皮下植入式心律转复除颤器在致心律失常性右室心肌病患者中的应用：一项意大利多中心注册研究结果。

Subcutaneous implantable cardioverter defibrillator in patients with arrhythmogenic right ventricular cardiomyopathy: Results from an Italian multicenter registry.

机构信息

Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy.

Cardiology Division, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.

出版信息

Int J Cardiol. 2019 Apr 1;280:74-79. doi: 10.1016/j.ijcard.2019.01.041. Epub 2019 Jan 12.

DOI:10.1016/j.ijcard.2019.01.041

PMID:30661851

Abstract

BACKGROUND

Despite expanding indication of the subcutaneous implantable cardioverter defibrillator (S-ICD) in clinical practice, limited data exists on safety and efficacy of S-ICD in arrhythmogenic right ventricular cardiomyopathy (ARVC) patients. The aim of this multicenter study was to evaluate the safety and efficacy of S-ICD in ARVC patients.

METHODS

The study population included 44 consecutive patients with definite ARVC diagnosis according to the 2010 ITF criteria (57% male, mean age 37 ± 17 years [range 10-75 years]) who received an S-ICD. Eighteen (41%) patients were implanted for secondary prevention.

RESULTS

At implant, all inducible patients (34/44) had conversion of ventricular fibrillation at 65 J. No early complications occurred. During a median follow-up of 12 months (7-19), 3 (6.8%) patients experienced complications requiring surgical revision. No local or systemic device-related infections were observed. Six patients (14%) received a total of 61 appropriate and successful shocks on ventricular arrhythmias. Six (14%) patients experienced 8 inappropriate shocks for oversensing of cardiac signal (4 cases) and non-cardiac signal (4 cases) with one patient requiring device explantation. No patients had the device explanted due to the need for antitachycardia pacing.

CONCLUSIONS

The study shows that S-ICD provides safe and effective therapy for termination of both induced and spontaneous malignant ventricular tachyarrhythmias with high energy shocks in ARVC patients, but the risk of inappropriate shocks and complications needing surgical revision should be considered.

摘要

背景

尽管皮下植入式心律转复除颤器（S-ICD）在临床实践中的适应证不断扩大，但关于 S-ICD 在致心律失常性右心室心肌病（ARVC）患者中的安全性和疗效的数据有限。本多中心研究旨在评估 S-ICD 在 ARVC 患者中的安全性和疗效。

方法

研究人群包括 44 例根据 2010 年 ITF 标准明确诊断的 ARVC 患者（57%为男性，平均年龄 37±17 岁[10-75 岁]），这些患者均接受了 S-ICD 植入。18 例（41%）患者因二级预防而植入。

结果

在植入时，所有可诱发性患者（34/44）的心室颤动在 65J 时均能转复。未发生早期并发症。在中位随访 12 个月（7-19 个月）期间，有 3 例（6.8%）患者因并发症需要手术修正。未观察到局部或全身器械相关感染。6 例（14%）患者因室性心律失常共接受了 61 次适当且成功的电击。6 例（14%）患者因心脏信号（4 例）和非心脏信号（4 例）过度感知而发生了 8 次不适当的电击，其中 1 例患者需要进行器械取出。无患者因需要抗心动过速起搏而将设备取出。