与年龄相关的皮下植入式心律转复除颤器的差异及其相关的中期结果：来自多中心欧洲注册的倾向匹配分析。

Age-related differences and associated mid-term outcomes of subcutaneous implantable cardioverter-defibrillators: A propensity-matched analysis from a multicenter European registry.

机构信息

Arrhythmology and Electrophysiology Unit, San Raffaele Hospital, IRCCS, Milan, Italy.

Cardiology Unit, Luigi Sacco University Hospital, Milan, Italy.

出版信息

Heart Rhythm. 2022 Jul;19(7):1109-1115. doi: 10.1016/j.hrthm.2022.02.029. Epub 2022 Mar 5.

DOI:10.1016/j.hrthm.2022.02.029

PMID:35257974

Abstract

BACKGROUND

A few limited case series have shown that the subcutaneous implantable cardioverter-defibrillator (S-ICD) system is safe for teenagers and young adults, but a large-scale analysis currently is lacking.

OBJECTIVES

The purpose of this study was to compare mid-term device-associated outcomes in a large real-world cohort of S-ICD patients, stratified by age at implantation.

METHODS

Two propensity-matched cohorts of teenagers + young adults (≤30 years old) and adults (>30 years old) were retrieved from the ELISIR Registry. The primary outcome was the comparison of inappropriate shock rate. Complications, freedom from sustained ventricular arrhythmias, and overall and cardiovascular mortality were deemed secondary outcomes.

RESULTS

Teenagers + young adults represented 11.0% of the entire cohort. Two propensity-matched groups of 161 patients each were used for the analysis. Median follow-up was 23.1 (13.2-40.5) months. In total, 15.2% patients experienced inappropriate shocks, and 9.3% device-related complications were observed, with no age-related differences in inappropriate shocks (16.1% vs 14.3%; P = .642) and complication rates (9.9% vs 8.7%; P = .701). At univariate analysis, young age was not associated with increased rates of inappropriate shocks (hazard ratio [HR] 1.204 [0.675-2.148]: P = .529). At multivariate analysis, use of the SMART Pass algorithm was associated with a strong reduction in inappropriate shocks (adjusted HR 0.292 [0.161-0.525]; P <.001), whereas arrhythmogenic right ventricular cardiomyopathy (ARVC) was associated with higher rates of inappropriate shocks (adjusted HR 2.380 [1.205-4.697]; P = .012).

CONCLUSION

In a large multicenter registry of propensity-matched patients, use of the S-ICD in teenagers/young adults was safe and effective. The rates of inappropriate shocks and complications between cohorts were not significantly different. The only predictor of increased inappropriate shocks was a diagnosis of ARVC.

摘要

背景

少数有限的病例系列研究表明，皮下植入式心律转复除颤器（S-ICD）系统对青少年和年轻成年人是安全的，但目前缺乏大规模的分析。

目的

本研究旨在比较大规模真实世界 S-ICD 患者队列中，按植入年龄分层的中期设备相关结局。

方法

从 ELISIR 注册中心检索了青少年+年轻人（≤30 岁）和成年人（>30 岁）两个倾向评分匹配队列。主要结局是比较不适当电击率。并发症、无持续性室性心律失常、总死亡率和心血管死亡率被认为是次要结局。

结果

青少年+年轻人占整个队列的 11.0%。使用 161 例患者的两个倾向评分匹配组进行分析。中位随访时间为 23.1（13.2-40.5）个月。共有 15.2%的患者经历了不适当的电击，9.3%的患者出现了与设备相关的并发症，在不适当电击率（16.1%比 14.3%；P=.642）和并发症发生率（9.9%比 8.7%；P=.701）方面，年龄无差异。在单因素分析中，年轻与不适当电击发生率增加无关（风险比 [HR] 1.204 [0.675-2.148]：P=.529）。多因素分析显示，使用 SMART Pass 算法与不适当电击的强烈减少相关（调整后的 HR 0.292 [0.161-0.525]；P <.001），而致心律失常性右心室心肌病（ARVC）与不适当电击发生率增加相关（调整后的 HR 2.380 [1.205-4.697]；P=.012）。