Droghetti Andrea, Pecora Domenico, Maffè Stefano, Badolati Sandra, Pepi Patrizia, Nicolis Daniele, Lupo Pierpaolo, Lovecchio Mariolina, Valsecchi Sergio, Ottaviano Luca
Thoracic Surgery Division, ASST Mantova, Viale Lago Paiolo 10, 46100, Mantua, Italy.
Electrophysiology Unit, Cardiovascular Department, Poliambulanza Institute Hospital Foundation, Brescia, Italy.
J Interv Card Electrophysiol. 2025 Aug;68(5):1131-1139. doi: 10.1007/s10840-022-01312-y. Epub 2022 Aug 5.
The risk of complications has been shown to be lower with subcutaneous implantable defibrillator (S-ICD) than with conventional ICDs. Given the low frequency of complications, experience of how to manage them is limited. In this paper, we describe generator- and lead-related complications recorded in a series of S-ICD patients, and we propose our conservative approach to managing them.
The study cohort consisted of S-ICD patients who were referred to our institution owing to generator- or lead-related complications requiring surgical intervention. With our "shift and cover" approach, the system component involved is moved from its original position to an alternative, more protected location. In the case of the generator, this involves moving it to an intermuscular pocket. In the case of infections at the parasternal scar, the electrode sleeve is moved away from its original location, stitched, and then covered with the muscular fascia.
Fourteen S-ICD patients were referred to our institution owing to system-related complications. Complications involved the generator in 7 cases (deep pocket infections with erosion, extrusion, or pain), the lead in 5 cases (parasternal infections at the xyphoid incision site), and both the generator and the lead in 2 cases. Complications were managed without completely removing the device and resolved in a single surgical session with no intraoperative complications. During defibrillation testing, the first shock at 65 J was effective in all patients. The shock impedance after revision was significantly lower than that measured during first implantation (59 ± 10 Ohm versus 86 ± 24 Ohm, P = 0.013). In all cases, the cosmetic result was satisfactory. No complications or recurrent infections were reported at the 12-month follow-up visit.
The proposed conservative approach was successful in managing S-ICD complications. The revision procedure allowed to optimize the system configuration in terms of the defibrillation vector, resulting in lower shock impedance values and better device positioning.
皮下植入式除颤器（S-ICD）的并发症风险已被证明低于传统植入式心脏转复除颤器（ICD）。鉴于并发症发生率较低，处理这些并发症的经验有限。在本文中，我们描述了一系列S-ICD患者中记录的发生器和导线相关并发症，并提出了我们处理这些并发症的保守方法。
研究队列包括因发生器或导线相关并发症需要手术干预而转诊至我们机构的S-ICD患者。采用我们的“移位并覆盖”方法，将涉及的系统组件从其原始位置移至另一个更受保护的位置。对于发生器，这涉及将其移至肌间袋。对于胸骨旁瘢痕处的感染，将电极套管从其原始位置移开，缝合，然后用肌肉筋膜覆盖。
14例S-ICD患者因系统相关并发症转诊至我们机构。并发症涉及发生器7例（深部囊袋感染伴糜烂、挤压或疼痛），导线5例（剑突下切口部位胸骨旁感染），发生器和导线均受累2例。并发症处理时未完全移除装置，且在一次手术中解决，无术中并发症。在除颤测试期间，65J的首次电击对所有患者均有效。翻修后的电击阻抗显著低于首次植入时测量的值（59±10欧姆对86±24欧姆，P = 0.013）。在所有病例中，美容效果均令人满意。在12个月的随访中未报告并发症或复发性感染。
所提出的保守方法成功地处理了S-ICD并发症。翻修程序能够在除颤向量方面优化系统配置，从而降低电击阻抗值并改善装置定位。
