De Maria Elia, Bonetti Lorenzo, Patrizi Giampiero, Scrivener John, Andraghetti Alberto, Di Gregorio Franco, Montin Alessio, Zuccon Giulia, Cappelli Stefano
Cardiology Unit, Ramazzini Hospital, Via Molinari, Carpi, Modena, Italy, 41012.
J Interv Card Electrophysiol. 2012 Jun;34(1):105-13. doi: 10.1007/s10840-011-9626-5. Epub 2011 Oct 13.
Complications of implantable cardioverter-defibrillator (ICD) therapy are often linked to transvenous lead insertion, lead failure, or infections. An entirely subcutaneous ICD system (S-ICD) avoids the need for the placement of electrodes within the heart and can provide clinical advantages.
A 45-year-old patient with Brugada syndrome (spontaneous type 1 Brugada ECG, syncope during fever, family history of sudden death <45 years old) was implanted with an entirely S-ICD. A left lateral incision was made over the sixth rib in the anterior axillary line for pocket formation and pulse generator placement. The subcutaneous electrode was placed subcutaneously, parallel to and 2 cm to the left of the sternal midline, and was connected to the generator. The insertion of the system was guided only by anatomical landmarks, and no fluoroscopy was required. Ventricular fibrillation was induced and terminated by a 65-J shock (15-J safety margin). No complication occurred, and subsequent course was uneventful.
S-ICD is a new system for delivering lifesaving shock therapy in patients at risk of sudden cardiac death, without the need of intracardiac leads. Young patients with inherited arrhythmogenic syndromes could benefit the most from this system. This is the first case of Brugada syndrome implanted with a first-generation S-ICD in Italy.
植入式心律转复除颤器（ICD）治疗的并发症通常与经静脉导线插入、导线故障或感染有关。完全皮下ICD系统（S-ICD）避免了在心脏内放置电极的需求，并可提供临床优势。
一名45岁的Brugada综合征患者（自发1型Brugada心电图，发热时晕厥，有<45岁猝死家族史）植入了完全皮下ICD。在腋前线第六肋上方做一个左侧切口，用于形成囊袋并放置脉冲发生器。皮下电极平行于胸骨中线并在其左侧2 cm处皮下放置，并与发生器相连。系统的插入仅由解剖标志引导，无需荧光透视。通过65焦耳电击（15焦耳安全余量）诱发并终止心室颤动。未发生并发症，随后病程平稳。
S-ICD是一种用于为有心脏性猝死风险的患者提供救命电击治疗的新系统，无需心内导线。患有遗传性心律失常综合征的年轻患者可能从该系统中获益最大。这是意大利首例植入第一代S-ICD的Brugada综合征病例。
