How many icds are implanted annually

In addition, hematoma rates and length of stay appeared to decrease during the study period. The characteristics of the overall S-ICD—eligible and propensity-matched cohorts are detailed in the eTable in the Supplement and Table 3 , respectively. In-hospital mortality was infrequent 0. There were more hematomas among S-ICD recipients, but this increase did not reach statistical significance.

Patients with an S-ICD who had a periprocedural cardiac arrest were predominantly elderly individuals with ischemic cardiomyopathy, symptomatic heart failure, and advanced chronic kidney disease, including 5 patients undergoing dialysis. Regarding DFT testing, 4 patients had successful defibrillation at 65 J, 1 patient required 80 J, and 3 patients did not undergo DFT testing at the time of the implant. Device revisions during the index hospitalization were rare 0.

We report several key observations regarding the trends and in-hospital outcomes associated with early adoption of the S-ICD in the United States. First, although S-ICD use is steadily increasing, this device is being implanted in few candidates.

Our findings suggest that the S-ICD is being used most frequently in high-risk patients, including those with a prior cardiac arrest and dialysis-dependent renal failure. Third, although DFT at the time of S-ICD implantation carries a class I indication, it is performed in approximately three-fourths of all patients and use has been declining. Patient age, proportion of women, and rates of prior ICDs were comparable among the groups.

It is probable that S-ICD complication rates will decline as more operators gain experience with the procedure. Complications and successful DFT testing rates were comparable between the groups, although the small sample size limited the power for detecting between-group differences.

This association may be due to the risk of the S-ICD procedure, the comorbidities of the typical patient receiving the S-ICD, chance, or a combination of factors. If the S-ICD procedure was higher risk than implantation of the other ICDs, one might expect a greater rate of multiple complications with an associated increased length of stay, but this increase was not observed in our study.

Based on the fact that the S-ICD has been hypothesized to be more beneficial in patients at high risk for intravascular infections, it is likely that S-ICD recipients have several unmeasured confounders that influenced the decision to implant an S-ICD and may place these individuals at higher risk for complications.

Most of these patients were elderly and undergoing dialysis, making them marginal ICD candidates in many regards. These cardiac arrests did not appear to be related to failed DFT testing.

However, DFT testing typically requires deeper sedation compared with the device implantation and thus could predispose toward hemodynamic compromise and cardiac arrest even in the setting of successful ventricular fibrillation conversion. Our study has several key clinical implications. First, the S-ICD is being implanted in many high-risk patients with very low complication rates and high rates of successful DFT testing.

Although the favorable in-hospital outcomes suggest that wider adoption of the S-ICD may be warranted, additional studies with longitudinal follow-up are needed to better define the risk-benefit and cost-effectiveness of this potentially disruptive technology relative to traditional TV-ICDs. Our study has several key limitations. The design was observational and retrospective and treatment was not randomized. In addition, although we used robust statistical methods to account for differences between groups, we cannot rule out the possibility of residual confounding.

Implantation of S-ICDs may be preferentially performed in higher-risk patients because of lower predicted complication rates; this selection may have led to an overestimate of the true rates of S-ICD complications. The well-balanced characteristics in the propensity-matched groups suggest that our statistical methods were adequate. Only in-hospital outcomes were available for analysis; therefore, we are unable to report on mid-term and long-term outcomes and complications.

Our study included of the S-ICDs The comparative analysis included only patients who received ICDs implanted during an elective hospitalization and may not be generalizable to individuals who underwent the procedure during an acute hospitalization.

Despite frequent use in patients with several comorbidities, early adoption of S-ICDs has been associated with low complication rates and high rates of successful DFT testing.

Corresponding Author: Sana M. Published Online: September 7, Author Contributions: Drs Friedman and Al-Khatib had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Critical revision of the manuscript for important intellectual content: All authors. Dr Curtis owns stock in Medtronic, receives research funding from Boston Scientific, and receives salary support from the American College of Cardiology to provide data analytic services.

No other disclosures were reported. Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy Continue. View Large Download. Table 1. Table 2. Table 3. Table 4. A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias.

N Engl J Med. PubMed Google Scholar Crossref. Eur Heart J. Randomized comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from cardiac arrest: the Cardiac Arrest Study Hamburg CASH. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. A randomized study of the prevention of sudden death in patients with coronary artery disease. Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy.

B: shows the electrocardiographic records, trace channel and morphology electrogram during induced ventricular fibrillation in the operating room, reversed by a shock of 25 J from the device. After the procedure, the patient was admitted to the paediatric intensive care unit for 24 h with a good clinical outcome without complications from the procedure. Oral tolerance began at 24 h without abdominal discomfort. After hospital discharge, the patient was referred for outpatient control and monitoring in the defibrillator consultation of paediatric cardiology.

During follow-up a year and a half , with regular checks every 6 months, no significant arrhythmias were detected. The sensing and stimulation thresholds, as well as impedances, remained stable. The patient has remained asymptomatic without any kind of limitation placed on physical activity. The implantation of a subcutaneous coil, designed for intravenous use, reduces the number of complications of probe vascular access in children.

Use of the implantation technique can prevent venous obstruction, adhesions in venous walls, cardiac cavities or valvular structures, tricuspid regurgitation, the tension on the tube with the growth of the child and future hypothetical intracavitary abandonment if the probe is damaged and cannot be extracted. Furthermore, access via subxiphoid implant for the epicardial probes avoids sternotomy or thoracotomy. As a result, the challenge of implanting these devices in the paediatric population has led us to develop the technique described.

It is minimally invasive and its safety and efficacy have been established after a year and a half of monitoring. Home Articles in press Current Issue Archive. ISSN: Previous article Next article. Issue 1.

Pages January More article options. Download PDF. This item has received. Article information. Please consider upgrading your browser. Considering an ICD? Not Important Extremely Important 1 2 3 4 5 A chance to have a longer life. The ICD being a well-studied treatment option. My faith or beliefs about the ICD being the right choice for me.

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