Subcutaneous implantable cardioverter-defibrillator implantation position predicts successful defibrillation in obese and non-obese patients

Clay Hoster; Annas Rahman; Ansh Goyal; Graham Peigh; Richard Trohman; Bradley P. Knight; Henry Huang; Kousik Krishnan; Timothy Larsen; Alexander Mazur; Parikshit Sharma; Erica Engelstein; Nishant Verma; Jeremiah Wasserlauf

doi:10.1007/s10840-022-01462-z

Subcutaneous implantable cardioverter-defibrillator implantation position predicts successful defibrillation in obese and non-obese patients

Clay Hoster^*, Annas Rahman, Ansh Goyal, Graham Peigh, Richard Trohman, Bradley P. Knight, Henry Huang, Kousik Krishnan, Timothy Larsen, Alexander Mazur, Parikshit Sharma, Erica Engelstein, Nishant Verma, Jeremiah Wasserlauf

^*Corresponding author for this work

Medicine, Cardiology Division

Research output: Contribution to journal › Article › peer-review

10 Scopus citations

Abstract

Background: Subcutaneous implantable cardioverter-defibrillators (S-ICD) are an alternative to transvenous ICDs for patients without a need for cardiac pacing. Obese patients have been proposed to be at higher risk for conversion failure with S-ICDs due to subcutaneous fat underneath the device. Optimal device positioning may promote equivalent outcomes between obese and non-obese patients by minimizing the effects of excess adipose tissue. Methods: A retrospective analysis of patients undergoing defibrillation testing at the time of S-ICD implantation was performed. The primary endpoint was the rate of successful conversion of ventricular fibrillation (VF) at the time of implant. The secondary endpoint was shock impedance. Results: A total of 184 patients were included in the study. The rate of successful conversion of VF was 90.3% for obese patients (n = 72) and 96.4% for non-obese patients (n = 112) (p = 0.086). Compared to non-obese patients, obese patients had a higher mean PRAETORIAN score (78.5 ± 58.1 vs. 48.8 ± 35.5, p < 0.001) and higher measured mean impedance (82.0 ohms ± 26.5 vs. 69.8 ohms ± 19.3, p < 0.001). Patients with a PRAETORIAN score < 90 all had successful defibrillation testing regardless of BMI. Conclusions: In this study, a PRAETORIAN score < 90 was associated with a 100% success rate of defibrillation testing following S-ICD implantation regardless of patient body mass index (BMI). Thus, the impact of obesity on impedance and the risk of failed shocks may be minimized with close attention to implantation technique to achieve a low PRAETORIAN score.

Original language	English (US)
Journal	Journal of Interventional Cardiac Electrophysiology
DOIs	https://doi.org/10.1007/s10840-022-01462-z
State	Accepted/In press - 2023

Funding

Dr. Trohman reports serving as an advisor to Boston Scientific/Guidant; receiving research grants from Boston Scientific/Guidant, Medtronic Inc, St. Jude Medical (Abbott), Vitatron, and Wyeth-Ayerst/Wyeth Pharmaceuticals; serving as a consultant for Biosense Webster, Alta Thera Pharmaceuticals, and Newron Pharmaceuticals P.s.A.; and receiving speakers fees or honoraria from Boston Scientific/Guidant CRM, Medtronic Inc, Daiichi Sankyo, Alta Thera Pharmaceuticals, and St. Jude Medical (Abbott). Dr. Huang reports receiving a fellowship training grant from Boston Scientific. Dr. Krishnan reports serving as a Speaker/Speaker’s Bureau for Zoll. Dr. Sharma reports engaging in activities such as speaking, advising, consulting, or providing educational programs for the following companies or other entities: Medtronic, Biotronik, Abbott, and Biosense Webster. Dr. Knight reports engaging in activities such as speaking, advising, consulting, or providing educational programs for the following companies or other entities: Abbott Laboratories, Inc., Arrhythmia Foundation, Atricure, Inc., BCD Meetings & Events, BIOTRONIK, Baylis Medical Company, Inc., BioSig Technologies, Biosense Webster, Inc. (a Johnson & Johnson Company), Boston Scientific Corporation (includes Guidant Corporation), CVRx, Inc., Case Western Reserve University, Cleveland Clinic Health System, Einstein Medical Center Philadelphia, Global Health Education and Research, HMP Communications, LLC, Medical Device Business Services, Inc., Medtronic, Inc., Sanofi, University of Texas Health Science Center at San Antonio, Wiley-Blackwell (a John Wiley & Sons, Inc. company), Wolters Kluwer Health, Inc. (Wolters Kluwer NV), Women As One. In addition, he received compensation for medical record consultation and/or expert witness testimony. Dr. Verma reports serving as a Speaker/Speaker’s Bureau for Biotronik, Inc., Medtronic, Inc. All other authors report no relevant disclosures. The following co-authors of this study serve as editors and/or members of the editorial board for the Journal of Interventional Cardiac Electrophysiology: Henry Huang, MD, Richard Trohman, MD, Parikshit Sharma, MD, MDH, Tim Larsen, DO, Bradley Knight, MD, Jeremiah Wasserlauf, MD, MS, Alexander Mazur, MD.

