Subcutaneous Implantable Cardioverter-Defibrillator in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia: A Transatlantic Experience
Subcutaneous Implantable Cardioverter-Defibrillator in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia: A Transatlantic Experience
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DOI：
10.1161/jaha.118.008782
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发表时间：
2018-11-06
影响因子：
5.4
通讯作者：
Calkins, Hugh
中科院分区：
文献类型：
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作者：
Orgeron, Gabriela M.;Bhonsale, Aditya;Calkins, Hugh
背景-尽管皮下植入式心律转复除颤器（S-ICD）的使用越来越多，但其在致心律失常性右心室心肌病/发育不良（ARVC/D）患者中的临床作用仍不明确。我们的目的是阐明心脏的表型，植入物的特点，并在ARVC/D患者与S-ICD implant.Methods和Results-A跨大西洋队列的ARVC/D患者接受S-ICD implantation. Methods和并发症的适当的治疗和长期疗效进行了分析的临床特征，S-ICD治疗和长期的结果，包括设备相关的并发症。该队列包括29例患者（52%为男性，76%为先证者，59%为ARVC/D相关突变，59%为一级预防[既往无持续性室性心律失常]，45%为第一代S-ICD器械）。植入时，所有可诱导患者（27/29）均发生了诱导室颤的转化。2例患者（7%）切口部位浅表感染，保守治疗。中位随访时间为3.16年（四分位距：2.21-4.51年），所有持续性室性心律失常发作（6例患者，每年4%）均得到适当检测和治疗。6名患者（21%）经历了39次不适当电击，其中3例需要器械复位。非心脏信号（n=4;特别是肌电位）和心脏信号（n=4）的过度感知是最常见的病因。无导线或装置脱位，感染，皮肤糜烂，或相关的需要antitachycardia pacemaking.Conclusions-S-ICD可以有效地治疗ARVC/D患者的诱发性和自发性室性心律失常。不适当电击的发生率虽然相当大，但与接受经静脉ICD治疗的ARVC/D患者相当。当它们发生时，不适当的电击主要是由于心脏和独特的非心脏过感知。我们建议潜在的策略，尽量减少不适当的治疗。
Background-Despite growing use of the subcutaneous implantable cardioverter-defibrillator (S-ICD), its clinical role in arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) patients remains undefined. We aim to elucidate the cardiac phenotype, implant characteristics, and long-term efficacy regarding appropriate therapy and complications in ARVC/D patients with an S-ICD implant.Methods and Results-A transatlantic cohort of ARVC/D patients who underwent S-ICD implantation was analyzed for clinical characteristics, S-ICD therapy, and long-term outcome including device-related complications. The cohort included 29 patients (52% male, 76% probands, 59% with ARVC/D-associated mutation, 59% primary prevention [no prior sustained ventricular arrhythmias], and 45% first-generation S-ICD devices). At implant, all inducible patients (27/29) had conversion of induced ventricular fibrillation. Two patients (7%) had superficial infections of the incision site that were treated conservatively. Over a median follow-up of 3.16 years (interquartile range: 2.21-4.51 years), all episodes (6 patients, 4% per year) of sustained ventricular arrhythmias were appropriately detected and treated. Six patients (21%) experienced 39 inappropriate shocks, with 3 requiring device explantation. Oversensing of noncardiac signal (n=4; especially myopotentials) and cardiac signal (n=4) was the most frequent etiology. No lead or device dislodgement, infection, skin erosion, or explantation related to need for antitachycardia pacing was noted.Conclusions-S-ICD can effectively treat both induced and spontaneous ventricular arrhythmias in patients with ARVC/D. The rate of inappropriate shocks, although considerable, is comparable to that in ARVC/D patients treated with transvenous ICDs. When they occurred, inappropriate shocks were primarily due to cardiac and, uniquely, noncardiac oversensing. We suggest potential strategies for minimizing inappropriate therapy.