Letsas K P, Xydonas S, Karamichalakis N, Efremidis M, Manolatos D, Bazoukis G, Asvestas D, Vlachos K, Georgopoulos S, Saplaouras A, Winter J, Sideris A
Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Ipsilantou 47, 10676, Athens, Greece.
Division of Cardiac Surgery, University of Düsseldorf, 40225, Düsseldorf, Germany.
Herz. 2019 Sep;44(6):541-545. doi: 10.1007/s00059-018-4688-0. Epub 2018 Feb 21.
The conventional technique for subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation has been associated with pocket complications. The aim of this study was to evaluate the efficacy and safety of an alternative intermuscular technique for S‑ICD implantation.
S-ICDs were implanted in ten consecutive patients (ten males, mean age: 46.8 ± 14.7 years). The pocket for the pulse generator was made above the serratus anterior muscular fascia and beneath the latissimus dorsi muscle by detaching the fibrous tissue between the muscles. Electrode implantation was performed using the three- (n = 4) or the two-incision technique (n = 6).
All S‑ICDs were successfully implanted in the absence of any procedure-related complications with a successful 65-J standard polarity defibrillation threshold testing, apart from one patient with Brugada syndrome who needed device repositioning more dorsally. During a mean follow-up of 16.5 ± 7.3 months, no major complications requiring surgical repair were encountered, while patients demonstrated high levels of comfort and satisfaction with the cosmetic result. One patient experienced an inappropriate shock due to noise detection, which was resolved after reprogramming to a different sensing vector.
The intermuscular technique is a safe and efficacious approach for S‑ICD implantation. This technique could lead to fewer pocket-related complications and better cosmetic results.
皮下植入式心律转复除颤器（S-ICD）植入的传统技术一直与囊袋并发症相关。本研究的目的是评估一种用于S-ICD植入的替代性肌间技术的有效性和安全性。
连续10例患者（10例男性，平均年龄：46.8±14.7岁）植入S-ICD。通过分离肌肉间的纤维组织，在胸大肌筋膜上方和背阔肌下方制作脉冲发生器的囊袋。电极植入采用三切口技术（n = 4）或两切口技术（n = 6）。
除1例Brugada综合征患者需要将设备更向背部重新定位外，所有S-ICD均成功植入，且65-J标准极性除颤阈值测试成功，未出现任何与手术相关的并发症。在平均16.5±7.3个月的随访期间，未遇到需要手术修复的重大并发症，同时患者对美容效果表现出高度的舒适度和满意度。1例患者因噪音检测出现不适当电击，重新编程为不同的感知向量后问题得到解决。
肌间技术是一种安全有效的S-ICD植入方法。该技术可减少与囊袋相关的并发症，并获得更好的美容效果。
