心外膜与经静脉植入式心脏复律除颤器在儿童中的应用比较。

Epicardial vs. transvenous implantable cardioverter defibrillators in children.

机构信息

M3C-Necker, Hôpital Universitaire Necker-Enfants Malades, 149 rue de Sèvres, 75015 Paris, France.

Department of Pediatric Cardiac Surgery, Necker Hospital, 149 rue de Sèvres, 75015 Paris, France.

出版信息

Europace. 2023 Mar 30;25(3):961-968. doi: 10.1093/europace/euad015.

DOI:10.1093/europace/euad015

Abstract

AIMS

The implantable cardioverter defibrillator (ICD) has been increasingly used in children. Both epicardial and transvenous approaches are used, with controversy regarding the best option with no specific recommendations. We aimed to compare outcomes associated with epicardial vs. transvenous ICDs in children.

METHODS AND RESULTS

Data were analysed from a retrospective study including all patients <18-year-old implanted with an ICD in a tertiary centre from 2003 to 2021. Outcomes were compared between epicardial and transvenous ICDs. A total of 122 children with an ICD (mean age 11.5 ± 3.8 years, 57.4% males) were enrolled, with 84 (64.1%) epicardial ICDs and 38 (29.0%) transvenous ICDs. Early (<30 days) ICD-related complications were reported in 17 (20.2%) patients with an epicardial ICD vs. 0 (0.0%) with a transvenous ICD (P = 0.002). Over a mean follow-up of 4.8 ± 4.0 years, 25 (29.8%) patients with an epicardial ICD and 9 (23.7%) patients with a transvenous ICD experienced at least one late ICD-related complication [hazard ratio (HR) 1.8, 95% confidence interval (CI) 0.8-4.0]. Implantable cardioverter defibrillator lead dysfunction occurred in 19 (22.6%) patients with an epicardial ICD vs. 3 (7.9%) with a transvenous ICD (HR 5.7, 95% CI 1.3-24.5) and was associated with a higher incidence of ICD-related reintervention (HR 3.0, 95% CI 1.3-7.0). After considering potential confounders, especially age and weight at implantation, this association was no longer significant (P = 0.112). The freedom from ICD lead dysfunction was greater in patients with pleural coils than in those with epicardial coils (HR 0.38, 95% CI 0.15-0.96).

CONCLUSION

In children, after a consideration of patient characteristics at implantation, the burden of complications and ICD lead dysfunction appears to be similar in patients with epicardial and transvenous devices. Pleural coils seem to be associated with better outcomes than epicardial coils in this population.

CLINICAL TRIAL REGISTRATION

NCT05349162.

摘要

目的

植入式心脏复律除颤器（ICD）在儿童中的应用日益增多。目前有经心外膜和经静脉两种途径，哪种方法最佳存在争议，尚无具体建议。本研究旨在比较儿童经心外膜和经静脉 ICD 的结局。

方法和结果

本研究对 2003 年至 2021 年在一家三级中心植入 ICD 的所有<18 岁患者进行了回顾性研究数据分析。比较了经心外膜和经静脉 ICD 的结局。共纳入 122 例 ICD 患儿（平均年龄 11.5±3.8 岁，57.4%为男性），其中 84 例（64.1%）为经心外膜 ICD，38 例（29.0%）为经静脉 ICD。经心外膜 ICD 的 17 例（20.2%）患儿和经静脉 ICD 的 0 例（0.0%）患儿在早期（<30 天）出现 ICD 相关并发症（P=0.002）。在平均 4.8±4.0 年的随访中，经心外膜 ICD 的 25 例（29.8%）患儿和经静脉 ICD 的 9 例（23.7%）患儿至少经历了一次晚期 ICD 相关并发症[风险比（HR）1.8，95%置信区间（CI）0.8-4.0]。经心外膜 ICD 的 19 例（22.6%）患儿和经静脉 ICD 的 3 例（7.9%）患儿发生 ICD 导线功能障碍（HR 5.7，95%CI 1.3-24.5），与 ICD 相关再介入的发生率较高相关（HR 3.0，95%CI 1.3-7.0）。在考虑了潜在的混杂因素，特别是植入时的年龄和体重后，这种关联不再显著（P=0.112）。与经心外膜线圈相比，在有胸腔线圈的患儿中 ICD 导线功能障碍的发生率较低（HR 0.38，95%CI 0.15-0.96）。