Arrhythmias & electrophysiologyCohort study

Evaluation of a second-generation intercostal extravascular implantable cardioverter defibrillator lead with a pectoral pulse generator for sensing, defibrillation, and anti-tachycardia pacing

EuropacePublished

  • Prospective single-group pilot study
  • acute and 3-month follow-up
  • concomitant transvenous ICD (TV-ICD) as control

Extravascular implantable cardioverter defibrillator (EV-ICD) system followed in recording-only mode; control TV-ICD in therapy delivery mode · Devices evaluated before discharge, 2 weeks, 1, 2 and 3 months post-implant

Authors' conclusion

In this pilot experience with a second-generation intercostal EV-ICD lead implantation, sensing and defibrillation of induced VF were successful when paired with a standard ICD PG from either a left mid-axillary or pectoral pocket.

Study context

Population
Subjects undergoing a TV-ICD procedure who received a concomitant second-generation intercostal EV-ICD lead system
Participants
20 subjects
Exposure
Intercostal EV-ICD lead with left mid-axillary vs left pectoral PG
Outcome
Safety and performance outcomes (sensing, defibrillation of induced ventricular arrhythmias, pacing capture)
Follow-up
3 months

Main finding

As reported in the abstract

Successful defibrillation of induced VF
GroupValuePatients tested
Left mid-axillary PG100%17
Left pectoral PG95%20

Observational data: associations, not effects.

Further findings

Successful implantation

Successfully implanted
20/20 (100%)
Median implant time
9 min

Intraoperative pacing capture (integrated bipolar configuration)

Pacing capture achieved
19 of 20 (95%)
Pacing capture tolerated in all subjects; over 90% no pain after 1-month recovery

Sensing and defibrillation prior to lead removal

Successful
18 of 18 (100%)

Safety

Major lead complications · mean of 82 days

Major lead complications (lead movement; infection of both TV-ICD and EV-ICD systems)
2

Original publication

Evaluation of a second-generation intercostal extravascular implantable cardioverter defibrillator lead with a pectoral pulse generator for sensing, defibrillation, and anti-tachycardia pacing. Europace. Published 3 March 2025. doi:10.1093/europace/euaf044

Summarised from the published abstract; every number is checked against it