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How many patients fulfil the surface electrocardiogram criteria for subcutaneous implantable cardioverter-defibrillator implantation?

Daniel A. Randles , Nathaniel M. Hawkins , Matthew Shaw , Ashish Y. Patwala , Stephen J. Pettit , David J. Wright
DOI: http://dx.doi.org/10.1093/europace/eut370 1015-1021 First published online: 18 December 2013

Abstract

Aims To determine the number of patients with a primary or secondary prevention implantable cardioverter-defibrillator (ICD) indication who are eligible for subcutaneous ICD (S-ICD) implantation according to the S-ICD manufacturer's surface electrocardiogram (ECG) screening template.

Methods and results One hundred and ninety-six ICD patients with a non-paced ventricle were assessed using erect and supine ECG limb lead recordings to simulate the three S-ICD sensing vectors. Each ECG lead was scrutinized by two independent observers. Subcutaneous ICD eligibility required two or more leads to satisfy the S-ICD screening template in both erect and supine positions. Overall, 85.2% of patients [95% confidence interval (CI): 80.2–90.2%] fulfilled surface ECG screening criteria. The proportion of patients with 3, 2, 1, and 0 qualifying leads were 37.2% (95% CI: 30.4–44.0%), 48.0% (95% CI: 41.0–55.0%), 11.2% (95% CI: 6.8–15.6%), and 3.6% (95% CI: 1.0–6.2%). The S-ICD screening template was satisfied more often by Lead III (primary vector, 83.7%, 95% CI: 78.5–88.9%) and Lead II (secondary vector, 82.7%, 95% CI: 77.4–88.0%) compared with Lead I (alternate vector, 52.6%, 95% CI: 45.6–59.6%). A prolonged QRS duration was the only baseline characteristic independently associated with ineligibility for S-ICD implantation. There was 92.9% agreement between the two independent observers in assessment of eligibility using the S-ICD screening template.

Conclusion About 85.2% of patients with an indication for a primary or secondary prevention ICD have a surface ECG that is suitable for S-ICD implantation when assessed with an S-ICD screening template. There is minor inter-observer variation in assessment of eligibility using the S-ICD screening template.

  • Subcutaneous implantable cardioverter-defibrillator
  • Electrocardiogram
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