Long‐term follow‐up of the two‐incision implantation technique for the subcutaneous implantable cardioverter defibrillator

INTRODUCTION The two-incision implantation technique of the subcutaneous implantable cardioverter defibrillator (S-ICD) was introduced as an alternative to the standard three-incision approach by omitting the superior parasternal incision. Thereby, complications may be prevented. Short-term follow-up demonstrated the safety and efficacy of the two-incision technique. However, long-term results are lacking. METHODS This retrospective study included patients implanted between February 2009 and June 2020. Patients were divided into a group of patients who were implanted with the standard three-incision technique and a group who were implanted with the two-incision technique. Outcomes were defibrillation impedance and efficacy and complications requiring intervention. RESULTS A total of 268 patients were included (age 42.4±16.6 years, 35.4% female, BMI 25.1±4.5kg/m2 ). Thirty-one patients underwent S-ICD implantation with the three-incision technique and 237 patients with the two-incision technique. First shock efficacy during defibrillation testing was 93% in the three-incision group versus 94% in the two-incision group (P = 0.69) and shock impedance was 85 versus 68 ohms (P = 0.04). First shock success was 75% versus 76% for spontaneous episodes (P = 1.00). Complication-free survival at five year follow-up in the three-incision group was estimated at 0.96 (95%CI 0.90-1.00) versus 0.98 (95%CI 0.96-1.00) in the two-incision group (P = 0.20) and for inappropriate shocks at five year 0.77 (95%CI 0.63-0.94) versus 0.83 (95%CI 0.77-0.89, P = 0.30), respectively. CONCLUSION Five-year follow-up in this S-ICD cohort showed similar complication rates and effectiveness of two-incision technique compared to the three-incision technique. This technique offers physicians a less invasive and more simplified implantation procedure for the S-ICD, with a better cosmetic result. This article is protected by copyright. All rights reserved.