Pier Lambiase, EHRA 2018 – Patient Suitability for First- and Second-line Subcutaneous Defibrillator Implantation

Pier Lambiase (Institute of Cardiovascular Science, University College London, London) discusses the implantation of first- and second-line subcutaneous defibrillators and patient suitability for implantation. Implantation is mainly suitable for any patient that does not require a lead in their heart. The main contraindications for implantation are if the patient has a unipolar pacemaker, or if they have a recurrent monomorphic ventricular tachycardia which is responsive to ATP. Patients are screened through the use of ECG and an automated screening tool, which compares the patient’s results to an electronic template to see if the patient would pass screening with the device implanted. There are three vectors that can be used – ideally, two vectors are preferred to allow for some reserve but it is acceptable to have one vector for the patient.

Filmed at EHRA 2018, Barcelona.

Questions:
1. Please outline the key factors indicating patient suitability for first- and second-line subcutaneous defibrillator implantation. 0:07
2. What are the key contraindications for implantation of a subcutaneous defibrillator? 0:43
3. How do you screen patients ahead of subcutaneous defibrillator implantation? 1:05
4. What measures do you take to refine your patient selection criteria? How can data from patient registries help? 2:01