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      The Italian subcutaneous implantable cardioverter-defibrillator survey: S-ICD, why not?

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          A recommendation for a subcutaneous-implantable cardioverter-defibrillator (S-ICD) has been added to recent European Society of Cardiology Guidelines. However, the S-ICD is not ideally suitable for patients who need pacing. The aim of this survey was to analyse the current practice of ICD implantation and to evaluate the actual suitability of S-ICD.

          Methods and results

          The survey ‘S-ICD Why Not?’ was an independent initiative taken by the Italian Heart Rhythm Society (AIAC). Clinical characteristics, selection criteria, and factors guiding the choice of ICD type were collected in consecutive patients who underwent ICD implantation in 33 Italian centres from September to December 2015. A cardiac resynchronization therapy (CRT) device was implanted in 39% (369 of 947) of patients undergoing de novo ICD implantation. An S-ICD was implanted in 12% of patients with no CRT indication (62 of 510 with available data). S-ICD patients were younger than patients who received transvenous ICD, more often had channelopathies, and more frequently received their device for secondary prevention of sudden death. More frequently, the clinical reason for preferring a transvenous ICD over an S-ICD was the need for pacing (45%) or for antitachycardia pacing (36%). Nonetheless, only 7% of patients fulfilled conditions for recommending permanent pacing, and 4% of patients had a history of monomorphic ventricular tachycardia that might have been treatable with antitachycardia pacing.


          The vast majority of patients needing ICD therapy are suitable candidates for S-ICD implantation. Nevertheless, it currently seems to be preferentially adopted for secondary prevention of sudden death in young patients with channelopathies.

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          Most cited references 13

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          Percent right ventricular pacing predicts outcomes in the DAVID trial.

          The Dual-Chamber and VVI Implantable Defibrillator (DAVID) trial demonstrated a worse outcome in patients with implantable cardioverter-defibrillators (ICDs) programmed to DDDR at 70 bpm compared with patients who had ICDs programmed to VVI backup pacing at 40 bpm. Pacing was more frequent in the DDDR group. The purpose of this study was to determine whether right ventricular pacing (RV) is an independent predictor of outcome in the DAVID trial. We evaluated the relationship of percent RV pacing to the composite endpoint of death or hospitalization for congestive heart failure. Patients who had a 3-month follow-up and who had not yet reached an endpoint were included in the study. Using Cox regression analysis (VVI group N = 195; DDDR group N = 185), we examined multiple factors, including percent RV pacing at 3-month follow-up, that might be associated with adverse outcomes. Percent RV pacing as a continuous variable was correlated with the primary endpoint. As a dichotomous variable, the best separation for predicting endpoints occurred with DDDR RV pacing > 40% vs DDDR RV pacing < or = 40% (P = .025). Patients with DDDR RV pacing < or = 40% had similar or better outcomes to the VVI backup group (P = .07). Correction for baseline variables predictive of the composite outcome in the (nonpaced) VVI group (use of nitrates, increased heart rate, and increased age) did not change the findings for RV pacing (P = .008). In contrast, atrial pacing was not predictive of worse outcomes. These results suggest, but do not prove, a causal relationship between frequent RV pacing and adverse outcomes in patients with left ventricular ejection fraction < or = 40%.
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            2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing.

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              Catheter ablation of ventricular tachycardia in ischaemic and non-ischaemic cardiomyopathy: where are we today? A clinical review.

              According to the current guidelines, patients with ischaemic cardiomyopathy (ICM) or non-ischaemic cardiomyopathy (NICM) at risk for sudden cardiac death should undergo implantation of an implantable cardioverter-defibrillator (ICD). Although ICDs effectively terminate ventricular arrhythmias, the arrhythmogenic substrate remains unchanged or may progress over time, resulting in recurrent ICD shocks. Defibrillator shocks increase mortality and worsen quality of life. Evidence from two prospective randomized trials on outcome in patients with ischaemic heart disease undergoing catheter ablation for ventricular tachycardia (VT) suggests that ablation prevents recurrence of VT and decreases the number of ICD shocks. This review will highlight the recent progress made in the ablative treatment of VT in patients with ICM and NICM.

                Author and article information

                Oxford University Press
                November 2017
                23 December 2016
                23 December 2016
                : 19
                : 11
                : 1826-1832
                [1 ]Unit of Electrophysiology, S. Anna Hospital ASST Lariana, Via Ravona 1, San Fermo della Battaglia, 22020 Como, Italy
                [2 ]Cardiology, University of Tor Vergata, 00133 Rome, Italy
                [3 ]Cardiology and Arrhythmology Clinic, Università Politecnica delle Marche, 60020 Ancona, Italy
                [4 ]Cardiology, Casa di Cura Montevergine, Mercogliano, 83013 Avellino, Italy
                [5 ]EP lab, A.S. Ospedaliera S. Croce e Carle, 12100 Cuneo, Italy
                [6 ]Electrophysiology, Ospedale San Martino, 161332 Genova, Italy
                [7 ]Cardiology Unit, ‘Card. G. Panico’ Hospital, Tricase, 73039 Lecce, Italy
                [8 ]Cardiology, Ospedale Vito Fazzi, 73100 Lecce, Italy
                [9 ]Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy
                [10 ]Department of Cardiovascular Surgery Sant'Anna Hospital, 88100 Catanzaro, Italy
                [11 ]Department of Cardiology, Fondazione Policlinico S. Matteo IRCCS, 27100 Pavia, Italy
                [12 ]Cardiology, Ospedale S. Anna e S. Sebastiano, 81100 Caserta, Italy
                [13 ]Cardiology, Ospedale Papa Giovanni XXIII, 24127 Bergamo, Italy
                [14 ]Cardiology, Ospedale SS. Annunziata, 87100 Cosenza, Italy
                [15 ]Cardiology Department, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy
                [16 ]Cardiology, IRCCS MultiMedica, 20099 Sesto San Giovanni, Italy
                [17 ]CRM dept, Boston Scientific, 20134 Milan, Italy
                [18 ]Cardiology, Ospedale Monaldi, 80131 Naples, Italy
                Author notes
                [* ] Corresponding author. Tel: +39 031 585 8756; fax: +39 031 585 5946. E-mail address: gluca.botto@
                © The Author 2016. Published by Oxford University Press on behalf of the European Society of Cardiology.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact

                Page count
                Pages: 7
                Clinical Research
                Sudden death and ICDs


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