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Heart Rhythm. 2013 Aug;10(8):1240-3. doi: 10.1016/j.hrthm.2013.05.016. Epub 2013 May 21.

Two-incision technique for implantation of the subcutaneous implantable cardioverter-defibrillator.

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Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.



Three incisions in the chest are necessary for implantation of the entirely subcutaneous implantable cardioverter-defibrillator (S-ICD). The superior parasternal incision is a possible risk for infection and a potential source of discomfort. A less invasive alternative technique of implanting the S-ICD electrode--the two-incision technique--avoids the superior parasternal incision.


The purpose of this prospective cohort study was to evaluate the safety and efficacy of the two-incision technique for implantation of the S-ICD.


Consecutive patients who received an S-ICD between October 2010 and December 2011 were implanted using the two-incision technique, which positions the parasternal part of the S-ICD electrode using a standard 11Fr peel-away sheath. All patients were routinely evaluated for at least 1 year for complications and device interrogation at the outpatient clinic.


Thirty-nine patients (46% male, mean age 44 ± 15 years) were implanted with a S-ICD using the two-incision technique. During mean follow-up of 18 months (range 14-27 months) no dislocations were observed, and there was no need for repositioning of either the ICD or the electrode. No serious infections occurred during follow-up except for 2 superficial wound infections of the pocket incision site. Device function was normal in all patients, and no inappropriate sensing occurred related to the implantation technique.


The two-incision technique is a safe and efficacious alternative for S-ICD implantations and may help to reduce complications. The two-incision technique offers physicians a less invasive and simplified implantation procedure of the S-ICD.


DFT; EIT; ICD; Implantable cardioverter-defibrillator; Implantation technique; S-ICD; Subcutaneous implantable cardioverter-defibrillator; VF; defibrillation threshold; electrode insertion tool; implantable cardioverter-defibrillator; subcutaneous implantable cardioverter-defibrillator; ventricular fibrillation

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