Subcutaneous implantable cardioverter defibrillator for dialysis patients: a strategy to reduce central vein stenoses and infections.
Central venous stenosis is a common complication of the transvenous leads associated with an implantable cardioverter defibrillator (ICD). Although epicardial leads have been reported to bypass this complication, their placement is much more invasive than the subcutaneous ICDs (SICDs) and requires the services of a cardiothoracic surgeon. Recent data have demonstrated successful defibrillation using an SICD. In this report, we present 4 long-term hemodialysis patients treated successfully with an SICD. 3 patients received the device for primary prevention of sudden cardiac death (cardiomyopathy with low ejection fraction). The patient in the fourth case had a prolonged QT interval and received the device for secondary prevention. 3 patients had an arteriovenous fistula, whereas 1 patient was dialyzing with a tunneled dialysis catheter. Insertion of an SICD is a minimally invasive procedure. By virtue of leaving the venous system untouched, this approach might offer the advantage of reduced risk of central venous stenosis and infection over an endocardial ICD with transvenous leads. SICD is not experimental; it has been approved by the US Food and Drug Administration and is currently being used in the United States and Europe.
Rancho Los Amigos National Rehabilitation Center, Downey, CA.
Rajiv K
RK
Dhamija
Albany Medical College, Albany, NY.
Henry
H
Tan
Albany Medical College, Albany, NY.
Edward
E
Philbin
Albany Medical College, Albany, NY; Stratton VA Medical Center, Albany, NY.
Roy O
RO
Mathew
Albany Medical College, Albany, NY; Stratton VA Medical Center, Albany, NY.
Mandeep S
MS
Sidhu
Stratton VA Medical Center, Albany, NY.
Jeffrey
J
Wang
Albany Medical College, Albany, NY.
Basil
B
Saour
Albany Medical College, Albany, NY.
Syed S
SS
Haqqie
University of Texas, Galveston, TX.
Gerald
G
Beathard
University of Wisconsin, Madison, WI.
Alexander S
AS
Yevzlin
University of Miami Miller School of Medicine, Miami, FL.
Loay
L
Salman
Albany Medical College, Albany, NY; Stratton VA Medical Center, Albany, NY.
William E
WE
Boden
Albany Medical College, Albany, NY.
Gary
G
Siskin
Albany Medical College, Albany, NY. Electronic address: asifa@mail.amc.edu.
Arif
A
Asif
D000328:Adult; D000368:Aged; D017130:Angioplasty; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D016121:Brachiocephalic Veins / Q000473:pathology* / Q000601:surgery; D002404:Catheterization; D003251:Constriction, Pathologic / Q000517:prevention & control; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D017147:Defibrillators, Implantable; D004554:Electric Countershock; D004567:Electrodes, Implanted / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008133:Long QT Syndrome / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D015607:Stents; D040521:Subcutaneous Tissue; D017131:Thrombectomy; D013927:Thrombosis / Q000209:etiology / Q000601:surgery; D062666:Vascular Access Devices
Subcutaneous implantable cardioverter defibrillator (SICD); arteriovenous fistula (AVF); cardiac leads; central venous stenosis; end-stage renal disease (ESRD); hemodialysis; infection; tunneled dialysis catheter; venous occlusion