Skip to main content
SpringerLink
Log in

Gegenwärtiger Stand und Probleme vollständig subkutaner ICD-Systeme (S-ICD®)

Current status and problems of the entirely subcutaneous ICD (S-ICD®)

  • Schwerpunkt
  • Published:
Herzschrittmachertherapie + Elektrophysiologie Aims and scope Submit manuscript

Zusammenfassung

Die Prävention des plötzlichen Herztods ist eine der wichtigsten Aufgaben der Kardiologie. Transvenöse ICD-Systeme haben ihre Effektivität in zahlreichen randomisierten Studien eindrucksvoll belegt, aber sie haben ihre Grenzen durch häufige Komplikationen im Langzeitverlauf. Das seit wenigen Jahren verfügbare, rein subkutane ICD-System (S-ICD®, Boston Scientific, USA, zuvor Cameron Health, USA) scheint vielversprechend, obwohl prospektive, randomisierte Daten fehlen. Die Implantation des S-ICD® ist einfach, relevante Komplikationen sind wegen der rein subkutanen Lage selten. Die Erkennung und Therapie von lebensbedrohlichen Tachyarrhythmien scheint bislang sicher, obwohl Langzeitdaten noch fehlen und im Fall eines unzureichenden EKG-Screenings inadäquate Therapien ein häufiges Problem darstellen. Der S-ICD® ist wegen der begrenzten Programmiermöglichkeiten sowie der fehlenden Möglichkeit zur Stimulation keine Alternative zum transvenösen System, stellt aber eine interessante Ergänzung der ICD-Therapie dar.

Abstract

Prevention of sudden cardiac death is one of the most important tasks of cardiology. Transvenous ICD-systems have impressively proven their effectiveness in numerous randomized trials. Transvenous systems have their limitations due to frequent long-term lead complications. Having been available for a few years, the entirely subcutaneous ICD-system (S-ICD®, Boston Scientific, USA, former Cameron Health, USA) seems to be a promising alternative despite the lack of prospective data. The implantation of the S-ICD® can be performed easily; lead complications are rare because of the totally subcutaneous implantation. The detection and therapy of life-threatening tachyarrhythmias seems to be safe, although inappropriate therapies are a common problem in cases of insufficient ECG screening. S-ICD® is no alternative to the transvenous system due to limited programming options and the lack of stimulation, but it is an interesting supplement of ICD therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Epstein A (2008) ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: executive summary. Heart Rhythm 5:934–955. doi:10.1016/j.hrthm.2008.04.015

    Article  PubMed  Google Scholar 

  2. Alter P, Waldhans S, Plachta E et al (2005) Complications of implantable cardioverter defibrillator therapy in 440 consecutive patients. Pacing Clin Electrophysiol 28:926–932. doi:10.1111/j.1540-8159.2005.00195.x

    Article  PubMed  Google Scholar 

  3. van Rees JB, de Bie MK, Thijssen J et al (2011) Implantation-related complications of implantable cardioverter-defibrillators and cardiac resynchronization therapy devices: a systematic review of randomized clinical trials. J Am Coll Cardiol 58:995–1000. doi:10.1016/j.jacc.2011.06.007

    Article  PubMed  Google Scholar 

  4. Maisel WH, Kramer DB (2008) Implantable cardioverter-defibrillator lead performance. Circulation 117:2721–2723. doi:10.1161/CIRCULATIONAHA.108.776807

    Article  PubMed  Google Scholar 

  5. Kleemann T, Becker T, Doenges K et al (2007) Annual rate of transvenous defibrillation lead defects in implantable cardioverter-defibrillators over a period of 10 years. Circulation 115:2474–2480. doi:10.1161/CIRCULATIONAHA.106.663807

    Article  PubMed  Google Scholar 

  6. Uslan DZ, Sohail MR, St SJLetal (2007) Permanent pacemaker and implantable cardioverter defibrillator infection: a population-based study. Arch Intern Med 167:669–675. doi:10.1001/archinte.167.7.669

