{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T17:34:12Z","timestamp":1787506452731,"version":"build-2736575974"},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2021,10,18]],"date-time":"2021-10-18T00:00:00Z","timestamp":1634515200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100016304","name":"Medtronic plc","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100016304","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008497","name":"Boston Scientific Corp.","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008497","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,5,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>The aim of this study is to provide a thorough, quantified assessment of the substernal space as the site of extravascular implantable cardioverter-defibrillator (ICD) lead placement using computed tomography (CT) scans and summarizing adverse events and defibrillation efficacy across anatomical findings. Subcutaneous ICDs are an alternative to transvenous defibrillators but have limitations related to ICD lead distance from the heart. An alternative extravascular system with substernal lead placement has the potential to provide defibrillation at lower energy and pacing therapies from a single device.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>A multi-centre, non-randomized, retrospective analysis of 45 patient CT scans quantitatively and qualitatively assessing bony, cardiac, vascular, and other organ structures from two human clinical studies with substernal lead placement. Univariate logistic regression was used to evaluate 15 anatomical parameters for impact on defibrillation outcome and adjusted for multiple comparisons. Adverse events were summarized. Substernal implantation was attempted or completed in 45 patients. Defibrillation testing was successful in 37 of 41 subjects (90%) using \u226510\u2009J safety margin. There were two intra-procedural adverse events in one patient, including reaction to anaesthesia and an episode of transient atrial fibrillation during ventricular fibrillation induction. Anatomical factors associated with defibrillation failure included large rib cage width, myocardium extending very posteriorly, and a low heart position in the chest (P-values &amp;lt;0.05), though not significant adjusting for multiple comparisons.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Retrospective analysis demonstrates the ability to implant within the substernal space with low intra-procedural adverse events and high defibrillation efficacy despite a wide range of anatomical variability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/europace\/euab243","type":"journal-article","created":{"date-parts":[[2021,9,22]],"date-time":"2021-09-22T23:14:11Z","timestamp":1632352451000},"page":"762-773","source":"Crossref","is-referenced-by-count":13,"title":["The extravascular implantable cardioverter-defibrillator: characterization of anatomical parameters impacting substernal implantation and defibrillation efficacy"],"prefix":"10.1093","volume":"24","author":[{"given":"Levente","family":"Moln\u00e1r","sequence":"first","affiliation":[{"name":"Semmelweis University, Heart and Vascular Center, 68, Varosmajor Street, H-1122 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Crozier","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Christchurch Hospital, PO Box 4345, Christchurch, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haris","family":"Haqqani","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Queensland, Department of Cardiology, Prince Charles Hospital, Brisbane, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"O'Donnell","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Kotschet","sequence":"additional","affiliation":[{"name":"Monash Cardiac Rhythm Management Department, MonashHeart, Monash Medical Centre, 246 Clayton Road, Clayton, Melbourne, Victoria, 3168, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Alison","sequence":"additional","affiliation":[{"name":"Monash Cardiac Rhythm Management Department, MonashHeart, Monash Medical Centre, 246 Clayton Road, Clayton, Melbourne, Victoria, 3168, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy E","family":"Thompson","sequence":"additional","affiliation":[{"name":"Medtronic plc, Mounds View, Minneapolis, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Varun A","family":"Bhatia","sequence":"additional","affiliation":[{"name":"Medtronic plc, Mounds View, Minneapolis, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland","family":"Papp","sequence":"additional","affiliation":[{"name":"Semmelweis University, Heart and Vascular Center, 68, Varosmajor Street, H-1122 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Endre","family":"Zima","sequence":"additional","affiliation":[{"name":"Semmelweis University, Heart and Vascular Center, 68, Varosmajor Street, H-1122 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c1d\u00e1m","family":"Jermendy","sequence":"additional","affiliation":[{"name":"Semmelweis University, Heart and Vascular Center, 68, Varosmajor Street, H-1122 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Astrid","family":"Apor","sequence":"additional","affiliation":[{"name":"Semmelweis University, Heart and Vascular Center, 68, Varosmajor Street, H-1122 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6514-0723","authenticated-orcid":false,"given":"B\u00e9la","family":"Merkely","sequence":"additional","affiliation":[{"name":"Semmelweis University, Heart and Vascular Center, 68, Varosmajor Street, H-1122 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,10,18]]},"reference":[{"key":"2022050518235074500_euab243-B1","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1056\/NEJMoa0909545","article-title":"An entirely subcutaneous implantable cardioverter-defibrillator","volume":"363","author":"Bardy","year":"2010","journal-title":"N Engl J Med"},{"key":"2022050518235074500_euab243-B2","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.1161\/CIRCEP.115.002953","article-title":"Longevity of the subcutaneous implantable defibrillator: long-term follow-up of the European Regulatory Trial Cohort","volume":"8","author":"Theuns","year":"2015","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"2022050518235074500_euab243-B3","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1016\/j.jacep.2016.12.026","article-title":"Novel extravascular defibrillation configuration with a coil in the substernal space: the ASD clinical