Kaczmarek Krzysztof, Kempa Maciej, Grabowski Marcin, Tajstra Mateusz, Sokal Adam, Cygankiewicz Iwona, Zwoliński Radosław, Michalak Marcin, Kowara Michal, Budrejko Szymon, Kurek Anna, Wranicz Jerzy K, Raczak Grzegorz, Opolski Grzegorz, Gąsior Mariusz, Kowalski Oskar, Ptaszyński Paweł
Department of Electrocardiology, Medical University of Lodz, Lodz, Poland.
Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland.
Arch Med Sci. 2019 May 21;16(4):764-771. doi: 10.5114/aoms.2019.83817. eCollection 2020.
Implantable cardioverter-defibrillators (ICD) have a strong position in the prevention of sudden death. Nowadays, the most commonly used high-energy cardiac devices are transvenous ICDs. A new technology of totally subcutaneous ICDs (S-ICD) was invented and recently introduced into clinical practice in order to reduce lead-related complications of conventional ICDs. The aim of this paper is to present early experience with this new technology implemented in a few centres in Poland.
Medical records of patients who had S-ICD-related interventions in Poland were retrospectively analysed.
During the first year of S-ICD introduction into the Polish health system 18 patients underwent surgery connected with S-ICDs. Majority of them (17 patients) were implanted de novo. In one patient surgical revision of a device implanted abroad was performed. Most of patients (78%) had S-ICDs implanted for secondary prevention. Inability of transvenous system implantation due to venous access obstruction or high risk of infection related with transvenous leads accounted for 83% of indications for S-ICD. Only in three patients were S-ICDs implanted due to young age and active mode of life. The implantations of S-ICDs were performed without important early or late complications. During follow-up one patient had episodes of ventricular arrhythmia successfully terminated with high-energy shocks. One patient died due to progression of heart failure.
S-ICD implantation procedure has been successfully and safely introduced in Polish clinical routine. Nevertheless, despite clear indications in recent ESC guidelines, this therapy is not directly reimbursed in Poland and needs individual application for refund.
植入式心脏复律除颤器（ICD）在预防心源性猝死方面具有重要地位。目前，最常用的高能心脏设备是经静脉ICD。为减少传统ICD与导线相关的并发症，一种全新的完全皮下ICD（S-ICD）技术应运而生，并于近期应用于临床实践。本文旨在介绍波兰部分中心应用这项新技术的早期经验。
回顾性分析在波兰接受与S-ICD相关干预措施的患者的病历。
在S-ICD引入波兰医疗体系的第一年，有18例患者接受了与S-ICD相关的手术。其中大多数患者（17例）为首次植入。有1例患者接受了国外植入设备的手术翻修。大多数患者（78%）植入S-ICD是用于二级预防。因静脉通路阻塞或经静脉导线相关感染风险高而无法植入经静脉系统的情况占S-ICD植入指征的83%。仅有3例患者因年龄较轻且生活方式活跃而植入S-ICD。S-ICD植入过程未出现严重的早期或晚期并发症。在随访期间，1例患者发生室性心律失常，经高能电击成功终止发作。1例患者因心力衰竭进展而死亡。
S-ICD植入手术已成功且安全地引入波兰临床常规操作。然而，尽管近期欧洲心脏病学会（ESC）指南中有明确指征，但该疗法在波兰不能直接报销，需要单独申请退款。