    Article  PubMed  Google Scholar 

  7. Sohail MR, Henrikson CA, Braid-Forbes MJ et al (2011) Mortality and cost associated with cardiovascular implantable electronic device infections. Arch Intern Med 171:1821–1828. doi:10.1001/archinternmed.2011.441

    Article  PubMed  Google Scholar 

  8. Kennergren C, Bjurman C, Wiklund R, Gäbel J (2009) A single-centre experience of over one thousand lead extractions. Europace 11:612–617. doi:10.1093/europace/eup054

    Article  PubMed  Google Scholar 

  9. Baumgartner H, Bonhoeffer P, de Groot NM et al (2010) ESC guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J 31:2915–2957. doi:10.1093/eurheartj/ehq249

    Article  PubMed  Google Scholar 

  10. Goette A, Cantu F, van Erven L et al (2009) Performance and survival of transvenous defibrillation leads: need for a European data registry. Europace 11:31–34. doi:10.1093/europace/eun301

    Article  PubMed  Google Scholar 

  11. Bardy GH, Smith WM, Hood MA et al (2010) An entirely subcutaneous implantable cardioverter-defibrillator. N Engl J Med 363:36–44. doi:10.1056/NEJMoa0909545

    Article  PubMed  CAS  Google Scholar 

  12. Jarman JW, Lascelles K, Wong T et al (2012) Clinical experience of entirely subcutaneous implantable cardioverter-defibrillators in children and adults: cause for caution. Eur Heart J 33:1351–1359. doi:10.1093/eurheartj/ehs017

    Article  PubMed  Google Scholar 

  13. Zumhagen S, Grace AA, O’Connor S et al (2011) Totally subcutaneous implantable cardioverter defibrillator with an alternative, right parasternal, electrode placement. Pacing Clin Electrophysiol 1–4. doi:10.1111/j.1540-8159.2011.03043.x

  14. Köbe J, Zumhagen S, Reinke F et al (2011) [Totally subcutaneous cardioverter-defibrillator (S-ICD®): recent experience and future perspectives]. Herz 36:586–591. doi:10.1007/s00059-011-3508-6

    Article  PubMed  Google Scholar 

  15. Dabiri Abkenari L, Theuns DA, Valk SD et al (2011) Clinical experience with a novel subcutaneous implantable defibrillator system in a single center. Clin Res Cardiol 100:737–744. doi:10.1007/s00392-011-0303-6

    Article  PubMed  Google Scholar 

  16. Grace AA, Hood MA, Smith WM et al (2006) Evaluation of four distinct subcutaneous implantable defibrillator (S-ICD) lead systems in humans. Heart Rhythm 3:128–129. doi:10.1016/j.hrthm.2006.02.388

    Article  Google Scholar 

  17. Köbe J, Reinke DF, Meyer C et al (2013) Implantation and follow-up of totally subcutaneous versus conventional implantable cardioverter-defibrillators: a multicenter case-control study. Heart Rhythm 10:29–36. doi:10.1016/j.hrthm.2012.09.126

    Article  PubMed  Google Scholar 

  18. Aydin A, Hartel F, Schluter M et al (2012) Shock efficacy of subcutaneous implantable cardioverter-defibrillator for prevention of sudden cardiac death: initial multicenter experience. Circ Arrhythm Electrophysiol 5:913–919. doi:10.1161/CIRCEP.112.973339

    Article  PubMed  Google Scholar 

  19. Dickstein K, Vardas PE, Auricchio A et al (2010) 2010 Focused update of ESC guidelines on device therapy in heart failure: an update of the 2008 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure and the 2007 ESC guidelines for cardiac and resynchronization therapy. Developed with the special contribution of the Heart Failure Association and the European Heart Rhythm Association. Eur Heart J 31:2677–2687. doi:10.1093/eurheartj/ehq337

    Article  PubMed  Google Scholar 

  20. van Opstal J, Geskes G, Debie L (2011) A completely subcutaneous implantable cardioverter defibrillator system functioning simultaneously with an endocardial implantable cardioverter defibrillator programmed as pacemaker. Europace 13:141–142. doi:10.1093/europace/euq187

