全皮下植入式心律转复除颤器——仅仅是权宜之举?

An Entirely Subcutaneous Implantable Cardioverter-Defibrillators——Expedient Measure?

植入式心脏转复除颤器(ICD)是预防心脏性猝死最重要的手段。尽管电极导线设计在不断创新,功能逐渐完善,但静脉植入电极导线仍存在一定的风险和相关并发症,三尖瓣病变有时使得电极导线难以植入,而植入的电极导线亦会发生断裂、脱位和穿孔。需要拔除或导线故障需要更换时往往带来额外风险,甚至导致死亡。全皮下植入ICD适合不需要起搏支持的ICD适应证患者,其安全有效性已得到越来越多的证实。

Implantable cardioverter-defibrillator （ICD） is an established therapy for the prevention of death from ventricular arrhyth- mia. Conventional ICD rely on transvenous leads for cardiac sensing and defibrillation. Complications of defibrillator implantation have been associated mainly with transvenous lead insertion and have included pneumothorax, hemothorax, and cardiac tamponade. Moreover, failed leads often require removal, a procedure that is associated with substantial morbidity and mortality. Subcutaneous ICD （S-1CD） is suitable in patients without an indication for antibradycardia pacing or cardiac resynchronization therapy and the efficacy and safety of the S-ICD sys- tem for the treatment of life-threatening ventrieular arrhythmias were supported by clinical trial findings.