Arrhythmias & electrophysiology
Epicardial placement of implantable cardioverter-defibrillators in adults: Technical considerations, system performance, and clinical outcomes
Authors' conclusion
Surgical implantation of epicardial ICD systems with HV coils/leads is safe and feasible.
Study context
- Population
- Adults receiving surgically implanted epicardial implantable cardioverter-defibrillator (ICD) high voltage (HV) coils or leads, Hospital of the University of Pennsylvania, 2014–202514 men, median age 64 years
- Participants
- 19 adults
- Outcome
- Indications, techniques, safety and long-term performance
- Follow-up
- Median 468 days
Methodological detailssingle-centre
- Single-centre
Main finding
As reported in the abstract
- Indication: ICD replacement after lead extraction for endocarditis
- 7
- Indication: placement during concomitant surgery, incl. for tricuspid regurgitation
- 6
- Indication: LV assist device
- 3
- Indication: lack of venous access
- 3
- HV coils used
- 58%
- Epicardial leads received
- 42%
- CRT received
- 68%
- HV coil/lead site: posterior LV
- 48%
- HV coil/lead site: anterior RV
- 16%
- HV coil/lead site: both ventricles
- 26%
- HV coil/lead site: transverse sinus
- 11%
Observational data: associations, not effects.
Further findings
System performance and mortality · median follow-up 468 days
- Impedances > 200 Ω (loose set screw; damaged connector pin)
- 2
- Impedances < 20 Ω without clinical impact
- 2
- Coil fracture 1.5 years post-implant
- 1
- Failed shocks or lead migrations
- 0
- Died, largely from advanced HF; none attributable to surgery
- 26%
Original publication
Epicardial placement of implantable cardioverter-defibrillators in adults: Technical considerations, system performance, and clinical outcomes. Heart Rhythm. Published 22 May 2025. doi:10.
Summarised from the published abstract; every number is checked against it