Poojita Shivamurthy MD , Marisa Cevasco MD, MPH , Gregory E. Supple MD , Balaram Krishna Hanumanthu MD , Timothy M. Markman MD , Gustavo Guandalini MD , Matthew C. Hyman MD , Andres Enriquez MD , Ramanan Kumareswaran MD , Michael G. Fradley MD , Rajat Deo MD , Vincent Y. See MD , Michael Riley MD , Fermin Garcia MD , Saman Nazarian MD , David Lin MD , David S. Frankel MD , Sanjay Dixit MD , Andrew E. Epstein MD , David J. Callans MD , Robert D. Schaller DO
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引用次数: 0
Abstract
Background
Surgical implantation of epicardial implantable cardioverter-defibrillator (ICD) is considered when transvenous ICD placement is not feasible because of congenital anomalies, venous obstruction, or prior infections. Epicardial pacemakers are well-studied but less is known about contemporary epicardial ICD systems in adults.
Objectives
This case series details the indications, techniques, safety, and long-term performance of surgically implanted epicardial high voltage (HV) coils and leads in adults.
Methods
We included all patients who received epicardial HV coils or leads at the Hospital of the University of Pennsylvania between 2014 and 2025.
Results
Nineteen patients (14 men, median age 64 years) were identified. Indications included ICD replacement after lead extraction for endocarditis (7), placement during concomitant surgery, including for tricuspid regurgitation (6), left ventricular assist device (3), and lack of venous access (3). HV coils were used in 58%, and 42% received epicardial leads. All patients received epicardial pace-sense leads; 68% received cardiac resynchronization therapy. HV coils or leads were sewn to the epicardium: 48% on the posterior left ventricle, 16% on the anterior right ventricle, 26% on both ventricles, and 11% in the transverse sinus. Two patients had impedances > 200 Ω because of a loose set screw and a damaged connector pin, respectively. Two had impedances < 20 Ω without clinical impact. One coil fractured 1.5 years post-implant. No failed shocks or lead migrations occurred. During a median follow-up of 468 days, 26% died, largely from advanced heart failure, none were attributable to surgery.
Conclusion
Surgical implantation of epicardial ICD systems with HV coils/leads is safe and feasible. Multidisciplinary planning and long-term monitoring are essential.
期刊介绍:
HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability.
HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community.
The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.