2. Sudden Cardiac Arrest
Morhaf Ibrahim, MD, FHRS
Electrophysiology

3. Causes of Death in USA 1999

4. Etiology of SCA

5. Prior cardiovascular event
SCA Risk Factors
Prior cardiovascular event
Advancing age
Hereditary factors
African American Ethnicity
40% of all SCA occur in patients with known risk factors
Zipes Circulation 1998;98: b: Zipes JACC 2006;48:e247-e346

6. Arrhythmia Cause of SCA

7. Underlying Arrhythmias of SCA

8. LVEF and SCA

9. Heart Failure and SCA

10. Severity of Heart Failure Modes of Death

11. Incidence of SCA vs. Annual Sudden Deaths

12. AIVR

13. Nonsustained Monomorphic VT

14. Nonsustained LV VT

15. Sustained Monomorphic VT 72-year-old woman with CHD

16. Nonsustained Polymorphic VT

17. Sustained Polymorphic VT Exercise induced in patient with no structural heart disease

18. Bundle Branch Reentrant VT

19. Spontaneous conversion to NSR (12-lead ECG)
Ventricular Flutter
Spontaneous conversion to NSR (12-lead ECG)

20. VF with Defibrillation (12-lead ECG)

21. Wide QRS Irregular Tachycardia: Atrial Fibrillation with antidromic conduction in patient with accessory pathway – Not VT

22. Treatments to Reduce SCA

23. AICD

24. Michel Mirowski

25. Primary Prevention Trials
SCA Prevention
Primary Prevention Trials
Trial
Risk Type
Clinical Relevance
MADITa (1996)
EF<35%
prior MI
NSVT, EP+
The survival benefits of ICD therapy were demonstrated in high-risk patients who had not experienced life-threatening VT/VF
MADIT IIb (2001)
EF<30%
The survival benefits of ICD therapy were demonstrated in high-risk patients who did not have documented arrhythmias.
COMPANIONc (2002)
CAD; CHF
QRS >120
The survival benefits of CRT-D (defibrillation) therapy were demonstrated in heart failure patients who did not have an ICD indication
SCD-HeFTd (2005)
EF<35%; CAD±MI or NICM
The survival benefits of ICD therapy were demonstrated in NYHA Class II or III CHF patients with an LVEF < 35%
CAD = coronary artery disease; EP+ = positive for documented episode of asymptomatic, unsustained ventricular tachycardia; LVEF = Left ventricular ejection fraction; MI = myocardial infarction; NSVT = non-sustained ventricular tachyarrhythmia; NICM = non-ischemic cardiomyopathy; SCA = sudden cardiac arrest;
By 2005, the mortality benefit of ICD therapy was clearly established for both primary and secondary prevention of SCA.
a: Moss NEJM 1996;335: b: Moss NEJM 2002;346: c: Bristow NEJM 2004;350: d: Bardy NEJM 2005;352:

26. Introduction to the S-ICDTM System
Protection Without Touching the Heart

27. Subcutaneous ICD Therapy
The S-ICDTM System
Entirely subcutaneous
Does not require leads in the heart
Sophisticated algorithms provide effective detection and treatment of VT/VFa,b
a: Gold J Cardiovasc. Electrophysiol. 2012, 23: b: Weiss Circulation 2013;128:944–953

28. Implantation of S-ICDTM System
A predictable implant that relies only on anatomical landmarks

30. Implanted S-ICDTM Systems Device location is well accepted by patientsa
Smith W, Hood M. HRS 2007 Abstract Presentation S-ICD System Comfort and Tolerability Study Heart Rhythm; 4(5) S210. b) Case studies are not necessarily representative of clinical performance. Case study performance may vary .

31. EFFORTLESS Registry Broad Range of Clinical Indications
Patients with a broad range of cardiac conditions have received the S-ICDTM System
Lambiase EFFORTLESS S-ICD Registry, HRS 2012, Boston, MA

32. Broad Range of Body Habitus
Patients in all age groups and across a broad range of body habitus have received the S-ICDTM System
S-ICD System Commercial Implant Analysis, Q (1079 patients). Data on File. Boston Scientific, San Clemente, California

33. Appropriate Use of the S-ICDTM System Poole JE, Gold MR
Appropriate Use of the S-ICDTM System Poole JE, Gold MR. Circ Arrhythm Electrophysiol 2013;6:
Strong Candidates
No vascular access
History of recurrent TV lead infections/fractures
Renal failure, diabetes, immuno-compromised
Reasonable Candidates
Young patients with primary electrical problems
Patients with a primary prevention indication
Prior VF arrest
Prosthetic valves
Inappropriate Candidates
Patients with bradycardia pacing indications
Need for CRT
Recurrent monomorphic VT

34. Thank you!