Keywords

Defibrillation
ICD
Obesity
PRAETORIAN
S-ICD

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine
Physiology (medical)

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1007/s10840-022-01462-z

Cite this

Hoster, C., Rahman, A., Goyal, A., Peigh, G., Trohman, R., Knight, B. P., Huang, H., Krishnan, K., Larsen, T., Mazur, A., Sharma, P., Engelstein, E., Verma, N., & Wasserlauf, J. (Accepted/In press). Subcutaneous implantable cardioverter-defibrillator implantation position predicts successful defibrillation in obese and non-obese patients. Journal of Interventional Cardiac Electrophysiology. https://doi.org/10.1007/s10840-022-01462-z

@article{6547c594825c434c9fa058b558dd60e0,

title = "Subcutaneous implantable cardioverter-defibrillator implantation position predicts successful defibrillation in obese and non-obese patients",

abstract = "Background: Subcutaneous implantable cardioverter-defibrillators (S-ICD) are an alternative to transvenous ICDs for patients without a need for cardiac pacing. Obese patients have been proposed to be at higher risk for conversion failure with S-ICDs due to subcutaneous fat underneath the device. Optimal device positioning may promote equivalent outcomes between obese and non-obese patients by minimizing the effects of excess adipose tissue. Methods: A retrospective analysis of patients undergoing defibrillation testing at the time of S-ICD implantation was performed. The primary endpoint was the rate of successful conversion of ventricular fibrillation (VF) at the time of implant. The secondary endpoint was shock impedance. Results: A total of 184 patients were included in the study. The rate of successful conversion of VF was 90.3% for obese patients (n = 72) and 96.4% for non-obese patients (n = 112) (p = 0.086). Compared to non-obese patients, obese patients had a higher mean PRAETORIAN score (78.5 ± 58.1 vs. 48.8 ± 35.5, p < 0.001) and higher measured mean impedance (82.0 ohms ± 26.5 vs. 69.8 ohms ± 19.3, p < 0.001). Patients with a PRAETORIAN score < 90 all had successful defibrillation testing regardless of BMI. Conclusions: In this study, a PRAETORIAN score < 90 was associated with a 100% success rate of defibrillation testing following S-ICD implantation regardless of patient body mass index (BMI). Thus, the impact of obesity on impedance and the risk of failed shocks may be minimized with close attention to implantation technique to achieve a low PRAETORIAN score.",

keywords = "Defibrillation, ICD, Obesity, PRAETORIAN, S-ICD",

author = "Clay Hoster and Annas Rahman and Ansh Goyal and Graham Peigh and Richard Trohman and Knight, {Bradley P.} and Henry Huang and Kousik Krishnan and Timothy Larsen and Alexander Mazur and Parikshit Sharma and Erica Engelstein and Nishant Verma and Jeremiah Wasserlauf",

note = "Publisher Copyright: {\textcopyright} 2023, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.",

year = "2023",

doi = "10.1007/s10840-022-01462-z",

language = "English (US)",

journal = "Journal of Interventional Cardiac Electrophysiology",

issn = "1383-875X",

publisher = "Springer",

}

Hoster, C, Rahman, A, Goyal, A, Peigh, G, Trohman, R, Knight, BP, Huang, H, Krishnan, K, Larsen, T, Mazur, A, Sharma, P, Engelstein, E, Verma, N & Wasserlauf, J 2023, 'Subcutaneous implantable cardioverter-defibrillator implantation position predicts successful defibrillation in obese and non-obese patients', Journal of Interventional Cardiac Electrophysiology. https://doi.org/10.1007/s10840-022-01462-z

TY - JOUR

T1 - Subcutaneous implantable cardioverter-defibrillator implantation position predicts successful defibrillation in obese and non-obese patients

AU - Hoster, Clay

AU - Rahman, Annas

AU - Goyal, Ansh

AU - Peigh, Graham

AU - Trohman, Richard

AU - Knight, Bradley P.

