The subcutaneous ICD as an alternative to the conventional ICD system: Initial experience in Greece and a review of the literature.
The introduction of an implantable cardioverter defibrillator (ICD) in clinical practice has revolutionized our therapeutic approach for both primary and secondary prevention of sudden cardiac death (SCD), as it has proven to be superior to medical therapy in treating potentially life-threatening ventricular arrhythmias and has resulted in reduced mortality rates. However, implantation of a conventional ICD carries a non-negligible risk of periprocedural and long-term complications associated with the transvenous ICD leads. The entirely subcutaneous implantable cardioverter defibrillator (S-ICD) has recently emerged as a therapeutic alternative to the conventional ICD for patients with various cardiopathies and who are at high risk of SCD. The main advantage is the avoidance of vascular access and thus avoidance of complications associated with transvenous leads. Patients without pacing indications, such as bradycardia, a need for antitachycardia pacing or cardiac resynchronization, as well as those at higher risk of complications from transvenous lead implantation are perfect candidates for this novel technology. The subcutaneous ICD has proven to be equally safe and effective compared to transvenous ICD systems in early clinical trials. Further technical improvements of the system will likely lead to the expansion of indications and widespread use of this technology. In the present review, we discuss the indications for this system, summarize early clinical experiences and highlight the advantages and disadvantages of this novel technology. In addition, we present the first two cases of subcutaneous cardioverter defibrillator system implantation in Greece.
State Department of Cardiology, Hippokration Hospital, 114 Vasilisis Sofias street, 11528, Athens, Greece. Electronic address: skevos1@otenet.gr.
Skevos
S
Sideris
First Cardiology Division, University of Athens, Medical School, Hippokration Hospital, 114 Vasilisis Sofias street, 11528, Athens, Greece.
Stefanos
S
Archontakis
First Cardiology Division, University of Athens, Medical School, Hippokration Hospital, 114 Vasilisis Sofias street, 11528, Athens, Greece.
Konstantinos A
KA
Gatzoulis
First Cardiology Division, University of Athens, Medical School, Hippokration Hospital, 114 Vasilisis Sofias street, 11528, Athens, Greece.
Aristotelis
A
Anastasakis
State Department of Cardiology, Hippokration Hospital, 114 Vasilisis Sofias street, 11528, Athens, Greece.
Ilias
I
Sotiropoulos
First Cardiology Division, University of Athens, Medical School, Hippokration Hospital, 114 Vasilisis Sofias street, 11528, Athens, Greece.
Petros
P
Arsenos
State Department of Cardiology, Hippokration Hospital, 114 Vasilisis Sofias street, 11528, Athens, Greece.
Alexandros
A
Kasiakogias
State Department of Cardiology, Hippokration Hospital, 114 Vasilisis Sofias street, 11528, Athens, Greece.
Dimitrios
D
Terentes
State Department of Cardiology, Hippokration Hospital, 114 Vasilisis Sofias street, 11528, Athens, Greece.
Konstantinos
K
Trachanas
State Department of Cardiology, Hippokration Hospital, 114 Vasilisis Sofias street, 11528, Athens, Greece.
Eleftherios
E
Paschalidis
First Cardiology Division, University of Athens, Medical School, Hippokration Hospital, 114 Vasilisis Sofias street, 11528, Athens, Greece.
Dimitrios
D
Tousoulis
State Department of Cardiology, Hippokration Hospital, 114 Vasilisis Sofias street, 11528, Athens, Greece.
Ioannis
I
Kallikazaros
D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000503:physiopathology / Q000628:therapy*; D001919:Bradycardia / Q000628:therapy; D053840:Brugada Syndrome / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D058406:Cardiac Resynchronization Therapy / Q000379:methods; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D017147:Defibrillators, Implantable / Q000009:adverse effects* / Q000639:trends; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006115:Greece / Q000453:epidemiology; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D040521:Subcutaneous Tissue / Q000601:surgery*; D017180:Tachycardia, Ventricular / Q000628:therapy; D016896:Treatment Outcome
Brugada syndrome; Sudden cardiac death; Ventricular tachyarrhythmias