Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
Heart Rhythm. 2013 Aug;10(8):1240-3. doi: 10.1016/j.hrthm.2013.05.016. Epub 2013 May 21.
Three incisions in the chest are necessary for implantation of the entirely subcutaneous implantable cardioverter-defibrillator (S-ICD). The superior parasternal incision is a possible risk for infection and a potential source of discomfort. A less invasive alternative technique of implanting the S-ICD electrode--the two-incision technique--avoids the superior parasternal incision.
The purpose of this prospective cohort study was to evaluate the safety and efficacy of the two-incision technique for implantation of the S-ICD.
Consecutive patients who received an S-ICD between October 2010 and December 2011 were implanted using the two-incision technique, which positions the parasternal part of the S-ICD electrode using a standard 11Fr peel-away sheath. All patients were routinely evaluated for at least 1 year for complications and device interrogation at the outpatient clinic.
Thirty-nine patients (46% male, mean age 44 ± 15 years) were implanted with a S-ICD using the two-incision technique. During mean follow-up of 18 months (range 14-27 months) no dislocations were observed, and there was no need for repositioning of either the ICD or the electrode. No serious infections occurred during follow-up except for 2 superficial wound infections of the pocket incision site. Device function was normal in all patients, and no inappropriate sensing occurred related to the implantation technique.
The two-incision technique is a safe and efficacious alternative for S-ICD implantations and may help to reduce complications. The two-incision technique offers physicians a less invasive and simplified implantation procedure of the S-ICD.
植入完全皮下植入式心律转复除颤器（S-ICD）需要在胸部做三个切口。胸骨旁上切口可能有感染风险，且可能导致不适。一种更微创的植入 S-ICD 电极的替代技术——双切口技术——可避免胸骨旁上切口。
本前瞻性队列研究旨在评估双切口技术植入 S-ICD 的安全性和有效性。
2010 年 10 月至 2011 年 12 月期间，连续接受 S-ICD 植入的患者采用双切口技术，该技术使用标准的 11Fr 剥离鞘来定位 S-ICD 电极的胸骨旁部分。所有患者均在门诊常规随访至少 1 年，以评估并发症和设备检测情况。
39 例患者（46%为男性，平均年龄 44 ± 15 岁）采用双切口技术植入 S-ICD。在平均 18 个月（14-27 个月）的随访期间，未观察到脱位，无需重新定位 ICD 或电极。除 2 例口袋切口部位的浅表伤口感染外，随访期间无严重感染发生。所有患者的设备功能均正常，未发生与植入技术相关的不当感知。
双切口技术是植入 S-ICD 的一种安全有效的替代方法，可能有助于减少并发症。双切口技术为医生提供了一种更微创、简化的 S-ICD 植入程序。
