title: Implantable cardioverter defibrillator therapy in young individuals: comparison of conventional and subcostal approaches-a single-centre experience.
abstract: OBJECTIVE
  The aim of our study is to compare two approaches of implantable cardiac defibrillator (ICD) implantation, conventional (supra/subpectoral) and subcostal in young adults in terms of procedural complications and adverse events encountered during follow-up.
  
  
  RESULTS
  From January 2007 to December 2013, all patients under the age of 50 years who received an ICD in our centre were included in this study. Patient's hospital records were analysed for procedural complications and adverse events during follow-up until December 2014. Data from device on first interrogation after implantation and on follow-up were also noted. A total of 106 patients of which 40.6% had Brugada's syndrome (65.1% male, age 33.6 ± 10.97 years) were included in analysis; 71 (61%) had ICD placed in (sub/supra) pectoral and 35 (33%) in subcostal position. Only seven patients received an epicardial lead system. During the follow-up period of 2.1 ± 1.8 years, 84.90% of the patients had no adverse events. Most of the complications, procedural and during follow-up, occur in conventionally placed, pectoral ICD. Lead follow-up data in both groups, conventional and subcostal, showed no difference in right ventricular (RV) shock impedance and R wave sensing, P-value = 0.56 and 0.77, respectively. Lead survival was 95 and 97%, respectively, in conventional and subcostal groups over a mean follow-up of 2.1 ± 1.8 years. Log-rank test for lead survival was not significant in terms of site of implantation.
  
  
  CONCLUSIONS
  To the best our knowledge, this is the first study demonstrating subcostal ICD placement in young adults and resulting in equivalent to better outcomes when compared with conventionally placed pectoral ICD. Subcostal ICD placement might be considered an alternative option in young adults as it results in better procedural outcomes and also comparable rate of adverse events during follow-up, but bigger studies with a larger number of patients are needed for a definitive conclusion.
authors.affiliation: Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090 Brussels, Belgium ghazala.irfan@gmail.com.
authors.forename: Ghazala
authors.initials: G
authors.lastname: Irfan
authors.affiliation: Cardiac Surgery Department, UZ Brussel-VUB, Brussels, Belgium.
authors.forename: Jens
authors.initials: J
authors.lastname: Czapla
authors.affiliation: Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090 Brussels, Belgium.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Saitoh
authors.affiliation: Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090 Brussels, Belgium.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ciconte
authors.affiliation: Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090 Brussels, Belgium.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Mugnai
authors.affiliation: Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090 Brussels, Belgium.
authors.forename: Giulio
authors.initials: G
authors.lastname: Conte
authors.affiliation: Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090 Brussels, Belgium.
authors.forename: Burak
authors.initials: B
authors.lastname: Hunuk
authors.affiliation: Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090 Brussels, Belgium.
authors.forename: Vedran
authors.initials: V
authors.lastname: Velagic
authors.affiliation: Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090 Brussels, Belgium.
authors.forename: Erwin
authors.initials: E
authors.lastname: Stroker
authors.affiliation: Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090 Brussels, Belgium.
authors.forename: Gian Battista
authors.initials: GB
authors.lastname: Chierchia
authors.affiliation: Cardiac Surgery Department, UZ Brussel-VUB, Brussels, Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: Nijs
authors.affiliation: Cardiac Surgery Department, UZ Brussel-VUB, Brussels, Belgium.
authors.forename: Marc
authors.initials: M
authors.lastname: La Meir
authors.affiliation: Cardiac Surgery Department, UZ Brussel-VUB, Brussels, Belgium.
authors.forename: Francis
authors.initials: F
authors.lastname: Wellens
authors.affiliation: Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090 Brussels, Belgium.
authors.forename: Pedro
authors.initials: P
authors.lastname: Brugada
authors.affiliation: Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090 Brussels, Belgium.
authors.forename: Carlo
authors.initials: C
authors.lastname: De Asmundis
mesh_terms: D000328:Adult; D000367:Age Factors; D001530:Belgium; D017147:Defibrillators, Implantable / Q000009:adverse effects; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006406:Hematoma / Q000209:etiology; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D011474:Prosthesis Design; D011475:Prosthesis Failure; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology; D013908:Thoracotomy / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cardiac device complications; Implantable cardioverter defibrillator; Implantation technique; Lead failure; Subcostal ICD