International Journal of Cardiology 179 (2015) 42–45

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International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard

Letter to the Editor

A subcutaneous finger cardioverter-defibrillator system removal under local anesthesia Giuseppe Mario Calvagna ⁎, Salvatore Patanè Cardiologia Ospedale San Vincenzo-Taormina (Me), Azienda Sanitaria Provinciale di Messina, 98039 Taormina, Messina, Italy

a r t i c l e

i n f o

Article history: Received 17 October 2014 Accepted 20 October 2014 Available online 24 October 2014

(ICD) system is placed through subcutaneous tunneling technique in general or local anesthesia by an interventional cardiologist. We describe the case of the removal under local anesthesia and re-implantation of a

Keywords: Implantable cardioverter defibrillator (ICD) Endocarditis Infections Pacemaker Subcutaneous ICD (S-ICD)

The use of implantable cardiac devices has increased in the last 30 years. The evolution of devices in serious cardiac rhythm pathology management has led progressively to the development of devices for the treatment of bradycardia, ventricular arrhythmia, and heart failure and for the prevention of sudden cardiac arrest leading to delivery of pacemakers, implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy (CRT) plus ICD (CRT-D) [1–22] and to the recent subcutaneous implantable cardioverter-defibrillator (S-ICD) [23–27]. Infectious complications leading also to endocarditis [1,8, 28–35] and non-infectious complications [9,21,23,36–39] often necessitating removal [1,2,8,39–45] affect patient wellbeing also leading to psychological difficulty increase [46–52] in the emerging scenario of concomitant problems and diseases [53–76]. The modern ICDs in the market deliver a maximum energy of 35 to 41 J in relation to the model using single-coil leads or dual-coil leads. In particular patients, the electric shock delivered, cannot be sufficiently effective to suppress lifethreatening ventricular arrhythmias associated with serious diseases of the myocardium dilated cardiomyopathy (CMD) with non-compacted myocardium. In such patients, in addition to the ICD, devices may be used that facilitate cardioversion such as epicardial cardioverter defibrillation patches (Fig. 1) or a subcutaneous single-finger cardioverterdefibrillator (ICD) system (Fig. 2) [77–83]. Epicardial patches are placed at the sides of the heart through a cardiac surgery approach under general anesthesia, while subcutaneous single-finger cardioverter-defibrillator ⁎ Corresponding author at: Cardiologia Ospedale San Vincenzo-Taormina (Me), Azienda Sanitaria Provinciale di Messina, Contrada Sirina 98039 Taormina, Messina. E-mail address: [email protected] (G.M. Calvagna).

http://dx.doi.org/10.1016/j.ijcard.2014.10.053 0167-5273/© 2014 Elsevier Ireland Ltd. All rights reserved.

Fig. 1. Panel A: endovascular leads. Panel B: Finger lead dislodgement presenting in the left thoraco-axillary region.

G.M. Calvagna, S. Patanè / International Journal of Cardiology 179 (2015) 42–45

subcutaneous single-finger cardioverter-defibrillator (ICD) system in a 36year-old Italian man with CMD and with non-compacted myocardium and severe aortic, mitral and tricuspidal regurgitation. The patient had received an ICD PM with atrial lead, ventricular lead and Finger lead (Fig. 1 panel A) in the left pre-pectoral area awaiting cardiac transplantation. We observed a severe pocket sepsis with lead malfunctioning due to Finger lead dislodgement presenting in the left thoraco-axillary region (Fig. 1 panel B) and we removed the complete system. For the transvenous endocardiac lead removal, the venous entry-site approach was left subclavian vein and Byrd sheath (CooK Vascular Inc.) were utilized (Fig. 1 panels C and D). For the subcutaneous Finger lead removal, C Sheath Liberator (CooK Vascular Inc.) was utilized. Both procedures were performed under local anesthesia with subcutaneous injection with lidocaine 2%. After a 24 day antibiotic treatment, a new ICD was implanted in the down left subpectoral region with dual coil defibrillation lead through subclavian right vein access and connected to the device through subcutaneous suprasternal tunneling technique from right to left region (Fig. 2). The electric shock delivered weren't sufficiently effective to suppress induced ventricular tachycardia and thus we proceeded with lead Finger positioning through subcutaneous tunneling technique from

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device to left paravertebral region. The two 35 J ICD electric shocks delivered weren't sufficiently effective to suppress induced ventricular tachycardia and the second external electric shock delivered with bipolar 200 J. Epicardial patches were placed at the sides of the heart through a cardiac surgery approach under general anesthesia. 1. Conclusions In particular patients, the electric shock delivered, cannot be sufficiently effective to suppress life-threatening ventricular arrhythmias associated with serious diseases of the myocardium such as CMD with non-compacted myocardium. In these patients, in addition to the ICD, devices can be needed to facilitate cardioversion. This case focuses on the subcutaneous Finger lead removal performed without complications and under local anesthesia and on the importance of a collaborative vision of a multi-disciplinary treatment team [69] for patient's safety. Author contributions Giuseppe Mario Calvagna wrote the work and prepared the references, and Salvatore Patanè prepared the figures and figure legends. Acknowledgments The authors of this manuscript have certified that they adhere to the statement of ethical publishing as appears in International Journal of Cardiology. References

Fig. 2. Panels A and B transvenous endocardiac lead removal. The venous entry-site approach was left subclavian vein and Byrd sheath (CooK Vascular Inc.) were utilized. Panel C: A new ICD was implanted in the down left subpectoral region with dual coil defibrillation lead through subclavian right vein access and connected to the device through subcutaneous suprasternal tunneling technique from right to left region. Thus we proceeded with lead Finger positioning through subcutaneous tunneling technique from device to left paravertebral region.

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A subcutaneous finger cardioverter-defibrillator system removal under local anesthesia.

A subcutaneous finger cardioverter-defibrillator system removal under local anesthesia. - PDF Download Free
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