Department of Medicine, Pontificial Catholic University of Goiás/Goiânia, Brazil.
Faculty of Medicine, Federal University of Goiás/Goiânia, Brazil.
Curr Cardiol Rev. 2022;18(3):e081221198647. doi: 10.2174/1573403X17666211208100151.
BACKGROUND/OBJECTIVES: Implantable cardioverter defibrillators are used to prevent sudden cardiac death. The subcutaneous implantable cardioverter-defibrillator was newly developed to overcome the limitations of the conventional implantable cardioverter defibrillator-transvenous device. The subcutaneous implantable cardioverter defibrillator is indicated for young patients with heart disease, congenital heart defects, and poor venous access, who have an indication for implantable cardioverter defibrillator without the need for anti-bradycardic stimulation. We aimed to compare the efficacy and complications of subcutaneous with transvenous implantable cardioverter- defibrillator devices.
A systematic review was conducted using different databases. The inclusion criteria were observational and clinical randomized trials with no language limits and no publication date limit that compared subcutaneous with transvenous implantable cardioverter-defibrillators. The selected patients were aged > 18 years with complex ventricular arrhythmia.
Five studies involving 2111 patients who underwent implantable cardioverter defibrillator implantation were included. The most frequent complication in the subcutaneous device group was infection, followed by hematoma formation and electrode migration. For the transvenous device, the most frequent complications were electrode migration and infection. Regarding efficacy, the total rates of appropriate shocks were 9.04% and 20.47% in the subcutaneous and transvenous device groups, respectively, whereas inappropriate shocks to the subcutaneous and transvenous device groups were 11,3% and 10,7%, respectively.
When compared to the transvenous device, the subcutaneous device had lower complication rates owing to lead migration and less inappropriate shocks due to supraventricular tachycardia; nevertheless, infection rates and improper shocks due to T wave oversensing were comparable for both devices CRD42021251569.
背景/目的：植入式心脏复律除颤器用于预防心源性猝死。皮下植入式心脏复律除颤器是为克服传统经静脉植入式心脏复律除颤器的局限性而新开发的。皮下植入式心脏复律除颤器适用于患有心脏病、先天性心脏病和静脉通路不良的年轻患者，这些患者有植入式心脏复律除颤器的适应证，而无需抗心动过缓刺激。我们旨在比较皮下与经静脉植入式心脏复律除颤器设备的疗效和并发症。
使用不同的数据库进行系统评价。纳入标准为观察性和临床随机试验，无语言限制，无出版日期限制，比较皮下与经静脉植入式心脏复律除颤器。入选患者年龄>18 岁，伴有复杂室性心律失常。
共纳入 5 项研究，涉及 2111 例接受植入式心脏复律除颤器植入的患者。皮下装置组最常见的并发症是感染，其次是血肿形成和电极移位。对于经静脉装置，最常见的并发症是电极移位和感染。关于疗效，皮下装置组和经静脉装置组总适当电击率分别为 9.04%和 20.47%，而皮下装置组和经静脉装置组不适当电击率分别为 11.3%和 10.7%。
与经静脉装置相比，由于导线迁移，皮下装置的并发症发生率较低，由于室上性心动过速，不适当电击率也较低；然而，两种装置的感染率和因 T 波过感知引起的不适当电击率相当。
