Department of Cardiology, St Antonius Hospital, Koekoekslaan 1, 3435, CM Nieuwegein, The Netherlands.
Heart Centre, Department of Clinical and Experimental Cardiology, Amsterdam University Medical Center, Amsterdam, The Netherlands.
Herz. 2021 Dec;46(6):520-525. doi: 10.1007/s00059-021-05077-4. Epub 2021 Nov 9.
Subcutaneous implantable cardioverter/defibrillators (S-ICDs) have been developed to offer ICD treatment to patients without venous access to the heart and to overcome complications associated with transvenous leads, particularly lead fracture/insulation defects and endocarditis. Several studies and registries have demonstrated the feasibility and safety of S‑ICD in different groups of patients. Further developments in S‑ICD technology involve the combination with devices that can provide anti-bradycardia and anti-tachycardia pacing if needed. The extravascular ICD (EV-ICD) is a new system that similarly offers ICD therapy without a transvenous lead but uses a substernal instead of a subcutaneous lead to facilitate detection of ventricular fibrillation and to provide anti-tachycardia and also temporary anti-bradycardia pacing. The first animal but also clinical data on EV-ICDs have been published. This review discusses the current state, potential advantages and limitations, and future research of both S‑ICD and EV-ICD.
皮下植入式心脏复律除颤器 (S-ICD) 的开发旨在为无法经静脉进入心脏的患者提供 ICD 治疗，并克服与经静脉导联相关的并发症，特别是导联断裂/绝缘缺陷和心内膜炎。多项研究和注册研究表明，S-ICD 在不同患者群体中的可行性和安全性。S-ICD 技术的进一步发展涉及与可按需提供抗心动过缓和抗心动过速起搏的设备相结合。体外 ICD (EV-ICD) 是一种新系统，它同样提供无需经静脉导联的 ICD 治疗，但使用胸骨下导联而不是皮下导联来促进心室颤动的检测，并提供抗心动过速和临时抗心动过缓起搏。已经发表了关于 EV-ICD 的首批动物和临床数据。本文综述了 S-ICD 和 EV-ICD 的现状、潜在优势和局限性以及未来研究。
