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general anaesthesia, as creating a larger pocket between the muscles and tunnelling the lead over the sternum, as well as performing defibrillation threshold testing, can be quite painful. The S-ICD can deliver only temporary post-shock pacing, but cannot otherwise address bradycardia and cannot deliver anti-tachycardia pacing. Inappropriate shocks were numerically more frequent in those with subcutaneous ICDs. Defibrillation testing has traditionally been considered mandatory in patients with subcutaneous implantable cardioverter–defibrillator to confirm appropriate ventricular fibrillation detection. However, PRAETORIAN-DFT
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be relatively thin and flexible, since they have to pass through (and remain in) the heart valve(s) and need to flex with every heartbeat. This makes the leads more vulnerable to lead fracture (and therefore complications). It has been demonstrated that device-related complications were numerically more frequent in patients with transvenous ICDs. Due to the position of the pulse generator under the collarbone, it can be more visible with clothing with low neckline.
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The lead does not go into the heart, which means it leaves the veins and the heart completely intact. This reduces chance of complications (e.g. systemic infections). Because the lead does not go into the heart it can be thicker and more robust. This minimizes / reduces the chance of lead fracture.
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The leads go into the vein and heart and will grow into the heart wall over time. This may increase the chance of complications if the leads need to be removed or replaced, as the procedure to extract an intracardiac leads can be a challenge. Because the leads need to go into the heart they need to
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The generator is smaller than the S-ICD generator, which may result in a less visible implanted device. This could improve the time needed to get used to the implantable device, although this is subjective. The procedure can usually be done under local anesthesia and light sedation. The transvenous
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The pulse generator is larger than most transvenous ICD pulse generators. This could result in a longer time needed to get used to it, although this is subjective. Depending on the physique of a person, the S-ICD may be more visible with bare chest. The procedure usually requires deep sedation or
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The S-ICD was developed to reduce the risk of complications associated with transvenous leads. Potential complications, such as infections in the bloodstream and the need to remove or replace the leads in the heart, are minimised or entirely eliminated with the S-ICD system.
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Poole, Jeanne E.; Olshansky, Brian; Mark, Daniel B.; Anderson, Jill; Johnson, George; Hellkamp, Anne S.; Davidson-Ray, Linda; Fishbein, Daniel P.; Boineau, Robin E.; Anstrom, Kevin J.; Reinhall, Per G.; Packer, Douglas L.; Lee, Kerry L.; Bardy, Gust H. (2020-07-28).
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Quast, Anne-Floor B. E.; Baalman, Sarah W. E.; Betts, Tim R.; Boersma, Lucas V. A.; Bonnemeier, Hendrik; Boveda, Serge; Brouwer, Tom F.; Burke, Martin C.; Delnoy, Peter Paul H. M.; El-Chami, Mikhael; Kuschyk, Juergen (August 2019).
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Waroux, Jean-Benoit le Polain de; Ploux, Sylvain; Mondoly, Pierre; Eschalier, Romain; Strik, Marc; Houard, Laura; Pierre, Bertrand; Buliard, Samuel; Klotz, Nicolas; Ritter, Philippe; Haissaguerre, Michel (2018-05-01).
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Patients who are relatively younger, who need ICD for primary prevention, and who do not require pacing or cardiac resynchronisation therapy, are more suitable for S-ICD implantation. A young survivor of aborted
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In contrast to a transvenous ICD, the pulse generator is implanted on the left side of the chest next to the rib cage, just under the arm, and the lead is implanted just under the skin above the breastbone.
662:"Rationale and design of the PRAETORIAN-DFT trial: A prospective randomized CompArative trial of SubcutanEous ImplanTable CardiOverter-DefibrillatoR ImplANtation with and without DeFibrillation testing"
373:
Guided by anatomical landmarks and/or an X-ray image, the subcutaneous ICD electrode is tunneled under the skin. The subcutaneous ICD delivers therapy without the need for wires implanted in the heart.
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is aiming to demonstrate non-inferiority of omitting DFT in patients undergoing S-ICD implantation in which the S-ICD system components are optimally positioned by calculated PRAETORIAN score.
281:(ATP). However, device-related complications were numerically more frequent in patients with transvenous ICDs, inappropriate shocks are less frequent that in those with subcutaneous ICDs.
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A transvenous ICD is typically implanted in the left shoulder area, near the collarbone. Occasionally the right side is preferred for certain patients or other specific reasons.
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are more suitable for transvenous ICD implantation. An older patient with ischemic cardiomyopathy and documented symptomatic ventricular tachycardia is a typical example.
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Depending on heart condition, 1, 2 or 3 leads will be placed in the heart. Once the leads are put in place, they are attached to the heart wall for optimal connectivity.
612:"Defibrillation testing is mandatory in patients with subcutaneous implantable cardioverter–defibrillator to confirm appropriate ventricular fibrillation detection"
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Patients who are relatively older, who need ICD for secondary prevention, or who have concomitant bradycardia requiring pacing, or heart failure requiring
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Using X-ray imaging (fluoroscopy), the leads are fed through a vein into the heart and through the heart valve(s) into the heart.
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but unlike the transvenous ICD, the S-ICD lead is placed just under the skin, leaving the heart and veins untouched.
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536:"Subcutaneous vs. Transvenous Implantable Cardioverter–Defibrillator: Which Is Better?. NEJM Journal Watch"
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In the event the system needs to be explanted, the procedure is a relatively simple surgical procedure.
