title: Two-incision technique for implantation of the subcutaneous implantable cardioverter-defibrillator.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands. r.e.knops@amc.uva.nl
authors.forename: Reinoud E
authors.initials: RE
authors.lastname: Knops
authors.forename: Louise R A
authors.initials: LR
authors.lastname: Olde Nordkamp
authors.forename: Joris R
authors.initials: JR
authors.lastname: de Groot
authors.forename: Arthur A M
authors.initials: AA
authors.lastname: Wilde
mesh_terms: D000328:Adult; D001145:Arrhythmias, Cardiac / Q000628:therapy*; D015331:Cohort Studies; D017147:Defibrillators, Implantable; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: DFT; EIT; ICD; Implantable cardioverter-defibrillator; Implantation technique; S-ICD; Subcutaneous implantable cardioverter-defibrillator; VF; defibrillation threshold; electrode insertion tool; implantable cardioverter-defibrillator; subcutaneous implantable cardioverter-defibrillator; ventricular fibrillation