SPC365

Implantation of Extravascular ICD: a single-centre experience

Session: SESSÃO DE POSTERS 42 - DISPOSITIVOS CARDÍACOS IMPLANTÁVEIS: CDI E CRT
Speaker: Miguel Sobral Domingues

Congress: CPC 2025
Topic: C. Arrhythmias and Device Therapy
Theme: 09. Device Therapy
Subtheme: 09.2 Implantable Cardioverter / Defibrillator
Session Type: Cartazes
FP Number: ---
Authors: Miguel Sobral Domingues; Daniel Gomes; Gustavo Rodrigues; João Carmo; Daniel Matos; Francisco Costa; Pedro Galvão Santos; Pedro Carmo; Francisco Morgado; Diogo Cavaco; Pedro Adragão

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif">Background: </span></strong><span style="font-family:&quot;Calibri&quot;,sans-serif">The extravascular implantable cardioverter-defibrillator (EV-ICD) is an innovative technology for preventing sudden cardiac death. The EV-ICD lead is implanted in the retrosternal space and offers advantages over the subcutaneous, including anti-tachycardia pacing (ATP), pause-preventing pacing and an increased generator projected longevity (11.7 years vs. 7.3 years). </span><span style="font-family:&quot;Calibri&quot;,sans-serif">While it has recently received approval for clinical use, clinical experience with its implantation remains limited, and data concerning its efficacy and safety are still sparse.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif">Objective: </span></strong><span style="font-family:&quot;Calibri&quot;,sans-serif">We aim to describe our single-centre experience with EV-ICD implantation and to evaluate immediate and short-term safety and efficacy outcomes.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif">Methods: </span></strong><span style="font-family:&quot;Calibri&quot;,sans-serif">We retrospectively collected data from consecutive patients submitted to EV-ICD implantation since January 2023 to September 2024. We evaluated the procedural success, peri-procedural complications and the stability of ICD functional parameters at a 6-month follow-up.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif">Results: </span></strong><span style="font-family:&quot;Calibri&quot;,sans-serif">Six patients (mean age 33 years; 4 male) underwent EV-ICD implantation &ndash; 5 patients in 1ary prevention and 1 patient in 2ary prevention</span><span style="font-family:&quot;Calibri&quot;,sans-serif">. Indications included genetic dilated cardiomyopathy (n=2), status post myocardial infarction with reduced LV function (n=1), hypertrophic cardiomyopathy (n=1), and primary/idiopathic electrical disease (n=2). All patients underwent a thoracic CT scan for procedural planning. The mean procedure duration was 69&plusmn;22 minutes. Electrodes were placed retrosternally in a left parasternal position, with generators positioned at the 5th intercostal space along the mid-axillary line. Defibrillation testing was successful in all cases, achieving termination of induced VF with a single 30J shock. No peri-procedural complications were observed, including bleeding, infection and lead dislodgement or dysfunction. During a median follow-up of 143 days (IQR 63&ndash;224) no therapies (appropriate or inappropriate) were delivered. Sensing amplitude, pacing lead impedance, and shock lead impedance remained stable and did not significantly change during follow-up compared to implantation values (8.7 [1.5&ndash;20] mV vs. 7.5 [2.8&ndash;16] mV; 494 [399&ndash;608] ? vs. 445 [342&ndash;562] ?; 88 &plusmn; 16 ? vs. 70 &plusmn; 24 ?, all p &gt; 0.05). One patient died of a non-cardiac cause.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif">Conclusion: </span></strong><span style="font-family:&quot;Calibri&quot;,sans-serif">In our initial experience, EV-ICD implantation was feasible, safe and effective. There were no complications during the peri-procedural phase and the device performance remained stable throughout the follow-up period. These findings highlight the potential of EV-ICDs for arrhythmia management and support their use in clinical practice. </span></span></span></p>