Our Summary

The study focused on the use of a specific type of heart defibrillator, the subcutaneous ICD (S-ICD), in patients who have previously undergone a sternotomy - a surgical procedure that involves cutting through the breastbone. The S-ICD is implanted under the skin and is a good alternative for patients who don’t need a pacemaker, as it avoids complications related to inserting devices into the blood vessels.

The researchers looked back at the records of adult patients who had an S-ICD implant between January 2014 and June 2020. They were particularly interested in comparing patients who had previously undergone a sternotomy with those who hadn’t.

The study included 212 patients, 22% of whom had previously undergone a sternotomy. They found that there was no significant difference in several key outcomes between the two groups. These included the ‘sensing vector’ (the pathway the electrical signal follows), the position of the S-ICD lead relative to the breastbone, and the energy level required to reset the heart’s rhythm.

They also found that the frequency of complications within the first 30 days following implantation, and the frequency of unnecessary shocks delivered by the device, were similar between the two groups over an average follow-up period of 28 months.

The study concluded that implantation of an S-ICD in patients with previous sternotomy is as safe as in those without, with similar risks of early complications and unnecessary shocks.

FAQs

  1. What is a subcutaneous ICD (S-ICD) and how is it used in patients who have undergone a sternotomy?
  2. What were the key outcomes considered in the study comparing patients with and without a previous sternotomy?
  3. According to the study, what are the risks of implanting an S-ICD in patients with a previous sternotomy?

Doctor’s Tip

One helpful tip a doctor might tell a patient about sternotomy is to avoid heavy lifting or strenuous activities that involve using the arms and chest muscles for several weeks after the procedure. This can help prevent excessive strain on the healing incision and breastbone, allowing for proper healing and reducing the risk of complications. It’s important to follow your doctor’s advice and gradually increase your activity level as you recover.

Suitable For

Patients who are recommended sternotomy typically include those who require heart surgery, such as coronary artery bypass grafting, valve replacement, or other complex cardiac procedures. These patients may have a history of heart disease, arrhythmias, or other heart conditions that require surgical intervention. Additionally, patients who have previously undergone a sternotomy and require an implantable defibrillator, such as the S-ICD, may also be recommended sternotomy to access the necessary area for device placement.

Timeline

Before the sternotomy:

  • Patient is diagnosed with a heart condition that requires the implantation of a defibrillator
  • Patient undergoes pre-operative evaluations and discussions with their healthcare team
  • Surgical team plans the procedure, including the positioning of the device and the incision site
  • Patient undergoes the sternotomy surgery to access the heart and implant the S-ICD

After the sternotomy:

  • Patient is monitored in the hospital for any immediate post-operative complications
  • Patient may experience pain and discomfort at the incision site
  • Patient is provided with instructions for post-operative care, including wound care and activity restrictions
  • Patient is followed up with by their healthcare team for regular check-ups and device monitoring
  • Over time, patient resumes normal activities and experiences the benefits of having the S-ICD in place for their heart condition.

What to Ask Your Doctor

Some questions a patient should ask their doctor about sternotomy and the use of an S-ICD include:

  1. How does my previous sternotomy impact the implantation and function of an S-ICD?
  2. What specific risks or complications should I be aware of when undergoing S-ICD implantation after a sternotomy?
  3. Will the positioning of the S-ICD lead be different due to my previous sternotomy?
  4. How will the sensing vector be affected by my sternotomy?
  5. What energy level will be required to reset my heart’s rhythm with an S-ICD after a sternotomy?
  6. Are there any specific precautions or considerations I should take with an S-ICD given my history of sternotomy?
  7. How often will I need to follow up with you after receiving an S-ICD following a sternotomy?
  8. What is the likelihood of unnecessary shocks from the S-ICD after a sternotomy, and how will this be managed?
  9. Are there any alternative treatment options for me considering my history of sternotomy?
  10. Can you provide me with more information or resources about S-ICDs and sternotomy for further education and understanding?

Reference

Authors: Al-Kofahi M, Adeola OG, Payne J, Mohammed M, Reddy YM, Dendi R, Pimentel R, Berenbom L, Emert M, Ramirez R, Noheria A, Montgomery JA, Sheldon SH. Journal: Pacing Clin Electrophysiol. 2023 Feb;46(2):100-107. doi: 10.1111/pace.14615. Epub 2022 Nov 21. PMID: 36355425