Departamento de Investigación Clínica.
Departamento de Electrofisiología pediátrica.
Arch Cardiol Mex. 2023;93(3):276-283. doi: 10.24875/ACM.22000061.
The transvenous implantable cardioverter defibrillator (ICD) is the treatment of choice for the prevention of sudden cardiac death (SCD). Its use could be restricted when device-related infections occurs or in the pediatric population. In the later, an ICD represents a challenge, due to the minimal dimensions of the venous system in children, the length of the electrodes, the size of the generator, as well as the anatomical complexity in cases with associated congenital heart disease.
This article presents the first Mexican patients with a subcutaneous ICD (SC-ICD) implant as a therapy for the prevention of SCD.
The first four cases were implanted at the Ignacio Chávez National Institute of Cardiology with a SC-ICD (Emblem, Boston Scientific, USA), three of them were pediatric patients, including the first implant of this type of device in a pediatric patient in Latin America. The 3-incision and 2-incision techniques were used under general anesthesia.
A successful implantation was obtained with the 3-incision technique in the first 2 cases and the last 2 with the 2-incision technique. Proper functioning of the device was corroborated in the operating room with proof of appropriate therapy (65 J) for ventricular fibrillation induced with 50 Hz stimulation. No immediate complications were observed. One patient had appropriate shocks two months after the implant. During follow-up, one child developed skin erosion at the level of the curve of the electrode on the sternum, with no signs of infection. In the operating room, the damaged skin was resected, the barrel and the fixation silk were removed, surgical lavage was performed, and the skin was closed again, thus avoiding removal of the system.
The SC-ICD is an alternative therapy to the transvenous ICD. It can be considered first choice in subjects who do not require ventricular pacing, including pediatric patients. Skin complications can occur but do not pose a threat as venous complications of conventional ICDs.
经静脉植入式心脏复律除颤器（ICD）是预防心源性猝死（SCD）的首选治疗方法。当发生器械相关感染或在儿科人群中时，可能会限制其使用。在后一种情况下，由于儿童静脉系统的最小尺寸、电极的长度、发生器的尺寸以及伴有先天性心脏病的病例的解剖复杂性，ICD 代表了一个挑战。
本文介绍了首例在墨西哥使用皮下 ICD（SC-ICD）植入作为预防 SCD 的治疗方法的患者。
前四个病例在 Ignacio Chávez 国家心脏病学研究所使用 SC-ICD（Emblem，波士顿科学，美国）进行植入，其中三个是儿科患者，包括该类型设备在拉丁美洲儿科患者中的首次植入。在全身麻醉下使用 3 切口和 2 切口技术。
前 2 例采用 3 切口技术成功植入，后 2 例采用 2 切口技术成功植入。在手术室中用 50Hz 刺激诱导室颤时，用适当的治疗（65J）证实了设备的正常运行。未观察到即时并发症。一名患者在植入后两个月发生了适当的电击。在随访期间，一名儿童在胸骨电极曲线上出现皮肤侵蚀，但没有感染迹象。在手术室中，切除受损的皮肤，取出桶和固定丝，进行手术冲洗，再次闭合皮肤，从而避免了系统的移除。
SC-ICD 是经静脉 ICD 的替代治疗方法。对于不需要心室起搏的患者，包括儿科患者，可考虑首选。可能会发生皮肤并发症，但不像传统 ICD 的静脉并发症那样构成威胁。
