Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan.
Section of arrhythmia, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan.
J Cardiovasc Electrophysiol. 2023 Jul;34(7):1569-1576. doi: 10.1111/jce.15967. Epub 2023 Jun 14.
Intermuscular implantations of subcutaneous implantable cardioverter-defibrillators (S-ICD) have been recommended, but the position of the anterior border of the latissimus dorsi muscle (LDM) has not previously been evaluated in establishing an incision line to facilitate the intermuscular approach. The objective of this study is to evalua the position and trend of the anterior border of the LDM in patients who are candidates for implantable cardioverter-defibrillators.
The distance from the back to the anterior border of the LDM (A) and the anterior-posterior width of the chest wall (B) were measured on computed tomography retrospectively, and the ratio (=A/B) was used as the position of the anterior border of the LDM. In addition, the variability and factors affecting the values were evaluated.
An analysis was performed on 78 patients, and the position of the anterior border of the LDM (=A/B) exhibited a normal distribution, with a mean value of 0.53 ± 0.062 (0.41-0.69). The position of the anterior border of the LDM tended to be more anterior in younger, taller, male, primary prevention, nonheart failure, low brain natriuretic peptide level, and nondiabetic patients.
The position of the anterior border of the LDM varied from case to case with variable results. Conventional incisions on the midaxillary line may be inappropriate for intermuscular implantations, and the position of the anterior border of the LDM should be evaluated in each individual case to establish the incision line.
皮下植入式心律转复除颤器（S-ICD）的肌间植入已被推荐，但在建立便于肌间入路的切口线时，尚未对背阔肌（LDM）前边界的位置进行评估。本研究旨在评估植入式心律转复除颤器候选患者的 LDM 前边界的位置和趋势。
回顾性地在计算机断层扫描上测量从背部到 LDM 前边界的距离（A）和胸壁的前后宽度（B），并将比值（= A/B）用作 LDM 前边界的位置。此外，还评估了变异性和影响这些值的因素。
对 78 例患者进行了分析，LDM 前边界的位置（= A/B）呈正态分布，平均值为 0.53±0.062（0.41-0.69）。在年轻、身高较高、男性、原发性预防、非心力衰竭、低脑利钠肽水平和非糖尿病患者中，LDM 前边界的位置更靠前。
LDM 前边界的位置因个体而异，结果也有所不同。传统的腋中线切口可能不适合肌间植入，应在每个个体病例中评估 LDM 前边界的位置，以确定切口线。
