title: Intermuscular Two-Incision Technique for Subcutaneous Implantable Cardioverter Defibrillator Implantation: Results from a Multicenter Registry.
abstract: BACKGROUND
  The traditional technique for subcutaneous implantable cardioverter defibrillator (S-ICD) implantation, which involves three incisions and a subcutaneous pocket, is associated with possible complications, including inappropriate interventions. The aim of this prospective multicenter study was to evaluate the efficacy and safety of an alternative intermuscular two-incision technique for S-ICD implantation.
  
  
  METHODS
  The study population included 36 consecutive patients (75% male, mean age 44 ± 12 years [range 20-69]) who underwent S-ICD implantation using the intermuscular two-incision technique. This technique avoids the superior parasternal incision for the lead placement and consists of creating an intermuscular pocket between the anterior surface of the serratus anterior and the posterior surface of the latissimus dorsi muscles instead of a subcutaneous pocket.
  
  
  RESULTS
  All patients were successfully implanted in the absence of any procedure-related complications with a successful 65-J standard polarity defibrillation threshold testing, except in one, who received a second successful shock after pocket revision. During a mean follow-up of 10 months (range 3-30), no complications requiring surgical revision were observed. At device interrogation, stable sensing without interferences was observed in all patients. Two patients (5.5%) experienced appropriate and successful shock on ventricular fibrillation and in four patients (11%), a total of seven nonsustained self-terminated ventricular tachycardias were correctly detected. No inappropriate interventions were observed.
  
  
  CONCLUSIONS
  Our experience suggests that the two-incision intermuscular technique is a safe and efficacious alternative to the current technique for S-ICD implantation that may help reducing complications including inappropriate interventions and offer a better cosmetic outcome, especially in thin individuals.
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Migliore
authors.affiliation: Department of Cardiology, General Hospital of Conegliano, Treviso, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Allocca
authors.affiliation: Department of Cardiology, Cà Foncello, Civil Hospital, Treviso, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Calzolari
authors.affiliation: Department of Cardiology, Cà Foncello, Civil Hospital, Treviso, Italy.
authors.forename: Martino
authors.initials: M
authors.lastname: Crosato
authors.affiliation: Ospedale S. Maria della Misericordia, University of Udine, Udine, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Facchin
authors.affiliation: Ospedale S. Maria della Misericordia, University of Udine, Udine, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Daleffe
authors.affiliation: Cardiovascular Department, University of Trieste, Trieste, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Zecchin
authors.affiliation: Department of Cardiology, Civil Hospital, Feltre, Belluno, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Fantinel
authors.affiliation: Department of Cardiology, Santorso Civil Hospital, Thiene, Vicenza, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Cannas
authors.affiliation: Department of Cardiology, Santorso Civil Hospital, Thiene, Vicenza, Italy.
authors.forename: Rocco
authors.initials: R
authors.lastname: Arancio
authors.affiliation: Department of Cardiology, Mazzoni Civil Hospital, Ascoli Piceno, Italy.
authors.forename: Procolo
authors.initials: P
authors.lastname: Marchese
authors.affiliation: Cardiology Department, Arrhythmia and Electrophysiology Unit, Santa Maria Della Misericordia Hospital, Rovigo, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Zanon
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Zorzi
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: Sabino
authors.initials: S
authors.lastname: Iliceto
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Bertaglia
mesh_terms: D000328:Adult; D000368:Aged; D064131:Back Muscles / Q000601:surgery*; D017147:Defibrillators, Implantable; D005260:Female; D006333:Heart Failure / Q000517:prevention & control*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: implantable cardioverter defibrillator complications; subcutaneous implantable cardioverter defibrillator (S-ICD); two-incision technique