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Eligibility of Pacemaker Patients for Subcutaneous Implantable Cardioverter Defibrillators
Author(s) -
IP JAMES E.,
WU MICHAEL S.,
KENNEL PETER J.,
THOMAS GEORGE,
LIU CHRISTOPHER F.,
CHEUNG JIM W.,
MARKOWITZ STEVEN M.,
LERMAN BRUCE B.
Publication year - 2017
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.13182
Subject(s) - medicine , qrs complex , cardiology , candidacy , implantable cardioverter defibrillator , sudden cardiac death , cardiac pacing , cardiac resynchronization therapy , heart failure , ejection fraction , politics , political science , law
S‐ICD Candidacy Among Ventricularly Paced Patients Introduction The subcutaneous implantable cardioverter defibrillator (ICD) has emerged as a viable therapeutic option for patients who are deemed high risk for sudden cardiac death. Previous studies have shown that 7–15% of patients are not candidates for the S‐ICD based on their intrinsic QRS/T‐wave morphology. Presently, it is not known if the S‐ICD can be considered as supplementary therapy in patients who are ventricularly paced. We sought to determine the proportion of ventricularly paced patients who would qualify for an S‐ICD. Methods and Results We evaluated 100 patients with transvenous pacemakers/ICDs, including 25 biventricular devices to determine S‐ICD candidacy during right ventricular (RV) pacing and biventricular pacing based on the recommended QRS:T‐wave ratio screening template. Fifty‐eight percent of patients qualified for an S‐ICD based on their QRS morphology during ventricular pacing. More patients during biventricular pacing met criteria compared to during RV pacing alone (80% vs. 46%, P <0.01). Patients that were paced from the RV septum were more likely to qualify compared to those paced from the RV apex (67% vs. 37%, respectively, P <0.01). Conclusion While S‐ICD implantation may be considered as supplemental therapy in select patients with preexisting transvenous devices, relatively fewer candidates who are paced from the RV apex qualify. QRS morphologies generated from biventricular pacing as well as from septal RV pacing are more likely to screen in based on the recommended S‐ICD template.