Yang Ying Chi, Shetty Suchith, Koranne Ketan, Malik Aaqib, Giudici Michael
Department of Internal Medicine, University of Iowa Health Care, Carver College of Medicine, Iowa City, IA, USA.
Department of Cardiology, MercyOne North Iowa Medical Center, Mason City, IA, USA.
J Innov Card Rhythm Manag. 2022 May 15;13(5):4987-4993. doi: 10.19102/icrm.2022.130502. eCollection 2022 May.
Defibrillation threshold (DFT) testing is performed in individuals with higher predicted risks of defibrillation failure. Many strategies have been explored to overcome the challenge of high DFT, including an insertion of a defibrillator lead into the azygos vein. We performed a systematic review of the literature to evaluate the safety and efficacy of azygos vein implantable cardioverter-defibrillator insertion for high DFT combined with the analysis of a single-center experience of the procedure at our institution. The literature search was performed in PubMed and Embase from database inception to December 2020 to identify all case reports and case series related to azygos vein defibrillator lead insertion. Our search identified 291 records. After excluding duplicate studies and those without DFT thresholds and non-azygos vascular destinations, 12 studies (23 cases) were reviewed from the current database. We also conducted a retrospective analysis of 5 cases performed at our institution, and a total of 28 patients were included in our final analysis. The mean age of the pooled cohort was 47 years (range, 17-88 years). Men composed 92% of the total cases, and the average body mass index was 34 kg/m. The mean ejection fraction (EF) was 25%, with 78% having non-ischemic cardiomyopathy. The left axillary (36%) or subclavian (48%) vein was the common percutaneous access point. The mean duration of azygos vein access and lead delivery was 22 min (range, 13-60 min). The average DFT prior to azygos coil insertion was 35 J (range, 20-45 J). Fifty-seven percent of cases achieved substantial DFT improvement, whereas 18% achieved relative improvement compared to the pre-procedural threshold. No immediate or remote procedure-related complications were reported in 24 cases where data were available. During an average follow-up period of 18 months, 5 patients had ventricular arrhythmic events requiring device therapy and 4 had successful cardioversion from the device. One patient died from cardiac arrest with variable device therapies of both unsuccessful and successful events. In conclusion, azygos vein defibrillator lead insertion has a considerable rate of success, ease of vascular access with minimal procedural time, and lower risks and complications. Larger studies and longer follow-up periods are warranted to establish its efficacy and safety.
除颤阈值（DFT）测试在预测除颤失败风险较高的个体中进行。人们探索了多种策略来应对高DFT的挑战，包括将除颤器导线插入奇静脉。我们对文献进行了系统回顾，以评估奇静脉植入式心脏复律除颤器插入术治疗高DFT的安全性和有效性，并结合我们机构该手术的单中心经验进行分析。从数据库建立到2020年12月，在PubMed和Embase中进行文献检索，以识别所有与奇静脉除颤器导线插入相关的病例报告和病例系列。我们的检索共识别出291条记录。在排除重复研究以及那些没有DFT阈值和非奇静脉血管目的地的研究后，从当前数据库中回顾了12项研究（23例）。我们还对在我们机构进行的5例病例进行了回顾性分析，最终分析共纳入28例患者。汇总队列的平均年龄为47岁（范围17 - 88岁）。男性占总病例的92%，平均体重指数为34kg/m²。平均射血分数（EF）为25%，78%患有非缺血性心肌病。左腋静脉（36%）或锁骨下静脉（48%）是常见的经皮穿刺接入点。奇静脉接入和导线置入的平均持续时间为22分钟（范围13 - 60分钟）。插入奇静脉线圈前的平均DFT为35J（范围20 - 45J）。57%的病例DFT有显著改善，而与术前阈值相比，18%有相对改善。在有数据的24例病例中，未报告立即或远期与手术相关的并发症。在平均18个月的随访期内，5例患者发生需要设备治疗的室性心律失常事件，4例通过设备成功转复。1例患者死于心脏骤停，设备治疗有不成功和成功的不同情况。总之，奇静脉除颤器导线插入术成功率较高，血管接入容易，手术时间短，风险和并发症较低。需要更大规模的研究和更长的随访期来确定其疗效和安全性。
