DISCLOSURES
No external funding was received. The authors report no conflict of
interest.
We thank Antonio Bisignani et al. for their valuable contribution
regarding the evaluation of the case reported by us1.
Despite the results of their experience regarding the stability of the
subcutaneous catheter even with the technique with only two
incisions, in our opinion perhaps 38 cases, especially without
considering selective patients, could be not sufficient to exclude the
risk of mid and long-term lead migration. We think that some groups of
patients can be a challenge during perioperative management and
follow-up. Furthermore, we know that some special categories of
patients, such as athletes, for examples cyclists, can face sensing
mistakes due to the position and that they need an optimal programmation
to avoid inappropriate shock2. Leads displacement can
occur in every kind of implantable device, even a transvenous one; and
this complication is more frequent in young and athletic patients, but
the literature doesn’t give us any suggestion on the kind of ideal
device based on specific physical activity3. S-ICD is
very safe in detecting and treating fatal
arrhythmias4; anyway, follow-up electric data don’t
match with the possibility of lead displacement, while this is possible
with a transvenous defibrillator.
In the case proposed by us, the effectiveness of the shock was not
verified before lead reimplantation because we considered it ethically
incorrect. Nevertheless, a lead displacement can lay the foundation for
shock failure. That is a real and disastrous occurrence that, to date,
only an X-ray check can reveal. The importance that an unknown
displacement can have, especially possible in some categories of
patients at risk of developing this complication, such as the obese,
young patients, or athletes, justifies the efforts to exclude it and has
prompted us to suggest routine X-ray checks. Only in this way is it
possible to quantify a problem that is currently unknown. The hope is
that by interrogating the device it is possible to obtain technical
parameters that can make the displacement of the lead manifest, as is
the case with a transvenous devices.