Introduction: The fully Subcutaneous Implantable Cardioverter Defibrillator (SICD) has been introduced as a less invasive option for the prevention of Sudden Cardiac Death (SCD). According to the labeling, the implantation of the device requires three incisions: one pocket incision for the pulse generator and two parasternal incisions to tunnel the lead. These parasternal incisions are a potential source of discomfort and infection. Also the superior parasternal incision leaves a cosmetically notable scar on the upper chest. A less invasive, two incision, implantation technique has recently been introduced that omits the superior parasternal incision. Short term follow-up in a small patient cohort has shown that it is a safe and efficacious alternative for S-ICD implantation and may help to reduce complications. No long term follow up data is available on this technique.
Methods: The two incision technique has been described previously. It makes use of a peelable sheeth to avoid the superior parasternal incision. We performed a retrospective analysis of all the patients in our center that have been implanted with this technique.
Results: A total of 107 S-ICD patients were implanted with the two incision technique (56% male, mean age 40±16, BMI 25 (16.6-37.3). During a total follow up of 180 years patient years (mean 12 months, range 1-48) no dislocations were observed. One S-ICD system was repositioned due to DFT failure. First shock efficacy during DFT was 96% and 75% (6/8) for spontaneous episodes (100% efficacy with multiple shocks). The 1 year inappropriate shock rate was 7.4%. Device function was normal in all patients, and no inappropriate sensing occurred related to the implantation technique. Four infections occurred of which one originated from the parasternal incision.
Conclusions: Long term follow up in a large patient cohort continues to show the safety and effectiveness of the two incision technique for S-ICD implantation. This technique offers physicians a less invasive and simplified implantation procedure for the S-ICD