    Article  PubMed  Google Scholar 

  21. van Rees JB, Borleffs CJ, de Bie MK et al (2011) Inappropriate implantable cardioverter-defibrillator shocks: incidence, predictors, and impact on mortality. J Am Coll Cardiol 57:556–562. doi:10.1016/j.jacc.2010.06.059

    Article  PubMed  Google Scholar 

  22. Daubert JP, Zareba W, Cannom DS et al (2008) Inappropriate implantable cardioverter-defibrillator shocks in MADIT II: frequency, mechanisms, predictors, and survival impact. J Am Coll Cardiol 51:1357–1365. doi:10.1016/j.jacc.2007.09.073

    Article  PubMed  Google Scholar 

  23. Streitner F, Kuschyk J, Dietrich C et al (2011) Comparison of ventricular tachyarrhythmia characteristics in patients with idiopathic dilated or ischemic cardiomyopathy and defibrillators implanted for primary prevention. Clin Cardiol 34:604–609. doi:10.1002/clc.20949

    Article  PubMed  Google Scholar 

  24. McLeod KA, McLean A (2010) Implantation of a Fully Subcutaneous ICD in Children. Pacing Clin Electrophysiol 35:e20–e23. doi:10.1111/j.1540-8159.2010.02865.x

    Article  PubMed  CAS  Google Scholar 

  25. Olde Nordkamp LR, Dabiri Abkenari L, Boersma LV et al (2012) The entirely subcutaneous implantable cardioverter-defibrillator: initial clinical experience in a large Dutch cohort. J Am Coll Cardiol 60:1933–1939. doi:10.1016/j.jacc.2012.06.053

    Article  PubMed  Google Scholar 

  26. Jarman JW, Todd DM (2013) United Kingdom national experience of entirely subcutaneous implantable cardioverter-defibrillator technology: important lessons to learn. Europace. doi:10.1093/europace/eut016

  27. Hook BG, Callans DJ, Kleiman RB et al (1993) Implantable cardioverter-defibrillator therapy in the absence of significant symptoms. Rhythm diagnosis and management aided by stored electrogram analysis. Circulation 87:1897–1906

    Article  PubMed  CAS  Google Scholar 

  28. Singer I, de Borde R, Veltri EP et al (1988) The automatic implantable cardioverter defibrillator: T wave sensing in the newest generation. Pacing Clin Electrophysiol 11:1584–1591

    Article  PubMed  CAS  Google Scholar 

  29. Weretka S, Michaelsen J, Becker R et al (2003) Ventricular oversensing: a study of 101 patients implanted with dual chamber defibrillators and two different lead systems. Pacing Clin Electrophysiol 26:65–70

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

L. Eckardt ist Inhaber der Peter-Osypka-Stiftungsprofessur für Experimentelle und Klinische Elektrophysiologie. F. Reinke, A. Löher, J. Köbe und L. Eckardt haben Vortragshonorare der Firmen Biotronik, Boston Scientific, Medtronic, SorinGroup und St. Jude Medical erhalten.

Author information

Authors and Affiliations

  1. Abteilung für Rhythmologie, Department für Kardiologie und Angiologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, A1, 48149, Münster, Deutschland

    Florian Reinke, J. Köbe & L. Eckardt

  2. Klinik für Herzchirurgie, Department für Herz- und Thoraxchirurgie, Universitätsklinikum Münster, Münster, Deutschland

    A. Löher

Authors
  1. Florian Reinke
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Löher
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Köbe
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L. Eckardt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Florian Reinke.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Reinke, F., Löher, A., Köbe, J. et al. Gegenwärtiger Stand und Probleme vollständig subkutaner ICD-Systeme (S-ICD®). Herzschr Elektrophys 24, 165–170 (2013). https://doi.org/10.1007/s00399-013-0277-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00399-013-0277-3

Schlüsselwörter

Keywords

Search

Navigation