Subcutaneous implantable cardioverter defibrillator for dialysis patients: A strategy to reduce central vein stenoses and infections

Rajiv K. Dhamija, Henry Tan, Edward Philbin, Roy O. Mathew, Mandeep S. Sidhu, Jeffrey Wang, Basil Saour, Syed S. Haqqie, Gerald Beathard, Alexander S. Yevzlin, Loay Salman, William E. Boden, Gary Siskin, Arif Asif

Research output: Contribution to journalArticle

24 Scopus citations

Abstract

Central venous stenosis is a common complication of the transvenous leads associated with an implantable cardioverter defibrillator (ICD). Although epicardial leads have been reported to bypass this complication, their placement is much more invasive than the subcutaneous ICDs (SICDs) and requires the services of a cardiothoracic surgeon. Recent data have demonstrated successful defibrillation using an SICD. In this report, we present 4 long-term hemodialysis patients treated successfully with an SICD. 3 patients received the device for primary prevention of sudden cardiac death (cardiomyopathy with low ejection fraction). The patient in the fourth case had a prolonged QT interval and received the device for secondary prevention. 3 patients had an arteriovenous fistula, whereas 1 patient was dialyzing with a tunneled dialysis catheter. Insertion of an SICD is a minimally invasive procedure. By virtue of leaving the venous system untouched, this approach might offer the advantage of reduced risk of central venous stenosis and infection over an endocardial ICD with transvenous leads. SICD is not experimental; it has been approved by the US Food and Drug Administration and is currently being used in the United States and Europe.

Original languageEnglish (US)
Pages (from-to)154-158
Number of pages5
JournalAmerican Journal of Kidney Diseases
Volume66
Issue number1
DOIs
StatePublished - Jul 1 2015

Keywords

  • arteriovenous fistula (AVF)
  • cardiac leads
  • central venous stenosis
  • end-stage renal disease (ESRD)
  • hemodialysis
  • infection
  • Subcutaneous implantable cardioverter defibrillator (SICD)
  • tunneled dialysis catheter
  • venous occlusion

ASJC Scopus subject areas

  • Nephrology

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    Dhamija, R. K., Tan, H., Philbin, E., Mathew, R. O., Sidhu, M. S., Wang, J., Saour, B., Haqqie, S. S., Beathard, G., Yevzlin, A. S., Salman, L., Boden, W. E., Siskin, G., & Asif, A. (2015). Subcutaneous implantable cardioverter defibrillator for dialysis patients: A strategy to reduce central vein stenoses and infections. American Journal of Kidney Diseases, 66(1), 154-158. https://doi.org/10.1053/j.ajkd.2015.01.028