全皮下植入型心律转复除颤器植入单中心临床观察

Clinical observation of subcutaneous implantable cardioverter defibrillator implanted in a single center

目的观察全皮下植入型心律转复除颤器(S-ICD)植入术中、术后情况,探讨S-ICD植入技术的安全性及有效性。方法选取2016年2月到2020年8月在新疆医科大学第一附属医院植入S-ICD的患者,回顾性分析其临床特征、术前筛查特点、麻醉方式、植入技术要点以及随访情况。结果研究纳入16例患者,中位随访时间为7个月;男13例,女3例;平均年龄49.5岁,年龄范围33~65岁。其中一级预防10例、二级预防6例。疾病谱为离子通道病、肥厚型心肌病、扩张型心肌病等,其中2例开创性起搏器结合S-ICD治疗;13例为无插管全身麻醉+局部麻醉,3例为全身麻醉,无麻醉相关并发症发生。植入后室性心动过速(室速)、心室颤动(室颤)等恶性心律失常共发生40次,正确识别并恰当放电52次;1例患者因反复出现室速、室颤引起S-ICD电风暴,最终行射频消融终止。结论对于经静脉植入ICD高风险患者,选择S-ICD是安全有效的,且学习曲线短、并发症少,值得推广和应用。另外,对于致命性室性快速性心律失常需要起搏治疗的患者,可以尝试行单腔起搏器结合S-ICD治疗。

Objective To observe the intraoperative and postoperative situation of all subcutaneous implantable cardioverter defibrillator(S-ICD),and to investigate the safety and efficacy of S-ICD implantation.Methods The patients with S-ICD implantation in the First Affiliated Hospital of Xinjiang Medical University from February 2016 to August 2020 were selected.Their clinical features,preoperative screening features,anesthesia methods,key points of implantation technology and follow-up status were analyzed retrospectively.Results The study included 16 patients with a median follow-up time of 7 months,13 males and 3 females,with average age of 49.5 years,ranging from 33 to 65 years old.There were 10 cases of primary prevention and 6 cases of secondary prevention.The spectrum of disease was plasma channel disease,hypertrophic cardiomyopathy,dilated cardiomyopathy,et al.Among them,2 case were treated with pioneering pacemaker combined with S-ICD.There were 13 cases had general anesthesia plus local anesthesia without intubation,and 3 cases had general anesthesia without anesthesia-related complications.Malignant arrhythmias such as ventricular tachycardia(VT)and ventricular fibrillation(VF)occurred 40 times.And 52 times were correctly recognized and discharged.In 1 patient,S-ICD electrical storm was caused by recurrent VT and VF,which was finally terminated by radiofrequency ablation.Conclusion It is safe and effective to select S-ICD for patients with high risk of implantable cardioverter defibrillator(ICD)implantation via vein.Besides,the learning curve is short and the complications are few,so it is worthy of promotion and application.In addition,for patients with fatal ventricular tachyarrhythmias requiring pacemaker treatment,single-chamber pacemaker+S-ICD therapy may be attempted.