study","volume":"3","author":"Chan","year":"2017","journal-title":"JACC Clin Electrophysiol"},{"key":"2022050518235074500_euab243-B4","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1016\/j.hrthm.2017.11.030","article-title":"Feasibility of extravascular pacing with a novel substernal electrode configuration: the Substernal Pacing Acute Clinical Evaluation study","volume":"15","author":"Sholevar","year":"2018","journal-title":"Heart Rhythm"},{"key":"2022050518235074500_euab243-B5","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1016\/j.jacep.2018.11.003","article-title":"Therapy from a novel substernal lead: the ASD2 study","volume":"5","author":"Boersma","year":"2019","journal-title":"JACC Clin Electrophysiol"},{"key":"2022050518235074500_euab243-B6","doi-asserted-by":"crossref","first-page":"1525","DOI":"10.1016\/j.jacep.2020.05.029","article-title":"First-in-human chronic implant experience of the substernal extravascular implantable cardioverter defibrillator","volume":"6","author":"Crozier","year":"2020","journal-title":"JACC Clin Electrophysiol"},{"key":"2022050518235074500_euab243-B7","first-page":"32","article-title":"Manubrium-sparing median sternotomy as a uniform approach for cardiac operations","volume":"27","author":"Choi","year":"2000","journal-title":"Tex Heart Inst J"},{"key":"2022050518235074500_euab243-B8","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1097\/01.sla.0000133116.16484.bb","article-title":"Open repair of pectus excavatum with minimal cartilage resection","volume":"240","author":"Fonkalsrud","year":"2004","journal-title":"Ann Surg"},{"key":"2022050518235074500_euab243-B9","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1016\/j.ejcts.2006.12.016","article-title":"A comparison of outcomes after robotic open extended thymectomy for myasthenia gravis","volume":"31","author":"Cakar","year":"2007","journal-title":"Eur J Cardiothorac Surg"},{"key":"2022050518235074500_euab243-B10","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1007\/s00276-003-0134-x","article-title":"The superior epigastric artery does not pass through Larrey\u2019s space (trigonum sternocostale)","volume":"25","author":"Baudoin","year":"2003","journal-title":"Surg Radiol Anat"},{"key":"2022050518235074500_euab243-B11","doi-asserted-by":"crossref","first-page":"1878","DOI":"10.1016\/j.athoracsur.2014.02.049","article-title":"The safety and efficacy of mediastinoscopy when performed by general thoracic surgeons","volume":"97","author":"Wei","year":"2014","journal-title":"Ann Thorac Surg"},{"key":"2022050518235074500_euab243-B12","doi-asserted-by":"crossref","first-page":"397","DOI":"10.2214\/ajr.155.2.2115273","article-title":"CT anatomy of the internal mammary vessels: importance in planning percutaneous transthoracic procedures","volume":"155","author":"Glassberg","year":"1990","journal-title":"AJR Am J Roentgenol"},{"key":"2022050518235074500_euab243-B13","first-page":"6","article-title":"Morphometric study of sternum for determination of sex","volume":"2","author":"Kaneriya","year":"2013","journal-title":"Cibtech J Bio Protoc"},{"key":"2022050518235074500_euab243-B14","doi-asserted-by":"crossref","first-page":"2191","DOI":"10.1001\/jama.2013.281053","article-title":"World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects","volume":"310","year":"2013","journal-title":"JAMA"},{"key":"2022050518235074500_euab243-B15","first-page":"1601","article-title":"2015 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: the task force for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death of the European Society of Cardiology (ESC","volume":"17","author":"Priori","year":"2015","journal-title":"Europace"},{"key":"2022050518235074500_euab243-B16","first-page":"143","article-title":"Liver diseases in heart failure","volume":"3","author":"Maleki","year":"2011","journal-title":"Heart Asia"},{"key":"2022050518235074500_euab243-B17","doi-asserted-by":"crossref","first-page":"1078","DOI":"10.1111\/jce.13943","article-title":"Effectiveness of single- vs. dual-coil implantable defibrillator leads: observations analysis from the SIMPLE study","volume":"30","author":"Neuzner","year":"2019","journal-title":"J Cardiovasc Electrophysiol"},{"key":"2022050518235074500_euab243-B18","doi-asserted-by":"crossref","first-page":"1636","DOI":"10.1016\/j.hrthm.2019.04.048","article-title":"Understanding outcomes with the S-ICD in primary prevention patients with low EF Study (UNTOUCHED): clinical characteristics and perioperative results","volume":"16","author":"Boersma","year":"2019","journal-title":"Heart Rhythm"},{"key":"2022050518235074500_euab243-B19","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1046\/j.1460-9592.2002.00408.x","article-title":"Clinical predictors of defibrillation thresholds with an active pectoral pulse generator lead system","volume":"25","author":"Hodgson","year":"2002","journal-title":"PACE"},{"key":"2022050518235074500_euab243-B20","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1016\/j.hrthm.2018.09.029","article-title":"A novel tool to evaluate the implant position and predict defibrillation success of the subcutaneous implantable cardioverter-defibrillator: the PRAETORIAN score","volume":"16","author":"Quast","year":"2019","journal-title":"Heart Rhythm"},{"key":"2022050518235074500_euab243-B21","doi-asserted-by":"crossref","DOI":"10.1016\/j.jacep.2021.03.004","article-title":"Design and preliminary results of sensing and detection for an extravascular implantable cardioverter-defibrillator","volume":"7","author":"Swerdlow","year":"2021","journal-title":"JACC Clin Electrophys"}],"container-title":["EP Europace"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/europace\/article-pdf\/24\/5\/762\/43526522\/euab243.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/europace\/article-pdf\/24\/5\/762\/43526522\/euab243.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,9]],"date-time":"2023-11-09T01:47:20Z","timestamp":1699494440000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/europace\/article\/24\/5\/762\/6400299"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,18]]},"references-count":21,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,10,18]]},"published-print":{"date-parts":[[2022,5,3]]}},"URL":"https:\/\/doi.org\/10.1093\/europace\/euab243","relation":{},"ISSN":["1099-5129","1532-2092"],"issn-type":[{"value":"1099-5129","type":"print"},{"value":"1532-2092","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,5,1]]},"published":{"date-parts":[[2021,10,18]]}}}