Université de Paris, INSERM, Paris Cardiovascular Research Centre, Paris, France; Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, Paris, France; Pediatric and Congenital Medico-Surgical Unit, Necker Hospital, Paris, France; Cardiac Electrophysiology Unit, European Georges Pompidou Hospital, Paris, France.
CHU de Lille, Lille, France.
J Am Coll Cardiol. 2023 Aug 15;82(7):590-599. doi: 10.1016/j.jacc.2023.05.057.
Very few data have been published on the use of subcutaneous implantable cardioverter-defibrillators (S-ICDs) in patients with congenital heart disease (CHD).
The aim of this study was to analyze outcomes associated with S-ICDs in patients with CHD.
This nationwide French cohort including all patients with an S-ICD was initiated in 2020 by the French Institute of Health and Medical Research. Characteristics at implantation and outcomes were analyzed in patients with CHD.
From October 12, 2012, to December 31, 2019, among 4,924 patients receiving an S-ICD implant in 150 centers, 101 (2.1%) had CHD. Tetralogy of Fallot, univentricular heart, and dextro-transposition of the great arteries represented almost one-half of the population. Patients with CHD were significantly younger (age 37.1 ± 15.4 years vs 50.1 ± 14.9 years; P < 0.001), more frequently female (37.6% vs 23.0%; P < 0.001), more likely to receive an S-ICD for secondary prevention (72.3% vs 35.9%; P < 0.001), and less likely to have severe systolic dysfunction of the systemic ventricle (28.1% vs 53.1%; P < 0.001). Over a mean follow-up period of 1.9 years, 16 (15.8%) patients with CHD received at least 1 appropriate shock, with all shocks successfully terminating the ventricular arrhythmia. The crude risk of appropriate S-ICD shock was twice as high in patients with CHD compared with non-CHD patients (annual incidences of 9.0% vs 4.4%; HR: 2.1; 95% CI: 1.3-3.4); however, this association was no longer significant after propensity matching (especially considering S-ICD indication, P = 0.12). The burden of all complications (HR: 1.2; 95% CI: 0.7-2.1; P = 0.4) and inappropriate shocks (HR: 0.9; 95% CI: 0.4-2.0; P = 0.9) was comparable in both groups.
In this nationwide study, patients with CHD represented 2% of all S-ICD implantations. Our findings emphasize the effectiveness and safety of S-ICD in this particularly high-risk population. (S-ICD French Cohort Study [HONEST]; NCT05302115).
关于皮下植入式心律转复除颤器（S-ICD）在先天性心脏病（CHD）患者中的应用，仅有少量数据发表。
本研究旨在分析 S-ICD 在 CHD 患者中的应用结局。
这项法国全国性队列研究于 2020 年由法国健康与医学研究所发起，纳入所有接受 S-ICD 植入的患者。分析 CHD 患者的植入时特征和结局。
在 150 个中心接受 S-ICD 植入的 4924 例患者中，有 101 例（2.1%）患有 CHD。法洛四联症、单心室和右位心-大动脉转位几乎占患者总数的一半。CHD 患者明显更年轻（年龄 37.1±15.4 岁 vs 50.1±14.9 岁；P<0.001），更常为女性（37.6% vs 23.0%；P<0.001），更可能因二级预防而接受 S-ICD（72.3% vs 35.9%；P<0.001），且左心室收缩功能不全的严重程度较低（28.1% vs 53.1%；P<0.001）。在平均 1.9 年的随访期间，有 16 例（15.8%）CHD 患者至少接受了 1 次恰当电击，所有电击均成功终止了室性心律失常。与非 CHD 患者相比，CHD 患者发生恰当 S-ICD 电击的风险更高（粗发生率为 9.0% vs 4.4%；HR：2.1；95%CI：1.3-3.4）；然而，在倾向评分匹配后，这种关联不再显著（尤其是考虑到 S-ICD 适应证，P=0.12）。两组的所有并发症（HR：1.2；95%CI：0.7-2.1；P=0.4）和不恰当电击（HR：0.9；95%CI：0.4-2.0；P=0.9）的负担相似。
在这项全国性研究中，CHD 患者占所有 S-ICD 植入患者的 2%。我们的研究结果强调了 S-ICD 在这一高危人群中的有效性和安全性。（S-ICD 法国队列研究[HONEST]；NCT05302115）。
