Pick Justin M, Batra Anjan S
Children's Hospital of Orange County,University of California Irvine,Irvine, California,United States of America.
Cardiol Young. 2017 Jan;27(S1):S126-S131. doi: 10.1017/S1047951116002365.
Implantable cardioverter-defibrillators effectively reduce the rate of sudden cardiac death in children. Significant efforts have been made to better characterise the indications for their placement, and over the past two decades there has been a shift in their use from secondary to primary prevention. Primary prevention includes placement in patients thought to be at high risk of sudden cardiac death before the patient experiences any event. Secondary prevention includes placement after a high-risk event including sustained ventricular tachycardia or resuscitated cardiac arrest. Although liberal device implantation may be appealing even in patients having marginal indications, studies have shown high rates of adverse effects including inappropriate device discharges and the need for re-intervention because of hardware malfunction. The indications for placement of an implantable cardioverter-defibrillator, whether for primary or secondary prevention of sudden cardiac death, vary based on cardiac pathology. This review will assist the provider in understanding the risks and benefits of device implantation in order to enhance the shared decision-making capacity of patients, families, and providers.
植入式心脏复律除颤器可有效降低儿童心源性猝死的发生率。人们已做出巨大努力，以更好地明确其植入指征，在过去二十年中，其使用已从二级预防转向一级预防。一级预防包括在患者发生任何事件之前，为被认为有高心源性猝死风险的患者植入该设备。二级预防包括在发生高风险事件（如持续性室性心动过速或复苏的心脏骤停）后植入。尽管即使在适应证不明确的患者中，广泛植入设备可能很有吸引力，但研究表明，不良反应发生率很高，包括不适当的设备放电以及因硬件故障而需要再次干预。植入式心脏复律除颤器的植入指征，无论是用于心源性猝死的一级预防还是二级预防，都因心脏病理情况而异。本综述将帮助医疗服务提供者了解设备植入的风险和益处，以增强患者、家庭和医疗服务提供者共同决策的能力。
