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Introduction The subcutaneous implantable cardioverter defibrillator (S-ICD) has been considered as a comparable alternative to transvenous ICD in a wide array of patients (pts) without pacing indication. Recent data have reported high rates of inappropriate (inap) therapies with S-ICD, mostly due to T wave or noise oversensing. Purpose Our aim was to assess the predictive factors of inap therapies over a mid-term follow-up (FU) period after SICD implantation. Methods All pts implanted with an S-ICD and a FU above 6 months were included in a cross-sectional monocentric study. Data from preoperative screening with a thorough ECG study (amplitude of QRS complex, T wave and QRS:T ratio in leads I, II and III) has been collected. Pts were followed by remote monitoring. Results One hundred and twenty-four pts (50 ± 14 years old, male 84%) were included. Indications were: primary 73% and secondary prevention 27% (ischemic cardiopathy 39%; hypertrophic 8%; dilated 36%; channelopathy 2%). During a mean FU of 25 ± 16 months, 29 pts (23%) experienced at least one therapy: 15 pts with appropriate (12%) and 15 pts with inap shocks (12%). A total of 22 inap shocks have been observed after a mean FU period of 15 ± 18 months (1.5 ± 1 inap shock per pt, several shocks for 4 pts). Causes were: supraventricular arrhythmias (33%), T wave (20%) and noise (53%) oversensing. The number of eligible vectors during preoperative screening was correlated with the occurrence of inap shocks (−0.23; P Fig. 1 ). Conclusion Inap therapies remain frequent with S-ICD. Preoperative screening (number of eligible vectors) and ECG data may be taken into consideration to identify patients at high risk for inap shocks.

Background The increase in ICD implantation has been accompanied by an increase in lead-related complications. Non-functional ICD leads extraction can be challenging with a high rate of complications. Purpose The aim of this study was to examine transvenous ICD lead extraction at the University Hospital of Grenoble-Alpes. Methods This is a retrospective analysis of the extractions performed since May 2002, for lead dysfunction. The variables studied were extraction techniques and results. Results A total of 110 ICD leads were removed during 106 extraction procedures. The mean age was 61.8 ± 14.6 years and 80.2% were male. All procedures were performed in the operating room of cardiac surgery, under general anesthesia, with surgical stand-by and trans-esophageal echocardiographic monitoring. One ICD lead has been removed during the procedure in 96.2% (n = 102) and 2 leads in 3.8% (n = 4). These leads were double-coil in 88.2% (n = 97) and single-coil in 11.8% (n = 13). The extraction strategy consisted of simple traction (10%, n = 10), and in case of failure, gradual use of locking stylet (7.3%, n = 8), laser sheath (80%, n = 88) and femoral vascular approach by lasso (2.7%, n = 3). The global success rate was 97.2% (n = 103). Complications recorded were bleeding (8.5%, n = 9) and tamponade (1.9%, n = 2). The mortality rate was 2.8% (n = 3). All deaths were due to a vena cava injury, specifically superior vena cava in 2 cases and inferior vena cava in 1 case. Two deaths occurred during extraction and the third death after the end of the procedure. Univariate analysis has shown that lead age greater than 10 years is significantly associated with mortality (16.7% vs. 1.1%, P = 0.03). Conclusion In this long-term monocentric experience, ICD lead extraction had a high success rate, but is still challenging with vena cava injury leading to death is 2.8%.