植入技术与皮下除颤器的最佳胸部位置：一项基于PRAETORIAN评分的研究
Implantation technique and optimal subcutaneous defibrillator chest position: a PRAETORIAN score-based study.
作者信息
Francia Pietro, Biffi Mauro, Adduci Carmen, Ottaviano Luca, Migliore Federico, De Bonis Silvana, Dello Russo Antonio, De Filippo Paolo, Viani Stefano, Bongiorni Maria Grazia, Caravati Fabrizio, Lavalle Carlo, Landolina Maurizio Eugenio, Pisanò Ennio, Giorgi Davide, Lovecchio Mariolina, Valsecchi Sergio, Diemberger Igor
机构信息
Division of Cardiology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, St. Andrea Hospital, Via di Grottarossa, 1035, 00189 Rome, Italy.
Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy.
出版信息
Europace. 2020 Dec 23;22(12):1822-1829. doi: 10.1093/europace/euaa231.
AIMS
The traditional technique for subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation involves three incisions and a subcutaneous pocket. Recently, a two-incision and intermuscular (IM) technique has been adopted. The PRAETORIAN score is a chest radiograph-based tool that predicts S-ICD conversion testing. We assessed whether the S-ICD implantation technique affects optimal position of the defibrillation system according to the PRAETORIAN score.
METHODS AND RESULTS
We analysed consecutive patients undergoing S-ICD implantation. The χ2 test and regression analysis were used to determine the association between the PRAETORIAN score and implantation technique. Two hundred and thirteen patients were enrolled. The S-ICD generator was positioned in an IM pocket in 174 patients (81.7%) and the two-incision approach was adopted in 199 (93.4%). According to the PRAETORIAN score, the risk of conversion failure was classified as low in 198 patients (93.0%), intermediate in 13 (6.1%), and high in 2 (0.9%). Patients undergoing the two-incision and IM technique were more likely to have a low (<90) PRAETORIAN score than those undergoing the three-incision and subcutaneous technique (two-incision: 94.0% vs. three-incision: 78.6%; P = 0.004 and IM: 96.0% vs. subcutaneous: 79.5%; P = 0.001). Intermuscular plus two-incision technique was associated with a low-risk PRAETORIAN score (hazard ratio 3.76; 95% confidence interval 1.01-14.02; P = 0.04). Shock impedance was lower in PRAETORIAN low-risk patients than in intermediate-/high-risk categories (66 vs. 96 Ohm; P = 0.001). The PRAETORIAN score did not predict shock failure at 65 J.
CONCLUSION
In this cohort of S-ICD recipients, combining the two-incision technique and IM generator implantation yielded the lowest PRAETORIAN score values, indicating optimal defibrillation system position.
CLINICAL TRIAL REGISTRATION
http://clinicaltrials.gov/ Identifier: NCT02275637.
目的
传统的皮下植入式心律转复除颤器（S-ICD）植入技术需要三个切口和一个皮下囊袋。最近，一种双切口肌间（IM）技术被采用。PRAETORIAN评分是一种基于胸部X线片的工具，可预测S-ICD转换测试。我们评估了S-ICD植入技术是否会根据PRAETORIAN评分影响除颤系统的最佳位置。
方法和结果
我们分析了连续接受S-ICD植入的患者。采用χ2检验和回归分析来确定PRAETORIAN评分与植入技术之间的关联。共纳入213例患者。174例患者（81.7%）的S-ICD发生器置于肌间囊袋中，199例患者（93.4%）采用双切口入路。根据PRAETORIAN评分，198例患者（93.0%）的转换失败风险为低，13例患者（6.1%）为中度，2例患者（0.9%）为高。与采用三切口皮下技术的患者相比，采用双切口肌间技术的患者更有可能具有较低（<90）的PRAETORIAN评分（双切口：94.0%对三切口：78.6%；P = 0.004；肌间：96.0%对皮下：79.5%；P = 0.001）。肌间加双切口技术与低风险的PRAETORIAN评分相关（风险比3.76；95%置信区间1.01 - 14.02；P = 0.04）。PRAETORIAN低风险患者的电击阻抗低于中度/高风险患者（66对96欧姆；P = 0.001）。PRAETORIAN评分不能预测65 J时的电击失败。
结论
在这组S-ICD接受者中，双切口技术与肌间发生器植入相结合产生了最低的PRAETORIAN评分值，表明除颤系统位置最佳。
临床试验注册
http://clinicaltrials.gov/ 标识符：NCT02275637。
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