Giacomin Enrico, Falzone Pasquale Valerio, Dall'Aglio Pietro Bernardo, Pittorru Raimondo, De Lazzari Manuel, Vianello Riccardo, Bertaglia Emanuele, Tarzia Vincenzo, Iliceto Sabino, Gerosa Gino, Migliore Federico
Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, Padua, 35121, Italy.
J Interv Card Electrophysiol. 2025 Oct;68(7):1399-1407. doi: 10.1007/s10840-022-01293-y. Epub 2022 Jul 13.
Subcutaneous implantable cardioverter defibrillator (S-ICD) is a suitable alternative for transvenous ICD (TV-ICD) patients who have undergone transvenous lead extraction (TLE). Limited data are available on the outcome of S-ICD patients implanted after TLE. We assessed the safety, efficacy, and outcome of S-ICD implantation after TLE of TV-ICD.
The study population consisted of 36 consecutive patients with a median age of 52 (44-66) years who underwent S-ICD implantation after TLE of TV-ICD.
Indications for TLE were infection (63.9%) and lead malfunction (36.1%). During a median follow-up of 31 months, 3 patients (8.3%) experienced appropriate therapy and 7 patients (19.4%) experienced complications including inappropriate therapy (n = 4; 11.1%), isolated pocket erosion (n = 2; 5.5%), and ineffective therapy (n = 1; 2.8%). No lead/hardware dysfunction was reported. Premature device explantation occurred in 4 patients (11%). Eight patients (22.2%) died during follow-up, six of them (75%) because of refractory heart failure (HF). There were no S-ICD-related deaths. Predictors of mortality included NYHA class ≥ 2 (HR 5.05; 95% CI 1.00-26.38; p = 0.04), hypertension (HR 22.72; 95% CI 1.05-26.31; p = 0.02), diabetes (HR 10.64; 95% CI 2.05-55.60; p = 0.001) and ischemic heart disease (HR 5.92; 95% CI 1.17-30.30; p = 0.01).
Our study provides evidences on the use of S-ICD as an alternative after TV-ICD explantation for both infection and lead failure. Mortality of S-ICD patients who underwent TV-ICD explantation does not appear to be correlated with the presence of a prior infection, S-ICD therapy (appropriate or inappropriate), or S-ICD complications but rather to worsening of HF or other comorbidities.
皮下植入式心律转复除颤器（S-ICD）是已接受经静脉导线拔除（TLE）的经静脉植入式心律转复除颤器（TV-ICD）患者的合适替代方案。关于TLE后植入S-ICD患者的结局数据有限。我们评估了TV-ICD的TLE后植入S-ICD的安全性、有效性和结局。
研究人群包括36例连续患者，中位年龄为52（44-66）岁，这些患者在TV-ICD的TLE后接受了S-ICD植入。
TLE的指征为感染（63.9%）和导线故障（36.1%）。在中位随访31个月期间，3例患者（8.3%）接受了恰当治疗，7例患者（19.4%）出现并发症，包括不恰当治疗（n = 4；11.1%）、单纯囊袋侵蚀（n = 2；5.5%）和无效治疗（n = 1；2.8%）。未报告导线/硬件功能障碍。4例患者（11%）过早取出装置。8例患者（22.2%）在随访期间死亡，其中6例（75%）死于难治性心力衰竭（HF）。没有与S-ICD相关的死亡。死亡的预测因素包括纽约心脏协会（NYHA）分级≥2（HR 5.05；95% CI 1.00-26.38；p = 0.04）、高血压（HR 22.72；95% CI 1.05-26.31；p = 0.02）、糖尿病（HR 10.64；95% CI 2.05-55.60；p = 0.001）和缺血性心脏病（HR 5.92；95% CI 1.17-30.30；p = 0.01）。
我们的研究为TV-ICD拔除后使用S-ICD替代治疗感染和导线故障提供了证据。接受TV-ICD拔除的S-ICD患者的死亡率似乎与既往感染的存在、S-ICD治疗（恰当或不恰当）或S-ICD并发症无关，而是与HF恶化或其他合并症有关。
