Acute Feasibility Investigation of a New S-ICD Electrode

Not Applicable

Completed

Interventions: Device: commercially released subcutaneous implantable cardioverter defibrillator (S-ICD) and the Investigational S-ICD Adapter.

Brief Summary: This is an early-stage feasibility study. This study seeks to characterize the performance of the new electrode shock configuration with the S-ICD

Detailed Description: Background: The subcutaneous implantable cardioverter-defibrillator (S-ICD, EMBLEM®, Boston Scientific Corp) delivers 80 J shocks from an 8 cm left-parasternal coil (LPC) to a 59 cc left lateral pulse generator (PG). A system that defibrillates with lower energy could significantly reduce PG size. Computer modeling and animal studies suggest a 2nd shock coil either parallel (P) to LPC or transverse (T) from xiphoid to PG pocket would significantly reduce shock impedance and defibrillation threshold (DFT).

Objective: Acutely test defibrillation efficacy of P and T configurations in patients receiving an S-ICD.

Methods: Testing was performed in patients receiving a conventional S-ICD system (C) for standard indications. Patients at risk for conversion failure, stroke or infection were excluded. A 65 J success with the conventional S-ICD was required prior to investigational testing. A second electrode was temporarily inserted from the xiphoid incision using the same introducer and sheath tools and connected to the PG with an investigational Y-adapter (Model 3598, Boston Scientific). Phase 1 (n=11) tested only P at a starting energy of 50 J with subsequent tests at 65 or 30 J then 40 or 20 J depending upon outcome. Phase 2 (n=21) tested both P and T in random order, starting at 30 J then either 40 or 20 J.

Recruitment & Eligibility

Inclusion Criteria

Subject is scheduled to receive a de novo S-ICD system implant per labeled indication.
Passing S-ICD screening ECG performed per applicable user's manual.
Subject is willing and capable of providing informed consent specific to local and national laws.
Subject is age 18 or above, or of legal age to give informed consentspecific to local and national law.

Key

Exclusion Criteria

Subject has an unusual chest anatomy (eg. pectus excavatum and pectus carinatum) that might impede the ability to temporarily insert a second S-ICD electrode.
Subject has a left ventricular ejection fraction ≤ 20% within 3 months prior to enrollment.
Subject has NYHA Class IV or unstable Class III heart failure.
Subject that, in the opinion of the investigator, cannot tolerate the DFT testing required by this protocol.
Subject is morbidly obese, defined as BMI ≥ 35.
Subject has an active infection or has been treated for infection within the past 30 days.
Subject that, in the opinion of the investigator, has an increased risk of infection.
Subject is currently requiring/receiving dialysis.
Subject has insulin-dependent diabetes.
Subject had/has any prior or planned other surgical procedure within ±30 days of enrollment.
Subject that, in the opinion of the investigator, has an increased risk for thromboembolic event.
Subject that, in the opinion of the investigator, has an increased risk of excessive bleeding.
Subject is currently on an active heart transplant list.

Arm && Interventions

Group	Intervention	Description
Single Arm	commercially released subcutaneous implantable cardioverter defibrillator (S-ICD) and the Investigational S-ICD Adapter.	Defibrillation threshold (DFT) testing Arm

Primary Outcome Measures

Name	Time	Method
Defibrillation Threshold (DFT) of the New Shock Electrode Configuration in Joules	Acute- During the implant procedure- up to 1 hour	The primary objective of this acute feasibility study is to measure the DFT of the new shock electrode configuration with an S-ICD system. The unit of measure will be in Joules. Ventricular Fibrillation (VF) will be induced and the device will deliver a shock at a certain defined energy level as described in the protocol

Secondary Outcome Measures

Name	Time	Method
Number of Participants With Successful Ventricular Fibrillation (VF) Conversion at 40 Joules	Acute- During the implant procedure- up to 1 hour	The secondary objective is to assess the conversion success of the new electrode configuration to convert VF. VF will be induced and the device will deliver a shock at a certain defined energy level as described in the protocol

Locations (4): St. Antonius Ziekenhuis
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Nieuwegein, Netherlands
Erasmus MC - University Medical Center Rotterdam
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Rotterdam, Netherlands
Isala Klinieken
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Zwolle, Netherlands
Academisch Medisch Centrum
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Amsterdam, Netherlands