American Journal of Kidney Diseases

Subcutaneous Implantable Cardioverter Defibrillator for Dialysis Patients: A Strategy to Reduce Central Vein Stenoses and Infections

Published:April 22, 2015DOI:
      Central venous stenosis is a common complication of the transvenous leads associated with an implantable cardioverter defibrillator (ICD). Although epicardial leads have been reported to bypass this complication, their placement is much more invasive than the subcutaneous ICDs (SICDs) and requires the services of a cardiothoracic surgeon. Recent data have demonstrated successful defibrillation using an SICD. In this report, we present 4 long-term hemodialysis patients treated successfully with an SICD. 3 patients received the device for primary prevention of sudden cardiac death (cardiomyopathy with low ejection fraction). The patient in the fourth case had a prolonged QT interval and received the device for secondary prevention. 3 patients had an arteriovenous fistula, whereas 1 patient was dialyzing with a tunneled dialysis catheter. Insertion of an SICD is a minimally invasive procedure. By virtue of leaving the venous system untouched, this approach might offer the advantage of reduced risk of central venous stenosis and infection over an endocardial ICD with transvenous leads. SICD is not experimental; it has been approved by the US Food and Drug Administration and is currently being used in the United States and Europe.

      Index Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Kidney Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Epstein A.E.
        • DiMarco J.P.
        • Ellenbogen K.A.
        • et al.
        ACC⁄AHA⁄HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities.
        Circulation. 2008; 117: e350-e408
        • Moss A.J.
        • Zareba W.
        • Hall W.J.
        • et al.
        Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction.
        N Engl J Med. 2002; 346: 877-883
        • Bardy G.H.
        • Lee K.L.
        • Mark D.B.
        • et al.
        • Cardiac Death in Heart Failure Trial (SCD-HeFT) Investigators
        Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure.
        N Engl J Med. 2005; 352: 225-237
        • Desai A.S.
        • Fang J.C.
        • Maisel W.H.
        • Baughman K.L.
        Implantable defibrillators for the prevention of mortality in patients with nonischemic cardiomyopathy: a meta-analysis of randomized controlled trials.
        JAMA. 2004; 292: 2874-2879
        • The Antiarrhythmics Versus Implantable Defibrillators (AVID) Investigators
        A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias.
        N Engl J Med. 1997; 337: 1576-1583
        • Drew D.A.
        • Meyer K.B.
        • Weiner D.E.
        Transvenous cardiac device wires and vascular access in hemodialysis patients.
        Am J Kidney Dis. 2011; 58: 494-496
        • Asif A.
        • Carrillo R.
        • Garisto J.D.
        • et al.
        Epicardial cardiac rhythm devices for dialysis patients: minimizing the risk of infection and preserving central veins.
        Semin Dial. 2012; 25: 88-94
        • Asif A.
        • Salman L.
        • Lopera G.
        • Haqqie S.S.
        • Carrillo R.
        Transvenous cardiac implantable electronic devices and hemodialysis catheters: recommendations to curtail a potentially lethal combination.
        Semin Dial. 2012; 25: 582-586
        • Lin G.
        • Nishimura R.A.
        • Connolly H.M.
        • et al.
        Severe symptomatic tricuspid valve regurgitation due to permanent pacemaker or implantable cardioverter defibrillator leads.
        J Am Coll Cardiol. 2005; 45: 1672-1675
        • Heaven D.J.
        • Henein M.Y.
        • Sutton R.
        Pacemaker lead related tricuspid stenosis. A report of two cases.
        Heart. 2000; 83: 351-352
        • Ribeiro H.
        • Magalhães P.
        • Ferreira C.
        • et al.
        Pacemaker lead-induced tricuspid stenosis: a report of two cases.
        Rev Port Cardiol. 2012; 31: 305-308
        • Carrillo R.G.
        • Garisto J.D.
        • Salman L.
        • Merrill D.
