Kron J, Silka M J, Ohm O J, Bardy G, Benditt D
Department of Medicine, Oregon Health Sciences University, Portland 97201.
Pacing Clin Electrophysiol. 1994 Jan;17(1):26-30. doi: 10.1111/j.1540-8159.1994.tb01347.x.
Implantable cardioverter defibrillators represent an important treatment option for patients with life-threatening tachyarrhythmias. However, the requirement for surgical access to the thorax contributes to significant procedural morbidity with ICD implantation. This study was performed to assess an initial experience with a nonthoracotomy approach to ICD lead implantation in young patients. An international survey identified 17 patients, ranging in age from 12-20 years (mean = 16.7 +/- 2.4) and weighing from 33-89 kg (mean = 60.6 +/- 13.3), who had undergone placement of the Medtronic Transvene defibrillator lead system. Implant indications were aborted sudden cardiac death in 15 patients and recurrent ventricular tachycardia or familial sudden death in 2 patients. At a median follow-up of 7.9 months, 9 of 17 patients had received at least one ICD therapy. There have been no deaths. Complications included patch or generator erosion (3 patients), lead dislodgement (1 patient), and ICD system infection requiring explanation (1 patient). The initial experience with nonthoracotomy ICDs in young patients appears promising. This approach may be particularly advantageous for patients who have undergone prior thoracotomy. Prospective clinical trials will be required to establish the applicability of these lead systems to select patient populations.
植入式心脏复律除颤器是治疗危及生命的快速性心律失常患者的重要选择。然而，植入ICD需要通过手术进入胸腔，这会导致ICD植入过程中出现显著的手术并发症。本研究旨在评估年轻患者采用非开胸方法植入ICD导线的初步经验。一项国际调查确定了17例患者，年龄在12至20岁之间（平均 = 16.7 +/- 2.4），体重在33至89千克之间（平均 = 60.6 +/- 13.3），他们接受了美敦力经静脉除颤器导线系统的植入。植入指征为15例患者心脏性猝死未遂，2例患者为复发性室性心动过速或家族性猝死。在中位随访7.9个月时，17例患者中有9例接受了至少一次ICD治疗。无死亡病例。并发症包括补片或发生器侵蚀（3例患者）、导线脱位（1例患者）以及需要取出的ICD系统感染（1例患者）。年轻患者采用非开胸ICD的初步经验似乎很有前景。这种方法对于既往接受过开胸手术的患者可能特别有利。需要进行前瞻性临床试验来确定这些导线系统对特定患者群体的适用性。
