Background: The subcutaneous implantable-cardioverter defibrillator (S-ICD) is an appealing alternative to transvenous ICD systems. However, data on indications for S-ICD explantations are sparse. Objectives: To assess incidence and indications for S-ICD explantation at a large tertiary referral center. Methods: We conducted a retrospective study of all S-ICD explantations performed from 2014 to 2020. Data on demographics, comorbidities, implantation characteristics, and indications for explantation, were collected. Results: A total of 64 patients underwent S-ICD explantation during the study period. During that time, there were 410 S-ICD implantations at our institution of which 53 (12.9%) were explanted with a mean duration from implant to explant of 19.7±20.1 months. The mean age of the patients at explantation was 44.8±15.3 years, and 42% (n=27) were female. The indication for S-ICD implantation was primary prevention in 58% and secondary prevention in 42% of the patients. The most common reason for explantation was infection (32.8%) followed by abnormal sensing (25%) and need for pacing (18.8%). Those who underwent S-ICD explantation for pacing indications were significantly older (55.7±13.6 vs 42.3± 14.6 years, p = 0.005) with a wider QRS duration (111±19 ms vs 98±19 ms, p = 0.03) at device implantation compared to patients who underwent explantation for other indications. Conclusion: Incidence of S-ICD explantation in a large tertiary practice was 12.9%. While infection was the indication for a third of the explantations, a significant number were due to sensing abnormalities and need for pacing. These data may have implications for patient selection for S-ICD implantation.

The COVID-19 pandemic has had a profound effect on the practice of clinical medicine. Tremendous resources have been poured into caring for patients infected with the virus necessitating a reduction in elective medical procedures. The extent to which physicians have modified their behavior in treating non-COVID-19 patients remains unclear. To address this question, we queried major cardiology vendors (Boston Scientific, Abbott and Biosense Webster) in the Philadelphia region to quantify arrhythmia ablation and cardiac device implantation volumes at 27 hospitals. We observed a significant, inverse correlation between regional COVID-19 cases and cardiac electrophysiologic procedures since the beginning of the US outbreak in late January. Furthermore, we observed that atrial fibrillation ablation and ICD implantation rates dropped more than VT ablation and device generator change rates did consistent with a shift away from elective medical procedures. These results can inform expected procedural volume load and planning once routine clinical practice resumes.

Introduction: Catheter ablation (CA) of typical atrial flutter (AFl) is the preferred treatment for typical AFl due to excellent long-term success. However, current guidelines recommend oral anticoagulation (OAC) based on established indices of stroke regardless of the perceived success of ablation. Methods: We identified all patients who underwent typical AFl ablation at our institute from 2011-2017. All patients continued OAC for at least 6 weeks post CA and underwent 24-hour Holter monitoring. OAC was discontinued if there was no evidence of recurrence at 6 weeks. In patients with low LVEF or prior Atrial Fibrillation episodes, OAC was continued for 6 months with repeat Holter monitoring at 6 months. Results: A total of 106 patients were included in our analysis, mean age was 64±14 years and 78.3% were male. Mean CHADSVaSC score was 3±1. OAC was discontinued by 6 weeks in 17% and at 1 year in 55.7%. OAC was continued indefinitely in 44.3%. Over a mean follow up period of 28.6±27.3 months, there was one ischemic stroke in the OAC discontinuation group and no ischemic events in the continued OAC group. There was a total of 3 major bleeding events, all in the OAC group. Conclusion: In patients undergoing successful atrial flutter ablation, a strategy of OAC discontinuation with close rhythm monitoring appears feasible. Benefit of continued OAC in this cohort may be outweighed by the adverse risk of bleeding. Further studies examining rhythm guided OAC can minimize unnecessary exposure to long term anticoagulation.