AU - Huang, Henry

AU - Krishnan, Kousik

AU - Larsen, Timothy

AU - Mazur, Alexander

AU - Sharma, Parikshit

AU - Engelstein, Erica

AU - Verma, Nishant

AU - Wasserlauf, Jeremiah

PY - 2023

Y1 - 2023

N2 - Background: Subcutaneous implantable cardioverter-defibrillators (S-ICD) are an alternative to transvenous ICDs for patients without a need for cardiac pacing. Obese patients have been proposed to be at higher risk for conversion failure with S-ICDs due to subcutaneous fat underneath the device. Optimal device positioning may promote equivalent outcomes between obese and non-obese patients by minimizing the effects of excess adipose tissue. Methods: A retrospective analysis of patients undergoing defibrillation testing at the time of S-ICD implantation was performed. The primary endpoint was the rate of successful conversion of ventricular fibrillation (VF) at the time of implant. The secondary endpoint was shock impedance. Results: A total of 184 patients were included in the study. The rate of successful conversion of VF was 90.3% for obese patients (n = 72) and 96.4% for non-obese patients (n = 112) (p = 0.086). Compared to non-obese patients, obese patients had a higher mean PRAETORIAN score (78.5 ± 58.1 vs. 48.8 ± 35.5, p < 0.001) and higher measured mean impedance (82.0 ohms ± 26.5 vs. 69.8 ohms ± 19.3, p < 0.001). Patients with a PRAETORIAN score < 90 all had successful defibrillation testing regardless of BMI. Conclusions: In this study, a PRAETORIAN score < 90 was associated with a 100% success rate of defibrillation testing following S-ICD implantation regardless of patient body mass index (BMI). Thus, the impact of obesity on impedance and the risk of failed shocks may be minimized with close attention to implantation technique to achieve a low PRAETORIAN score.

AB - Background: Subcutaneous implantable cardioverter-defibrillators (S-ICD) are an alternative to transvenous ICDs for patients without a need for cardiac pacing. Obese patients have been proposed to be at higher risk for conversion failure with S-ICDs due to subcutaneous fat underneath the device. Optimal device positioning may promote equivalent outcomes between obese and non-obese patients by minimizing the effects of excess adipose tissue. Methods: A retrospective analysis of patients undergoing defibrillation testing at the time of S-ICD implantation was performed. The primary endpoint was the rate of successful conversion of ventricular fibrillation (VF) at the time of implant. The secondary endpoint was shock impedance. Results: A total of 184 patients were included in the study. The rate of successful conversion of VF was 90.3% for obese patients (n = 72) and 96.4% for non-obese patients (n = 112) (p = 0.086). Compared to non-obese patients, obese patients had a higher mean PRAETORIAN score (78.5 ± 58.1 vs. 48.8 ± 35.5, p < 0.001) and higher measured mean impedance (82.0 ohms ± 26.5 vs. 69.8 ohms ± 19.3, p < 0.001). Patients with a PRAETORIAN score < 90 all had successful defibrillation testing regardless of BMI. Conclusions: In this study, a PRAETORIAN score < 90 was associated with a 100% success rate of defibrillation testing following S-ICD implantation regardless of patient body mass index (BMI). Thus, the impact of obesity on impedance and the risk of failed shocks may be minimized with close attention to implantation technique to achieve a low PRAETORIAN score.

KW - Defibrillation

KW - ICD

KW - Obesity

KW - PRAETORIAN

KW - S-ICD

UR - http://www.scopus.com/inward/record.url?scp=85145508916&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85145508916&partnerID=8YFLogxK

U2 - 10.1007/s10840-022-01462-z

DO - 10.1007/s10840-022-01462-z

M3 - Article

C2 - 36596954

AN - SCOPUS:85145508916

SN - 1383-875X

JO - Journal of Interventional Cardiac Electrophysiology

JF - Journal of Interventional Cardiac Electrophysiology

ER -

Subcutaneous implantable cardioverter-defibrillator implantation position predicts successful defibrillation in obese and non-obese patients

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this