皮下植入式心律转复除颤器在18岁及以下儿童中的疗效：SAVE-CHILDREN注册研究
Efficacy of SubcutAneous implantable cardioVErter-defibrillators in ≤18 year-old CHILDREN: SAVE-CHILDREN registry.
作者信息
Mori Hitoshi, Sumitomo Naokata, Tsutsui Kenta, Fukunaga Hideo, Hayashi Hidemori, Nakajima Hiroshi, Muraji Shota, Nabeshima Taisuke, Kawano Daisuke, Ikeda Yoshifumi, Asano So, Nitta Junichi, Watanabe Shigeo, Hokosaki Tatsunori, Sato Seiichi, Chisaka Toshiyuki, Higaki Takashi, Nakajima Tadashi, Tamura Shuntaro, Kaneko Yoshiaki, Ikeda Kentaro, Okada Ayako, Kobayashi Hideki, Motoki Hirohiko, Minamiguchi Hitoshi, Imamura Tomohiko, Shizuta Satoshi, Kawamura Mitsuharu, Munetsugu Yumi, Suzuki Tsugutoshi, Murakami Takashi, Horigome Hitoshi, Wada Tsutomu, Takamuro Motoki, Ozawa Junichi, Suzuki Hiroshi, Izumi Daisuke, Otsuki Sou, Chinushi Masaomi, Kato Ken, Miura Masaru, Maeda Jun, Fukunaga Masato, Kondo Hidekazu, Takahashi Naohiko, Tobiume Takeshi, Morishima Itsuro, Kuraishi Kenji, Nakamura Kentaro, Hayashi Hiroshi, Suzuki Hirohiko, Yoshida Yukihiko, Fukamizu Seiji, Hojo Rintaro, Nuruki Norihito, Yoshinaga Masao, Hayashi Kentaro, Fukaya Hidehira, Kishihara Jun, Kobayashi Toshiki, Kato Ritsushi
机构信息
Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Saitama, Japan; Department of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan.
Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Saitama, Japan.
出版信息
Int J Cardiol. 2023 Jan 15;371:204-210. doi: 10.1016/j.ijcard.2022.09.008. Epub 2022 Sep 8.
BACKGROUND
In adult patients, subcutaneous implantable cardioverter defibrillators (S-ICDs) have been reported to be non-inferior to transvenous ICDs with respect to the incidence of device-related complications and inappropriate shocks. Only a few reports have investigated the efficacy of S-ICDs in the pediatric field. This study aimed to investigate the utility and safety of S-ICDs in patients ≤18 years old.
METHODS
This study was a multicenter, observational, retrospective study on S-ICD implantations. Patients <18 years old who underwent S-ICD implantations were enrolled. The detailed data on the device implantations and eligibility tests, incidence of appropriate- and inappropriate shocks, and follow-up data were assessed.
RESULTS
A total of 62 patients were enrolled from 30 centers. The patients ranged in age from 3 to 18 (median 14 years old [IQR 11.0-16.0 years]). During a median follow up of 27 months (13.3-35.8), a total of 16 patients (26.2%) received appropriate shocks and 13 (21.3%) received inappropriate shocks. The common causes of the inappropriate shocks were sinus tachycardia (n = 4, 30.8%) and T-wave oversensing (n = 4, 30.8%). In spite of the physical growth, the number of suitable sensing vectors did not change during the follow up. No one had any lead fractures or device infections in the chronic phase.
CONCLUSIONS
Our study suggested that S-ICDs can prevent sudden cardiac death in the pediatric population with a low incidence of lead complications or device infections. The number of suitable sensing vectors did not change during the patients' growth.
背景
在成年患者中，皮下植入式心律转复除颤器（S-ICD）在与设备相关的并发症和不适当电击发生率方面已被报道不劣于经静脉植入式心律转复除颤器。仅有少数报告研究了S-ICD在儿科领域的疗效。本研究旨在调查S-ICD在18岁及以下患者中的实用性和安全性。
方法
本研究是一项关于S-ICD植入的多中心、观察性、回顾性研究。纳入接受S-ICD植入的18岁以下患者。评估了设备植入和合格性测试的详细数据、适当和不适当电击的发生率以及随访数据。
结果
共从30个中心纳入62例患者。患者年龄范围为3至18岁（中位数14岁[四分位间距11.0 - 16.0岁]）。在中位随访27个月（13.3 - 35.8个月）期间，共有16例患者（26.2%）接受了适当电击，13例（21.3%）接受了不适当电击。不适当电击的常见原因是窦性心动过速（n = 4，30.8%）和T波感知过度（n = 4，30.8%）。尽管身体生长，但随访期间合适的感知向量数量未改变。在慢性期，没有人发生任何导线断裂或设备感染。
结论
我们的研究表明，S-ICD可预防儿科人群的心源性猝死，导线并发症或设备感染发生率较低。患者生长期间合适的感知向量数量未改变。
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