Kawabata Mihoko, Goya Masahiko, Sasaki Takeshi, Maeda Shingo, Yagishita Atsuhiko, Shirai Yasuhiro, Kaneko Masakazu, Shiohira Shinya, Isobe Mitsuaki, Hirao Kenzo
Heart Rhythm Center, Tokyo Medical and Dental University.
Department of Cardiovascular Medicine, Tokyo Medical and Dental University.
Circ J. 2017 Jun 23;81(7):981-987. doi: 10.1253/circj.CJ-16-1295. Epub 2017 Mar 28.
Subcutaneous implantable cardioverter-defibrillators (S-ICD) could eliminate lead-associated complications. We assessed the prevalence of S-ICD ineligibility in conventional ICD recipients and compared it in patients with and without Brugada syndrome (BrS).
Consecutive patients with a transvenous ICD without an indication for antibradycardia pacing were assessed. A patient was considered eligible for S-ICD if the ECG satisfied the screening template, both supine and standing, in ≥1 lead. Among 130 patients (103 men, age 57±15 years), a total of 18 (13.8%) patients were ineligible. The BrS group (n=33) had a significantly higher prevalence of S-ICD screening failure as compared with the non-BrS group (P=0.003; 30% vs. 8.2%). In the BrS group, the body mass index (BMI) was significantly lower, and T/QRS amplitude in lead I was significantly higher in those who were ineligible than that in the patients who were eligible. Of the 10 BrS patients failing the screening, 4 became eligible in the right parasternal electrode position.
Among current ICD patients, there was a high incidence of patients with BrS who were unsuitable for S-ICD based on the left parasternal screening test. Suitability screening of patients for S-ICDs should be conducted carefully in patients with BrS, particularly if the BMI is low. Right parasternal electrode positioning should also be tested in such BrS patients.
皮下植入式心律转复除颤器（S-ICD）可消除与导线相关的并发症。我们评估了传统ICD植入患者中S-ICD不适用的发生率，并比较了有和没有Brugada综合征（BrS）患者的情况。
对连续的经静脉植入ICD且无抗心动过缓起搏指征的患者进行评估。如果心电图在≥1个导联中仰卧位和站立位均符合筛查模板，则该患者被认为适合植入S-ICD。在130例患者（103例男性，年龄57±15岁）中，共有18例（13.8%）患者不适合。与非BrS组相比，BrS组（n = 33）的S-ICD筛查失败率显著更高（P = 0.003；30%对8.2%）。在BrS组中，不适合的患者体重指数（BMI）显著更低，I导联的T/QRS振幅显著高于适合的患者。在10例筛查失败的BrS患者中，4例在右胸骨旁电极位置变为适合。
在目前的ICD患者中，基于左胸骨旁筛查试验，有较高比例的BrS患者不适合S-ICD。对于BrS患者，尤其是BMI较低的患者，应仔细进行S-ICD的适用性筛查。对于此类BrS患者，还应测试右胸骨旁电极定位。