        • Asif A.
        Contamination of transvenous pacemaker leads due to tunneled hemodialysis catheter infection: a report of 2 cases.
        Am J Kidney Dis. 2010; 55: 1097-1101
        • Carrillo R.G.
        • Garisto J.D.
        • Salman L.
        • Asif A.
        Arteriovenous dialysis access-associated transvenous pacemaker infection.
        Clin Nephrol. 2011; 75: 174-178
        • Saad T.F.
        • Hentschel D.
        • Koplan B.
        • et al.
        Cardiovascular implantable electronic device leads in CKD and ESRD patients: review and recommendations for practice.
        Semin Dial. 2013; 26: 114-123
        • Baddour L.M.
        • Epstein A.E.
        • Erickson C.C.
        Update on cardiovascular implantable electronic device infections and their management: a scientific statement from the American Heart Association.
        Circulation. 2010; 121: 458-477
        • Cabell C.H.
        • Heidenreich P.A.
        • Chu V.H.
        • et al.
        Increasing rates of cardiac device infections among Medicare beneficiaries: 1990-1999.
        Am Heart J. 2004; 147: 582-586
        • Lekkerkerker J.C.
        • van Nieuwkoop C.
        • Trines S.A.
        • et al.
        Risk factors and time delay associated with cardiac device infections: Leiden device registry.
        Heart. 2009; 95: 715-720
        • Voigt A.
        • Shalaby A.
        • Saba S.
        Rising rates of cardiac rhythm management device infections in the United States: 1996 through 2003.
        J Am Coll Cardiol. 2006; 48: 590-591
        • Chamis A.L.
        • Peterson G.E.
        • Cabell C.H.
        • et al.
        Staphylococcus aureus bacteremia in patients with permanent pacemakers or implantable cardioverter-defibrillators.
        Circulation. 2001; 104: 1029-1033
        • Da Costa S.S.
        • Scalabrini Neto A.
        • Costa R.
        • et al.
        Incidence and risk factors of upper extremity deep vein lesions after permanent transvenous pacemaker implant: a 6-month follow-up prospective study.
        Pacing Clin Electrophysiol. 2002; 25: 1301-1306
        • Sticherling C.
        • Chough S.P.
        • Baker R.L.
        • et al.
        Prevalence of central venous occlusion in patients with chronic defibrillator leads.
        Am Heart J. 2001; 141: 813-816
        • Asif A.
        • Salman L.
        • Carrillo R.G.
        • et al.
        Patency rates for angioplasty in the treatment of pacemaker-induced central venous stenosis in hemodialysis patients: results of a multi-center study.
        Semin Dial. 2009; 22: 671-676
        • Teruya T.H.
        • Abou-Zamzam Jr., A.M.
        • Limm W.
        • Wong L.
        Symptomatic subclavian vein stenosis and occlusion in hemodialysis patients with transvenous pacemakers.
        Ann Vasc Surg. 2003; 17: 526-529
        • Wilkoff B.L.
        • Love C.J.
        • Byrd C.L.
        • et al.
        Transvenous lead extraction: Heart Rhythm Society expert consensus on facilities, training, indications, and patient management: this document was endorsed by the American Heart Association (AHA).
        Heart Rhythm. 2009; 6: 1085-1104
        • Sohail M.R.
        • Uslan D.Z.
        • Khan A.H.
        • et al.
        Management and outcome of permanent pacemaker and implantable cardioverter-defibrillator infections.
        J Am Coll Cardiol. 2007; 49: 1851-1859
        • Bloom H.
        • Heeke B.
        • Leon A.
        • et al.
        Renal insufficiency and the risk of infection from pacemaker or defibrillator surgery.
        Pacing Clin Electrophysiol. 2006; 29: 142-145
        • Greenspon A.J.
        • Rhim E.S.
        • Mark G.
        • et al.
        Lead-associated endocarditis: the important role of methicillin-resistant.
        Staphylococcus aureus. Pacing Clin Electrophysiol. 2008; 31: 548-553
        • Charytan D.M.
        • Patrick A.R.
        • Liu J.
        • et al.
        Trends in the use and outcomes of implantable cardioverter-defibrillators in patients undergoing dialysis in the United States.
        Am J Kidney Dis. 2011; 58: 409-417