Unit of Electrophysiology, S. Anna Hospital ASST Lariana, Via Ravona 1, San Fermo della Battaglia, 22020 Como, Italy.
Cardiology, University of Tor Vergata, 00133 Rome, Italy.
Europace. 2017 Nov 1;19(11):1826-1832. doi: 10.1093/europace/euw337.
A recommendation for a subcutaneous-implantable cardioverter-defibrillator (S-ICD) has been added to recent European Society of Cardiology Guidelines. However, the S-ICD is not ideally suitable for patients who need pacing. The aim of this survey was to analyse the current practice of ICD implantation and to evaluate the actual suitability of S-ICD.
The survey 'S-ICD Why Not?' was an independent initiative taken by the Italian Heart Rhythm Society (AIAC). Clinical characteristics, selection criteria, and factors guiding the choice of ICD type were collected in consecutive patients who underwent ICD implantation in 33 Italian centres from September to December 2015. A cardiac resynchronization therapy (CRT) device was implanted in 39% (369 of 947) of patients undergoing de novo ICD implantation. An S-ICD was implanted in 12% of patients with no CRT indication (62 of 510 with available data). S-ICD patients were younger than patients who received transvenous ICD, more often had channelopathies, and more frequently received their device for secondary prevention of sudden death. More frequently, the clinical reason for preferring a transvenous ICD over an S-ICD was the need for pacing (45%) or for antitachycardia pacing (36%). Nonetheless, only 7% of patients fulfilled conditions for recommending permanent pacing, and 4% of patients had a history of monomorphic ventricular tachycardia that might have been treatable with antitachycardia pacing.
The vast majority of patients needing ICD therapy are suitable candidates for S-ICD implantation. Nevertheless, it currently seems to be preferentially adopted for secondary prevention of sudden death in young patients with channelopathies.
最近的欧洲心脏病学会指南增加了皮下植入式心律转复除颤器（S-ICD）的推荐。然而，S-ICD 并不理想适用于需要起搏的患者。本调查的目的是分析目前 ICD 植入的实践情况，并评估 S-ICD 的实际适用性。
这项名为“S-ICD 为何不可？”的调查是由意大利心律失常学会（AIAC）独立发起的一项倡议。在 2015 年 9 月至 12 月期间，来自意大利 33 个中心的连续患者接受 ICD 植入，收集了他们的临床特征、选择标准以及指导 ICD 类型选择的因素。在接受新植入 ICD 的患者中，有 39%（369/947）植入了心脏再同步治疗（CRT）设备。在没有 CRT 指征的患者中（有可用数据的 510 例患者中有 62 例）植入了 S-ICD。S-ICD 患者比接受经静脉 ICD 的患者更年轻，更常患有通道疾病，更常因心脏性猝死的二级预防而接受设备治疗。更频繁地，选择经静脉 ICD 而不是 S-ICD 的临床原因是需要起搏（45%）或抗心动过速起搏（36%）。然而，只有 7%的患者符合推荐永久起搏的条件，4%的患者有单形性室性心动过速病史，可能需要抗心动过速起搏治疗。
绝大多数需要 ICD 治疗的患者都是 S-ICD 植入的合适候选者。然而，它目前似乎更优先用于有通道疾病的年轻患者的心脏性猝死二级预防。
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