title: Implantation of the Subcutaneous Implantable Cardioverter-Defibrillator: An Evaluation of 4 Implantation Techniques.
abstract: Alternative techniques to the traditional 3-incision subcutaneous implantation of the subcutaneous implantable cardioverter-defibrillator may offer procedural and cosmetic advantages. We evaluate 4 different implant techniques of the subcutaneous implantable cardioverter-defibrillator.
  
  
  
  Patients implanted with subcutaneous implantable cardioverter-defibrillators from 2 hospitals between 2009 and 2016 were included. Four implantation techniques were used depending on physician preference and patient characteristics. The 2- and 3-incision techniques both place the pulse generator subcutaneously, but the 2-incision technique omits the superior parasternal incision for lead positioning. Submuscular implantation places the pulse generator underneath the serratus anterior muscle and subfascial implantation underneath the fascial layer on the anterior side of the serratus anterior muscle. Reported outcomes include perioperative parameters, defibrillation testing, and clinical follow-up. A total of 246 patients were included with a median age of 47 years and 37% female. Fifty-four patients were implanted with the 3-incision technique, 118 with the 2-incision technique, 38 with submuscular, and 37 with subfascial. Defibrillation test efficacy and shock lead impedance during testing did not differ among the groups; respectively, P=0.46 and P=0.18. The 2-incision technique resulted in the shortest procedure duration and time-to-hospital discharge compared with the other techniques (P<0.001). A total of 18 complications occurred, but there were no significant differences between the groups (P=0.21). All infections occurred in subcutaneous implants (3-incision, n=3; 2-incision, n=4). In the 2-incision group, there were no lead displacements.
  
  
  
  The presented implantation techniques are feasible alternatives to the standard 3-incision subcutaneous implantation, and the 2-incision technique resulted in shortest procedure duration.
authors.affiliation: From the Department of Clinical & Experimental Cardiology, Heart Center, Amsterdam Medical Center, University of Amsterdam, Noord-Holland, The Netherlands (T.F.B., A.-F.B.E.Q., A.A.W., R.E.K.); and Helmsley Cardiac Arrhythmia Service, Icahn School of Medicine at Mount Sinai, New York, NY (M.A.M., C.P., S.R.D., V.R., J.M.W.). t.f.brouwer@amc.uva.nl.
authors.forename: Tom F
authors.initials: TF
authors.lastname: Brouwer
authors.affiliation: From the Department of Clinical & Experimental Cardiology, Heart Center, Amsterdam Medical Center, University of Amsterdam, Noord-Holland, The Netherlands (T.F.B., A.-F.B.E.Q., A.A.W., R.E.K.); and Helmsley Cardiac Arrhythmia Service, Icahn School of Medicine at Mount Sinai, New York, NY (M.A.M., C.P., S.R.D., V.R., J.M.W.).
authors.forename: Marc A
authors.initials: MA
authors.lastname: Miller
authors.affiliation: From the Department of Clinical & Experimental Cardiology, Heart Center, Amsterdam Medical Center, University of Amsterdam, Noord-Holland, The Netherlands (T.F.B., A.-F.B.E.Q., A.A.W., R.E.K.); and Helmsley Cardiac Arrhythmia Service, Icahn School of Medicine at Mount Sinai, New York, NY (M.A.M., C.P., S.R.D., V.R., J.M.W.).
authors.forename: Anne-Floor B E
authors.initials: AB
authors.lastname: Quast
authors.affiliation: From the Department of Clinical & Experimental Cardiology, Heart Center, Amsterdam Medical Center, University of Amsterdam, Noord-Holland, The Netherlands (T.F.B., A.-F.B.E.Q., A.A.W., R.E.K.); and Helmsley Cardiac Arrhythmia Service, Icahn School of Medicine at Mount Sinai, New York, NY (M.A.M., C.P., S.R.D., V.R., J.M.W.).
authors.forename: Chandrasekar
authors.initials: C
authors.lastname: Palaniswamy
authors.affiliation: From the Department of Clinical & Experimental Cardiology, Heart Center, Amsterdam Medical Center, University of Amsterdam, Noord-Holland, The Netherlands (T.F.B., A.-F.B.E.Q., A.A.W., R.E.K.); and Helmsley Cardiac Arrhythmia Service, Icahn School of Medicine at Mount Sinai, New York, NY (M.A.M., C.P., S.R.D., V.R., J.M.W.).
authors.forename: Srinivas R
authors.initials: SR
authors.lastname: Dukkipati
authors.affiliation: From the Department of Clinical & Experimental Cardiology, Heart Center, Amsterdam Medical Center, University of Amsterdam, Noord-Holland, The Netherlands (T.F.B., A.-F.B.E.Q., A.A.W., R.E.K.); and Helmsley Cardiac Arrhythmia Service, Icahn School of Medicine at Mount Sinai, New York, NY (M.A.M., C.P., S.R.D., V.R., J.M.W.).
authors.forename: Vivek
authors.initials: V
authors.lastname: Reddy
authors.affiliation: From the Department of Clinical & Experimental Cardiology, Heart Center, Amsterdam Medical Center, University of Amsterdam, Noord-Holland, The Netherlands (T.F.B., A.-F.B.E.Q., A.A.W., R.E.K.); and Helmsley Cardiac Arrhythmia Service, Icahn School of Medicine at Mount Sinai, New York, NY (M.A.M., C.P., S.R.D., V.R., J.M.W.).
authors.forename: Arthur A
authors.initials: AA
authors.lastname: Wilde
authors.affiliation: From the Department of Clinical & Experimental Cardiology, Heart Center, Amsterdam Medical Center, University of Amsterdam, Noord-Holland, The Netherlands (T.F.B., A.-F.B.E.Q., A.A.W., R.E.K.); and Helmsley Cardiac Arrhythmia Service, Icahn School of Medicine at Mount Sinai, New York, NY (M.A.M., C.P., S.R.D., V.R., J.M.W.).
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Willner
authors.affiliation: From the Department of Clinical & Experimental Cardiology, Heart Center, Amsterdam Medical Center, University of Amsterdam, Noord-Holland, The Netherlands (T.F.B., A.-F.B.E.Q., A.A.W., R.E.K.); and Helmsley Cardiac Arrhythmia Service, Icahn School of Medicine at Mount Sinai, New York, NY (M.A.M., C.P., S.R.D., V.R., J.M.W.).
authors.forename: Reinoud E
authors.initials: RE
authors.lastname: Knops
mesh_terms: D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019919:Prosthesis Implantation / Q000379:methods*; D016896:Treatment Outcome
keywords: implantable cardioverter-defibrillator; implantation; implantation technique; subcutaneous implantable cardioverter-defibrillator; ventricular arrhythmia