Rorris Filippos-Paschalis, Charitos Christos
Department of Thoracic and Cardiovascular Surgery, Evangelismos General Hospital, Athens, Greece.
Heart Fail Rev. 2021 Jul;26(4):763-765. doi: 10.1007/s10741-020-10064-8. Epub 2021 Jan 6.
There is currently conflicting data available regarding the use of implantable cardioverter-defibrillators (ICD) in left ventricular assist device (LVAD) patients. While the benefit of an ICD in heart failure patients is well demonstrated, such benefit has failed to reach the LVAD population. In lack of randomized control trial data on the topic of ICD use in LVAD recipients, major societal guidelines are in disagreement when comes to the topic of routine implantation of a permanent defibrillator in prospective ventricular assist device patients. Alternative permanent defibrillator strategies have been suggested for the LVAD population such as subcutaneous implantable cardioverter defibrillators (S-ICDs) but eligibility of patients for such practice remains disappointing. Although most of the heart failure patients undergoing LVAD implantation already bear an ICD, clinicians are left with the decision of de novo implanting an ICD in an important number of patients. Wearable cardioverter defibrillators could prove beneficial in LVAD recipients by utilizing them as a bridge to decision towards the implantation of a permanent defibrillator.
目前，关于在左心室辅助装置（LVAD）患者中使用植入式心脏复律除颤器（ICD）的现有数据相互矛盾。虽然ICD对心力衰竭患者的益处已得到充分证明，但这种益处尚未惠及LVAD患者群体。由于缺乏关于LVAD接受者使用ICD这一主题的随机对照试验数据，在对于前瞻性心室辅助装置患者常规植入永久性除颤器这一主题上，主要的社会指南存在分歧。已针对LVAD患者群体提出了替代性的永久性除颤器策略，如皮下植入式心脏复律除颤器（S-ICD），但患者接受这种治疗的符合条件率仍然令人失望。尽管大多数接受LVAD植入的心力衰竭患者已经植入了ICD，但临床医生仍需决定对大量患者重新植入ICD。可穿戴式心脏复律除颤器通过将其用作决定是否植入永久性除颤器的桥梁，可能对LVAD接受者有益。
