Department of Medicine, University Medical Center Mannheim, Mannheim, Germany
German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany.
J Am Heart Assoc. 2017 Oct 17;6(10):e006265. doi: 10.1161/JAHA.117.006265.
Up to 40% of patients with transvenous implantable cardioverter-defibrillator (ICD) experience lead-associated complications and may suffer from high complication rates when lead extraction is indicated. Subcutaneous ICD may represent a feasible alternative; however, the efficacy of the subcutaneous ICD in the detection and treatment of ventricular arrhythmias in patients with hereditary arrhythmia syndromes has not been fully evaluated.
Patients with primary hereditary arrhythmia syndromes who fulfilled indication for defibrillator placement were eligible for enrollment. Between 2010 and 2016, 62 consecutive patients with primary hereditary arrhythmia syndromes, without indication for antibradycardia therapy, were enrolled in the study. Mean follow-up was 31.0±14.2 months. The study cohort comprised of 24 patients with Brugada syndrome, 17 with idiopathic ventricular fibrillation, 6 with long-QT syndrome, 1 with short-QT syndrome, 3 with catecholaminergic polymorphic ventricular tachycardia, 8 with hypertrophic cardiomyopathy, and 3 with arrhythmogenic right ventricular cardiomyopathy. Thirty-nine patients were implanted for secondary prevention. Twenty-two patients had a previous transvenous ICD implanted, but required revision because of infection or lead defects. A total of 20 spontaneous ventricular tachyarrhythmias requiring shock intervention occurred in 10 patients during follow-up. All episodes were terminated within the first ICD shock delivery with 80 J. Two patients had inappropriate therapies caused by oversensing following an uneventful implantation. No pocket-site infections and no premature revisions have occurred during follow-up.
Our study supports the use of the subcutaneous ICD for both secondary and primary prevention of sudden cardiac death as a reliable alternative to the conventional transvenous ICD.
多达 40%的经静脉植入式心律转复除颤器(ICD)患者会出现与导线相关的并发症,在需要进行导线拔除时,他们可能会面临较高的并发症发生率。皮下 ICD 可能是一种可行的替代方案;然而,皮下 ICD 在检测和治疗遗传性心律失常综合征患者的室性心律失常方面的疗效尚未得到充分评估。
符合 ICD 植入适应证的原发性遗传性心律失常综合征患者有资格入组。2010 年至 2016 年间,连续纳入了 62 例原发性遗传性心律失常综合征患者(无抗心动过缓治疗适应证),平均随访 31.0±14.2 个月。研究队列包括 24 例 Brugada 综合征患者、17 例特发性室颤患者、6 例长 QT 综合征患者、1 例短 QT 综合征患者、3 例儿茶酚胺敏感性多形性室速患者、8 例肥厚型心肌病患者和 3 例致心律失常性右室心肌病患者。39 例患者因二级预防而植入。22 例患者曾植入过经静脉 ICD,但因感染或导线缺陷而需要修正。在随访期间,10 例患者共发生了 20 次需要电击干预的自发性室性心动过速/室颤事件。所有事件均在首次 ICD 电击治疗时即刻终止,能量为 80 J。2 例患者因植入过程顺利但术后发生感知不良而导致不适当的治疗。在随访期间,未发生囊袋部位感染,也未进行过早修正。
我们的研究支持将皮下 ICD 用于二级和一级预防心源性猝死,作为传统经静脉 ICD 的可靠替代方案。