Efficacy and safety of extravascular defibrillation (EV-ICD) implantation in young patients: a single-center experience

Background/Introduction

Extravascular (EV) Implantable Cardiac Defibrillators (ICD) with substernal lead have recently proved to be an alternative to conventional transvenous in the prevention of Sudden Cardiac Death (SCD).

In younger patients, lead-related complications over time, including infections, lead fractures, and vascular damage can lead to multiple device revisions and associated morbidity.

Therefore, EV-ICD implantation may offer a valuable solution by minimizing lead-related risks and facilitating long-term device management.

Purpose

To evaluate the safety and efficacy profile of EV-ICD implantation in a cohort of young patients at risk for SCD based on a single-center experience.

Methods

Ten (10) patients with a class I or IIa ICD indication either for primary (60%) or secondary (40%) prevention and especially younger patients with absence of pacing need underwent Extravascular Defibrillator implantation in our centre the last 24 months. Access and tunnelling along the retrosternal space and intermuscular pocket for generator placement were performed based on current standard recommendations for EV-ICDs implantation.

Results

Mean age of patients was 45± 12.3 yrs and 8(80%) were men with mean Left Ventricular Ejection Fraction (LVEF) 40±14.7% and mean BMI 23±6 kg/m2.

The main indications were inherited arrhythmia syndromes (6/10, 60%) including Brugada syndrome (40%), idiopathic ventricular fibrillation (10%) and genetic Mitochondrial Myopathy (10%).

3 patients (30%) had ischemic cardiomyopathy with a history of device pocket infection, an increased risk of pocket infection due to comorbidities (diabetes mellitus, chronic renal failure undergoing hemodialysis) and intravenous drug use.

The implantation was successful in all patients, with no implant failure. The median sensing amplitude was 2.1 mV (min = 1.6 mV; max = 4 mV) and Defibrillation Testing (DFT) was successfully performed in all patients.

No major perioperative complications occurred. Along an 18±4 months follow-up no patient had infection or skin erosion or complained pain/discomfort at the pocket site.

Conclusion(s)

EV-ICD implantation offers a safe alternative for young patients in need of ICD therapy.

Its advantageous safety and efficacy profile makes it a valuable alternative to intravenous treatment options especially for young and thin-habit patients.

Furthermore, this approach has the potential to reduce device-related complications in this vulnerable patient group.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.