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562:"Long-Term Outcomes of Implantable Cardioverter-Defibrillator Therapy in the SCD-HeFT"
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475:"An Overview of Clinical Outcomes in Transvenous and Subcutaneous ICD Patients"
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The subcutaneous ICD leaves the heart and blood vessels untouched and intact.
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Baalman, S. W. E.; Quast, A. B. E.; Brouwer, T. F.; Knops, R. E. (2018).
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Subcutaneous
Implantable Defibrillator (S-ICD) - Official Patient site
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EMBLEM™ MRI S-ICD System - Subcutaneous
Implantable Defibrillator
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is an implantable medical device for detecting and terminating
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in patients at risk of sudden cardiac arrest. It is a type of
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Transvenous vs subcutaneous ICD implantation procedure
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Subcutaneous implantable cardioverter defibrillator
87:. Unsourced material may be challenged and removed.
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402:Westerman, Stacy B; El-Chami, Mikhael (2018).
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566:Journal of the American College of Cardiology
458:: CS1 maint: DOI inactive as of May 2024 (
50:Learn how and when to remove these messages
794:Cardiology diagnostic tests and procedures
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890:Transcatheter pulmonary valve replacement
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212:Learn how and when to remove this message
147:Learn how and when to remove this message
933:shunt from heart chamber to blood vessel
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96:"Subcutaneous implantable defibrillator"
1033:shunt from blood vessel to blood vessel
732:Subcutaneous ICD - EMBLEM S-ICD™ System
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306:Subcutaneous ICD (lead under the skin)
249:implantable cardioverter defibrillator
1163:Valve-sparing aortic root replacement
902:enlargement of existing septal defect
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420:10.11909/j.issn.1671-5411.2018.03.004
897:production of septal defect in heart
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259:Transvenous ICD (leads in the heart)
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85:adding citations to reliable sources
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356:Subcutaneous ICD implant procedure
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994:transposition of the great vessels
919:creation of septal defect in heart
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1294:Cardiac resynchronization therapy
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353:Transvenous ICD implant procedure
300:cardiac resynchronisation therapy
228:S-ICD lead and generator position
31:This article has multiple issues.
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1301:Left atrial appendage occlusion
408:Journal of Geriatric Cardiology
72:needs additional citations for
39:or discuss these issues on the
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1423:Radionuclide ventriculography
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1408:Myocardial perfusion imaging
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1015:for univentricular defect
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479:Current Cardiology Reports
1552:Cardiac electrophysiology
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1355:Implantable loop recorder
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999:Arterial switch operation
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789:Interventional cardiology
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681:10.1016/j.ahj.2019.05.002
491:10.1007/s11886-018-1021-8
327:randomised clinical trial
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1434:Coronary catheterization
924:Blalock–Hanlon procedure
885:Mitral valve replacement
868:Aortic valve replacement
245:ventricular fibrillation
1430:Cardiac catheterization
1372:Electrophysiology study
1272:Radiofrequency ablation
1237:Alcohol septal ablation
422:(inactive 2024-05-10).
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241:ventricular tachycardia
1476:Impedance cardiography
1098:Coronary artery bypass
669:American Heart Journal
342:is a typical example.
279:antitachycardia pacing
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1507:Transcutaneous pacing
1311:Heart transplantation
1232:Ventricular reduction
1048:Blalock–Taussig shunt
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1481:Ballistocardiography
1038:systemic circulation
340:sudden cardiac death
183:improve this article
81:improve this article
1557:Implants (medicine)
1360:Cardiac stress test
1338:Electrocardiography
1277:Pacemaker insertion
1024:Kawashima procedure
988:compound procedures
863:Aortic valve repair
836:Mitral valve repair
185:by rewriting it in
1567:Cardiac procedures
1413:Cardiovascular MRI
1343:Vectorcardiography
1198:Pericardial window
1193:Pericardiocentesis
1134:Drug-eluting stent
963:Rastelli procedure
912:Balloon septostomy
269:ICD is capable of
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187:encyclopedic style
174:is written like a
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1386:Angiocardiography
1332:Electrophysiology
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1262:Catheter ablation
1245:Conduction system
1170:LeCompte maneuver
1158:Bentall procedure
1019:Norwood procedure
1009:Senning procedure
1004:Mustard procedure
907:Atrial septostomy
858:Valve replacement
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1267:Cryoablation
1108:Off-pump CAB
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826:Valve repair
816:Heart valves
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616:Heart Rhythm
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1444:Cardiac PET
1187:Pericardium
1151:Atherectomy
1089:Angioplasty
831:Valvulotomy
675:: 167–174.
275:bradycardia
1542:Cardiology
1536:Categories
1439:Cardiac CT
1306:Cardiotomy
1211:Myocardium
979:Sano shunt
769:procedures
767:Tests and
545:2022-01-30
389:References
195:March 2016
137:March 2016
107:newspapers
36:improve it
819:and septa
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1523:Category
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1252:Cox maze
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446:29721001
808:Surgery
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121:scholar
1495:Pacing
1103:MIDCAB
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1452:sound
1324:Tests
1282:S-ICD
1179:Other
1113:TECAB
958:aorta
773:heart
701:S2CID
665:(PDF)
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460:link
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424:ISSN
320:Cons
311:Pros
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273:for
264:Pros
243:and
100:news
1401:TEE
1396:TTE
1288:ICD
1083:CHD
1055:SVC
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