全皮下植入型心律转复除颤器植入技术安全性及有效性的单中心分析

A single-center analysis of the safety and efficiency of subcutaneous implantable cardioverter defibrillator implantation technique

目的评估全皮下植入型心律转复除颤器(S-ICD)植入技术的安全性及有效性,以期为临床推广提供参考。方法连续入选2018年8月至2020年8月在复旦大学附属中山医院心内科行S-ICD植入的患者共24例,其中男21例,女3例,年龄(41±18)岁。回顾采集患者基础心脏疾病等信息,分析其临床特征;分析术前心电图筛查、植入技术方法、学习曲线特点、并发症发生等情况;分析截至2020年8月30日患者随访数据,初步评估S-ICD的安全性及有效性。结果总计25例患者拟植入S-ICD,1例因未通过术前心电图筛查未植入,余24例经心电图筛查并植入S-ICD。基础疾病包括扩张型心肌病10例(10/24,41.7%)、肥厚型心肌病6例(6/24,25%)、离子通道疾病4例(4/24,16.7%)、缺血性心肌病1例(1/24,4.2%)及其他3例(3/24,12.5%)。手术学习曲线较短,手术时间为(55.0±18.7)min;按标准操作流程,术后短期无并发症。随访提示有17次事件,6次放电事件;其中4次正确处理,1次转复成功率100%;2次不恰当放电在程控处理后随访无不恰当放电再发,提示S-ICD具有较好的安全性及有效性。结论就本中心数据来看,S-ICD植入技术具有较短的学习曲线,短期并发症相对少见且安全有效,对于适应证人群具有进一步推广的价值。

Objective To evaluate the safety and efficiency of the subcutaneous implantable cardioverter defibrillator(S-ICD)system to provide evidence for its widespread in clinical practice.Methods Consecutively enroll patients prepared to receive S-ICD implantation from August 2018 to August 2020 in Department of Cardiology,Zhongshan Hospital of Fudan University.Twenty-four patients received S-ICD implantation,among which 21 cases were male and 3 female with an average age of(41±18)years.The patients’basic cardiovascular diseases spectrum was summarized and analyzed.The electrocardiogram(ECG)screening before implantation,the implantation techniques,the study curve characteristics and the complication post implantation were retrospectively studied.The follow-up data until August 30,2020 were analyzed to evaluate preliminarily the safety and efficiency of S-ICD.Results A total of 25 patients were prepared for S-ICD implantation,but one case failed in the ECG screening before surgery.And the other 24 patients received the S-ICD implantation.The basic cardiovascular diseases spectrum included 10 cases of dilated cardiomyopathy(10/24,41.7%),4 ion channel diseases(4/24,16.7%),6 hypertrophy cardiomyopathy(6/24,25%),1 ischemic heart disease(1/24,4.2%)and 3 others(3/24,12.5%).The implantation surgical technique learning curve was short with an average time consumption of(55.0±18.7)min.The complications were rare under the standard operation procedure so far.Seventeen events were recorded in routine follow-up.There were 6 discharge events,4 of which were handled correctly with 100%successful one-time defibrillation and 2 of inappropriate discharges.After program control treatment,there was no inappropriate discharge recurrence,indicating the safety and efficiency of the S-ICD system.Conclusion Based on our single-center experiences,S-ICD implantation technique had relatively short learning curve with fewer complications,and was safe and efficient for the prevention of sudden cardiac death.