Long-Term Clinical Outcomes of Subcutaneous Versus Transvenous Implantable Defibrillator Therapy
Long-Term Clinical Outcomes of Subcutaneous Versus Transvenous Implantable Defibrillator Therapy
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DOI：
10.1016/j.jacc.2016.08.044
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发表时间：
2016-11-08
影响因子：
24
通讯作者：
Knops, Reinoud E.
中科院分区：
文献类型：
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作者：
Brouwer, Tom F.;Yilmaz, Dilek;Knops, Reinoud E.
背景经静脉植入式心律转复除颤器（TV-ICD）可提高心源性猝死风险患者的生存率，但并发症仍是一个重要的缺点。皮下ICD（S-ICD）的开发旨在克服电极导线相关并发症。在以前的研究中，这两种设备类型的临床结果的比较是由不同的患者characteristics. AcceptativesThis回顾性研究比较了长期的临床结果S-ICD和TV-ICD治疗的倾向匹配coherents.METHODS作者分析了1,160例患者接受S-ICD或TV-ICD植入在2个高容量的医院在荷兰。包括诊断在内的16个基线特征的倾向匹配产生了140个匹配对。临床结局为需要手术干预的器械相关并发症，适当和不适当的ICD治疗，并报告为5年Kaplan-Meier率estimate.Results所有16个基线特征在匹配的140例S-ICD患者和140例TV-ICD患者队列中平衡（中位年龄41岁[四分位数范围：30至52岁]，40%为女性）。S-ICD组的并发症发生率为13.7%，TV-ICD组为18.0%（p = 0.80）。TV-ICD组的感染率分别为4.1%和3.6%（p = 0.36）。S-ICD组的电极导线并发症低于TV-ICD组，分别为0.8%和11.5%（p = 0.03）。S-ICD患者的非电极导线相关并发症多于TV-ICD患者，分别为9.9%和2.2%（p = 0.047）。TV-ICD组更常进行适当的ICD干预（抗心动过速起搏和电击）（风险比[HR]：2.42; p = 0.01）。适当（TV-ICD HR：1.46; p = 0.36）和不适当的电击（TV-ICD HR：0.85; p = 0.64）的发生率相似。结论：植入S-ICD或TV-ICD的患者的并发症发生率相似，但其性质不同。S-ICD显著减少了电极导线相关并发症，但以非电极导线相关并发症为代价。两组之间适当和不适当电击的发生率相似。(C)2016作者由Elsevier代表美国心脏病学会基金会发布。这是一个在CC BY-NC-ND许可证下的开放获取文章（http：//creativecommons.org/licenses/by-nc-nd/4.0/）。
BACKGROUND Transvenous implantable cardioverter-defibrillators (TV-ICDs) improve survival in patients at risk for sudden cardiac death, but complications remain an important drawback. The subcutaneous ICD (S-ICD) was developed to overcome lead-related complications. Comparison of clinical outcomes of both device types in previous studies was hampered by dissimilar patient characteristics.OBJECTIVES This retrospective study compares long-term clinical outcomes of S-ICD and TV-ICD therapy in a propensity-matched cohort.METHODS The authors analyzed 1,160 patients who underwent S-ICD or TV-ICD implantation in 2 high-volume hospitals in the Netherlands. Propensity matching for 16 baseline characteristics, including diagnosis, yielded 140 matched pairs. Clinical outcomes were device-related complications requiring surgical intervention, appropriate and inappropriate ICD therapy, and were reported as 5-year Kaplan-Meier rate estimates.RESULTS All 16 baseline characteristics were balanced in the matched cohort of 140 patients with S-ICDs and 140 patients with TV-ICDs (median age 41 years [interquartile range: 30 to 52 years] and 40% women). The complication rate was 13.7% in the S-ICD group versus 18.0% in the TV-ICD group (p = 0.80). The infection rate was 4.1% versus 3.6% in the TV-ICD groups (p = 0.36). Lead complications were lower in the S-ICD arm compared with the TV-ICD arm, 0.8% versus 11.5%, respectively (p = 0.03). S-ICD patients had more nonlead-related complications than TV-ICD patients, 9.9% versus 2.2%, respectively (p = 0.047). Appropriate ICD intervention (antitachycardia pacing and shocks) occurred more often in the TV-ICD group (hazard ratio [HR]: 2.42; p = 0.01). The incidence of appropriate (TV-ICD HR: 1.46; p = 0.36) and inappropriate shocks (TV-ICD HR: 0.85; p = 0.64) was similar.CONCLUSIONS The complication rate in patients implanted with an S-ICD or TV-ICD was similar, but their nature differed. The S-ICD reduced lead-related complications significantly, at the cost of nonlead-related complications. Rates of appropriate and inappropriate shocks were similar between the 2 groups. (C) 2016 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).