Gleva Marye J, Wang Yongfei, Curtis Jeptha P, Berul Charles I, Huddleston Charles B, Poole Jeanne E
Washington University School of Medicine, St. Louis, Missouri.
Yale University School of Medicine, New Haven, Connecticut.
Am J Cardiol. 2017 Nov 15;120(10):1891-1898. doi: 10.1016/j.amjcard.2017.07.103. Epub 2017 Aug 8.
Patients with childhood heart disease are living longer and entering adulthood, and may undergo implantable cardioverter-defibrillator (ICD) implantation to reduce the risk of sudden death. We evaluated the characteristics of adult patients with congenital heart disease or left ventricular noncompaction cardiomyopathy (LVNC) in the National Cardiovascular Disease Registry ICD Registry and determined ICD-related in-hospital complications. Patients with LVNC or transposition of the great arteries, tetralogy of Fallot, Ebstein's anomaly, atrial septal defect, ventricular septal defect, or common ventricle were identified in the registry. In-hospital complications were compared among different diagnoses using the chi-square test for categorical variables and the F-test in analyses of variance for continuous variables. A total of 3,077 patients were identified. The mean age was 48.0 ± 16.0 years, and 39.9% were female. Single-chamber ICDs were implanted in 25.2%, dual chamber in 41.9%, and cardiac resynchronization in 30.8%. Intraprocedural or postprocedural complications occurred in 70 patients (2.3%); there were 6 in-hospital deaths (0.2%). The most frequent complications were acute lead dislodgments, pneumothorax, and hematomas. Patients with Ebstein's anomaly had the greatest complication rate (8.3%, p = 0.03). The complication rate was 1.55% in single-chamber devices, 1.86% in dual chamber, and 3.5% in cardiac resynchronization (p < 0.001). For initial implants, the complication rate was 2.55%, 1.62% in generator replacements, and 8.77% in lead revisions (p = 0.001). In conclusion, in this large contemporary adult cohort of congenital heart disease and LVNC patients who underwent ICD implant procedures, periprocedural complication rates were low. Lead-related risks predominated.
患有儿童心脏病的患者寿命延长并步入成年期,可能会接受植入式心律转复除颤器(ICD)植入以降低猝死风险。我们在国家心血管疾病注册ICD注册中心评估了患有先天性心脏病或左心室致密化不全心肌病(LVNC)的成年患者的特征,并确定了与ICD相关的院内并发症。在注册中心识别出患有LVNC、大动脉转位、法洛四联症、埃布斯坦畸形、房间隔缺损、室间隔缺损或共同心室的患者。使用分类变量的卡方检验和连续变量方差分析中的F检验比较不同诊断之间的院内并发症。共识别出3077例患者。平均年龄为48.0±16.0岁,女性占39.9%。25.2%的患者植入了单腔ICD,41.9%植入了双腔ICD,30.8%植入了心脏再同步治疗设备。70例患者(2.3%)发生了术中或术后并发症;有6例院内死亡(0.2%)。最常见的并发症是急性导线脱位、气胸和血肿。埃布斯坦畸形患者的并发症发生率最高(8.3%,p=0.03)。单腔设备的并发症发生率为1.55%,双腔为1.86%,心脏再同步治疗为3.5%(p<0.001)。对于初次植入,并发症发生率为2.55%,发生器更换为1.62%,导线修订为8.77%(p=0.001)。总之,在这个接受ICD植入手术的当代大型先天性心脏病和LVNC成年队列中,围手术期并发症发生率较低。与导线相关的风险占主导。