Luca Avolio, Paolo Zappulla, Daniela Dugo, Maria Teresa Cannizzaro, Angelo Di Grazia, Davide Capodanno
{"title":"Progressive Anatomical Evolution Leading to Loss of S-ICD Eligibility in Hypertrophic Cardiomyopathy: A Case Report.","authors":"Luca Avolio, Paolo Zappulla, Daniela Dugo, Maria Teresa Cannizzaro, Angelo Di Grazia, Davide Capodanno","doi":"10.1111/pace.15169","DOIUrl":null,"url":null,"abstract":"<p><p>Subcutaneous implantable cardioverter defibrillators (S-ICDs) are designed to avoid complications from transvenous leads, but patient selection requires careful screening, especially in conditions like hypertrophic cardiomyopathy (HCM) with frequent conduction abnormalities. A 27-year-old male with HCM underwent S-ICD implantation in 2015 after successful screening. In 2020, inappropriate shocks due to T-wave oversensing led to vector adjustments. By 2022, further shocks and failed re-screening revealed ineligibility for S-ICD due to low R/T ratios in multiple vectors. Imaging and ECG comparisons from 2015 to 2022 showed disease progression, with increased fibrosis and conduction abnormalities. As a result, a transvenous ICD was implanted. This case underscores how HCM progression, associated with fibrosis and ECG changes, can render S-ICD unsuitable over time. It highlights the importance of periodic reassessment in high-risk patients, as disease progression can compromise S-ICD eligibility, necessitating alternative solutions for inappropriate shocks.</p>","PeriodicalId":54653,"journal":{"name":"Pace-Pacing and Clinical Electrophysiology","volume":" ","pages":"422-426"},"PeriodicalIF":1.7000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pace-Pacing and Clinical Electrophysiology","FirstCategoryId":"5","ListUrlMain":"https://doi.org/10.1111/pace.15169","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/3 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Subcutaneous implantable cardioverter defibrillators (S-ICDs) are designed to avoid complications from transvenous leads, but patient selection requires careful screening, especially in conditions like hypertrophic cardiomyopathy (HCM) with frequent conduction abnormalities. A 27-year-old male with HCM underwent S-ICD implantation in 2015 after successful screening. In 2020, inappropriate shocks due to T-wave oversensing led to vector adjustments. By 2022, further shocks and failed re-screening revealed ineligibility for S-ICD due to low R/T ratios in multiple vectors. Imaging and ECG comparisons from 2015 to 2022 showed disease progression, with increased fibrosis and conduction abnormalities. As a result, a transvenous ICD was implanted. This case underscores how HCM progression, associated with fibrosis and ECG changes, can render S-ICD unsuitable over time. It highlights the importance of periodic reassessment in high-risk patients, as disease progression can compromise S-ICD eligibility, necessitating alternative solutions for inappropriate shocks.
期刊介绍:
Pacing and Clinical Electrophysiology (PACE) is the foremost peer-reviewed journal in the field of pacing and implantable cardioversion defibrillation, publishing over 50% of all English language articles in its field, featuring original, review, and didactic papers, and case reports related to daily practice. Articles also include editorials, book reviews, Musings on humane topics relevant to medical practice, electrophysiology (EP) rounds, device rounds, and information concerning the quality of devices used in the practice of the specialty.