Khan Zahid, Sethumadhavan Dinesh, Rayner Tom, Kyaw Sithu
Acute Medicine, Mid and South Essex NHS Foundation Trust, Southend-on-Sea, GBR.
Cardiology, Barts Heart Centre, London, GBR.
Cureus. 2023 Feb 1;15(2):e34492. doi: 10.7759/cureus.34492. eCollection 2023 Feb.
Implantable cardioverter-defibrillators (ICDs) are increasingly used for the primary and secondary prevention of sudden cardiac death (SCD). Currently, transvenous (TV) and subcutaneous (S) ICDs are the two different types used. Preservation of central venous vasculature, no risk of vascular or myocardial injury during implant, easier explantation, and lower risk of systemic infections have driven the increased use of S-ICDs. The shocks delivered by ICDs for non-life-threatening arrhythmias or because of oversensing T waves or noise are known as inappropriate shocks. Here, we present the case of a 33-year-old man who had an S-ICD implanted in 2019 for hypertrophic cardiomyopathy. He had a TV-ICD implanted in 2010 which was explanted in 2013 due to infective endocarditis, and the patient underwent a mechanical mitral valve replacement. He was at intermediate risk for SCD over the next five years. He had an S-ICD implanted in 2019 and had never received any shock before. Electrocardiogram showed normal sinus rhythm, left axis deviation, QRS 110 ms, hyperacute T waves in inferior leads, and T-wave inversion in lateral leads. He then began experiencing inappropriate shocks three years after S-ICD placement due to a drop in R wave amplitude secondary to noise oversensing in October 2022. Despite reprogramming the device from the primary vector to an alternate vector, the patient had further inappropriate shocks two months later due to noise oversensing. The patient was discussed in a multidisciplinary team meeting and the S-ICD was explanted according to the patient's wishes and a loop recorder was implanted.
植入式心脏复律除颤器（ICD）越来越多地用于心脏性猝死（SCD）的一级和二级预防。目前，经静脉（TV）ICD和皮下（S）ICD是两种不同类型的使用设备。保留中心静脉血管系统、植入过程中无血管或心肌损伤风险、更易于取出以及全身感染风险较低，促使S-ICD的使用增加。ICD因非危及生命的心律失常或由于T波过感知或噪音而发放的电击被称为不适当电击。在此，我们报告一例33岁男性病例，该患者于2019年因肥厚型心肌病植入了S-ICD。他曾在2010年植入过TV-ICD，2013年因感染性心内膜炎将其取出，患者接受了机械二尖瓣置换术。在接下来的五年里，他处于SCD的中度风险。他于2019年植入了S-ICD，此前从未接受过任何电击。心电图显示窦性心律正常、电轴左偏、QRS波时限110毫秒、下壁导联T波超急性改变以及侧壁导联T波倒置。2022年10月，由于噪音过感知导致R波振幅下降，该患者在S-ICD植入三年后开始出现不适当电击。尽管将设备从主向量重新编程为备用向量，但两个月后患者仍因噪音过感知再次出现不适当电击。在多学科团队会议上对该患者进行了讨论，并根据患者意愿取出了S-ICD，植入了一个环路记录器。
