspondence to Tetsuji Shinohara.

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Shinohara, T., Abe, I., Hirota, K. et al. Usefulness of subcutaneous implantable cardioverter-defibrillator therapy in patients with Brugada syndrome. Heart Vessels 36, 260–266 (2021). https://doi.org/10.1007/s00380-020-01683-0

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