Subcutaneous-implantable cardiac defibrillators (S-ICDs) are used increasingly to prevent sudden cardiac death in young patients. This study was set up to gain insight in the indications for S-ICD, possible complications, and their predictors and follow-up results. A multicentre, observational, retrospective, non-randomized, standard-of-care registry on S-ICD outcome in young patients with congenital heart diseases (CHDs), inherited arrhythmias (IAs), idiopathic ventricular fibrillation (IVF), and cardiomyopathies (CMPs). Anthropometry was registered as well as implantation technique, mid-term device-related complications, and incidence of appropriate/inappropriate shocks (IASs). Data are reported as median (interquartile range) or mean ± standard deviation. Eighty-one patients (47% CMPs, 20% CHD, 21% IVF, and 12% IA), aged 15 (14–17) years, with body mass index (BMI) 21.8 ± 3.8 kg/m², underwent S-ICD implantation (primary prevention in 59%). This was performed with two-incision technique in 81% and with a subcutaneous pocket in 59%. Shock and conditional zones were programmed at 250 (200–250) and 210 (180–240) b.p.m., respectively. No intraoperative complications occurred. Follow up was 19 (6–35) months: no defibrillation failure occurred, 17% of patients received appropriate shocks, 13% of patients received IAS (supraventricular tachycardias 40%, T-wave oversensing 40%, and non-cardiac oversensing 20%). Reprogramming, proper drug therapy, and surgical revision avoided further IAS. Complications requiring surgical revision occurred in 9% of patients, with higher risks in patients with three-incision procedures [hazard ratio (HR) 4.3, 95% confidence interval (95% CI) 0.5–34, P = 0.038] and BMI < 20 (HR 5.1, 95% CI 1–24, P = 0.031). This multicentre European paediatric registry showed good S-ICD efficacy and safety in young patients. Newer implantation techniques and BMI > 20 showed better outcome.

DOI: 10.33963/KP.15824, Published online: February 24, 2021, Authors: Ryszard Piotrowicz^1,2, Paweł Krzesiński³, Paweł Balsam⁴, Ewa Piotrowicz⁵, Maciej Kempa⁶, Ewa Lewicka⁶, Renata Główczyńska⁴, Marcin Grabowski⁴, Łukasz Kołtowski⁴, Michał Peller⁴, Bartosz Szafran⁷, Justyna Zajdel-Całkowska⁸, Jan Pachocki⁹, Jakub Podolec^10,11, Adam Stańczyk^12,13, Grzegorz Opolski⁴

Permanent cardiac pacing is a recognized method of treatment of patients with sick sinus syndrome and/or atrioventricular conduction disturbances. Implantation of a traditional pacing system with transvenous leads is associated with a risk of complications, such as pneumothorax perforation of cardiac wall or cardiac device-related infection. An alternative method that may be used for permanent cardiac pacing is represented by the leadless pacemaker, implanted directly into the target cardiac chamber. Such devices have been implanted in Poland since 2016, but the number of procedures is limited due to the lack of clear reimbursement rules. The expert panel appointed by the National Consultant in Cardiology and the Executive Board of the Heart Rhythm Section of the Polish Cardiac Society presents a statement on the use of a leadless pacemaker in Polish conditions.The statement present streatment method and results of clinical studies that confirm its safety and efficacy, indications and contraindications for its use, and precise requirements to be fulfilled by the implanting centers.

Progressive aging of the population and the increasing number of complications of electrotherapy procedures are the main reasons of a remarkable increase in the number of transvenous extraction procedures of pacemaker (PM) and implantable cardioverter-defibrillator (ICD) leads in the elderly patients. To assess the safety and effectiveness of such procedures in patients under or over 80 years of age. The study included all patients who underwent transvenous PM/ICD lead extraction in 2003-2011. All patients were divided into two groups based on their age at the time of the procedure: group A included patients under 80 years of age (134 patients; 97 male, 37 female) and group B included patients over 80 years of age (26 patients; 16 male, 10 female). No differences were found between the two groups in terms of gender proportions, comorbidities, New York Heart Association (NYHA) functional class, and left ventricular ejection fraction. In total, 220 leads were removed (group A: 63 defibrillating and 122 pacing leads, group B: 2 defibrillating and 33 pacing leads). The most common indication for the lead removal procedure in both groups was infection, either in the form of PM/ICD pocket infection (46 and 13 cases, respectively) or infective endocarditis (18 and 2 cases, respectively). Procedural outcomes in both groups were not statistically different in terms of the final outcome or complication rates. The results in groups A and B were as follows: complete success 95.5% vs. 96.2%, respectively, clinical success 3% vs. 3.8%, respectively, and failure 1.5% vs. 0%, respectively, with no significant differences between the groups. No major complications of the procedure were observed in either of the groups. Our findings indicate that transvenous extraction of PM/ICD leads appears to be a safe and effective procedure both in relatively younger patients and in patients over 80 years of age.

A concomitant use of a pacemaker and a subcutaneous implantable cardioverter-de-fibrillator (S-ICD) may be required in some patients. Our study aimed to evaluate the influence of permanent cardiac pacing on the morphology of the QRS complex in the context of S-ICD screening. One hundred patients with cardiac electronic implantable devices (CIEDs) were included in whom S-ICD screening could be performed both during intrinsic and paced rhythm. The positive result of screening during spontaneous rhythm for at least one vector (in both supine and standing positions) was obtained in 80% and for 2 vectors in 59% of patients. Positive screening during paced rhythm for at least one vector was recorded in 36% of patients (78% right ventricular and 22% biventricular pacing) and for 2 vectors in 15% of patients (93% right ventricular and 7% biventricular pacing). At least one vector acceptable during both types of rhythm and in both positions was recorded in 23% of patients and at least 2 vectors in 8% of patients. The use of S-ICD in patients with paced ventricular rhythm is associated with a serious risk of inappropriate sensing due to different QRS morphology during intrinsic and paced rhythm, and it is particularly high in patients in whom periods of spontaneous rhythm interchange with periods of ventricular pacing. That risk has been hardly acknowledged in available reports, but according to our data, it is significant, and therefore it should be considered during S-ICD screening.