Long‐term follow‐up of the two‐incision implantation technique for the subcutaneous implantable cardioverter‐defibrillator

INTRODUCTION: The two‐incision implantation technique of the subcutaneous implantable cardioverter‐defibrillator (S‐ICD) was introduced as an alternative to the standard three‐incision approach by omitting the superior parasternal incision. Thereby, complications may be prevented. Short‐term follow‐up demonstrated the safety and efficacy of the two‐incision technique. However, long‐term results are lacking. METHODS: This retrospective study included patients implanted between February 2009 and June 2020. Patients were divided into a group of patients who were implanted with the standard three‐incision technique and a group who were implanted with the two‐incision technique. Outcomes were defibrillation impedance and efficacy and complications requiring intervention. RESULTS: A total of 268 patients were included (age 42.4 ± 16.6 years, 35.4% female, BMI 25.1 ± 4.5 kg/m(2)). Thirty‐one patients underwent S‐ICD implantation with the three‐incision technique and 237 patients with the two‐incision technique. First shock efficacy during defibrillation testing was 93% in the three‐incision group versus 94% in the two‐incision group (P = .69), and shock impedance was 85 versus 68 ohms (P = .04). First shock success was 75% versus 76% for spontaneous episodes (P = 1.00). Complication‐free survival at 5‐year follow‐up in the three‐incision group was estimated at 0.96 (95% CI 0.90‐1.00) versus 0.98 (95% CI 0.96‐1.00) in the two‐incision group (P = .20) and for inappropriate shocks at 5‐year 0.77 (95% CI 0.63‐0.94) versus 0.83 (95% CI 0.77‐0.89, P = .30), respectively. CONCLUSION: Five‐year follow‐up in this S‐ICD cohort showed similar complication rates and effectiveness of two‐incision technique compared to the three‐incision technique. This technique offers physicians a less invasive and more simplified implantation procedure for the S‐ICD, with a better cosmetic result.