血液透析患者皮下植入式心脏复律除颤器植入的结果
Outcomes of subcutaneous implantable cardioverter-defibrillator implantation in patients on hemodialysis.
作者信息
Koman Eduard, Gupta Ashwani, Subzposh Faiz, Saltzman Heath, Kutalek Steven P
机构信息
Department of Internal Medicine, Drexel University College of Medicine, New College Building 245 N. 15th Street, 6th Floor, Philadelphia, PA, 19102, USA.
Division of Cardiac Electrophysiology, Drexel University College of Medicine, Philadelphia, PA, USA.
出版信息
J Interv Card Electrophysiol. 2016 Mar;45(2):219-23. doi: 10.1007/s10840-015-0093-2. Epub 2016 Jan 14.
BACKGROUND
Subcutaneous implantable cardioverter-defibrillator (S-ICD) provides potential benefits in patients on hemodialysis (HD) by reducing the risk of blood stream infection and preserving vascular access sites. We evaluated the safety and efficacy of S-ICD in patients with end-stage renal disease (ESRD) on HD.
METHODS
All consecutive patients implanted with S-ICD between October 2012 and April 2015 at our high-volume center were included in this retrospective, single-center study. Baseline demographics, procedural details, and short- as well as long-term outcomes were compared between patients on HD and not on HD.
RESULTS
A total of 86 S-ICDs were implanted at our institution during the study period. Eighteen (21%) patients were on HD at the time of implant. HD patients were more likely to be implanted for secondary prevention. There was no statistically significant difference in procedural complications between the two groups. HD patients had a longer duration hospital stay after implant (3.6 ± 5.14 vs. 1.69 ± 2.29 days, p = 0.021). During a mean follow-up of 205 ± 208 days in the HD cohort and 242 ± 238 days in the non-HD cohort (p = 0.268), there was no device or blood stream infection in the HD group, compared with five device infections in the non-HD group. The incidence of inappropriate shocks was similar in both groups. All appropriate shocks were successful in terminating ventricular tachyarrhythmias in both groups. Patients on hemodialysis had worse inpatient as well as long-term mortality after S-ICD implant, compared with non-HD patients.
CONCLUSIONS
Our study demonstrates the safety and efficacy of S-ICD in patients on HD. Despite representing a sicker patient population, HD patients implanted with S-ICD had similar procedural outcomes and inappropriate shocks. There was no device or blood stream-related infection in HD patients. All appropriate shocks for ventricular arrhythmias in HD patients were successful.
背景
皮下植入式心律转复除颤器（S-ICD）通过降低血流感染风险和保留血管通路部位，为接受血液透析（HD）的患者带来潜在益处。我们评估了S-ICD在终末期肾病（ESRD）且接受HD治疗患者中的安全性和有效性。
方法
本回顾性单中心研究纳入了2012年10月至2015年4月期间在我们这个高容量中心连续植入S-ICD的所有患者。比较了接受HD治疗和未接受HD治疗患者的基线人口统计学特征、手术细节以及短期和长期结局。
结果
在研究期间，我们机构共植入了86台S-ICD。18名（21%）患者在植入时接受HD治疗。HD患者更有可能因二级预防而植入。两组手术并发症无统计学显著差异。HD患者植入后住院时间更长（3.6±5.14天对1.69±2.29天，p = 0.021）。HD队列平均随访205±208天，非HD队列平均随访242±238天（p = 0.268），HD组未发生设备或血流感染，而非HD组有5例设备感染。两组不适当电击的发生率相似。两组中所有适当的电击均成功终止了室性快速心律失常。与非HD患者相比，接受血液透析的患者在植入S-ICD后住院期间及长期死亡率更高。
结论
我们的研究证明了S-ICD在接受HD治疗患者中的安全性和有效性。尽管HD患者群体病情更重，但植入S-ICD的HD患者手术结局和不适当电击情况相似。HD患者未发生设备或血流相关感染。HD患者中所有针对室性心律失常的适当电击均成功。
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