Current clinical practice of subcutaneous implantable cardioverter-defibrillator: Analysis using the JROAD-DPC database
Current clinical practice of subcutaneous implantable cardioverter-defibrillator: Analysis using the JROAD-DPC database
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DOI：
10.1016/j.hrthm.2022.02.006
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发表时间：
2022-06-01
期刊：
影响因子：
5.5
通讯作者：
Kusano, Kengo
中科院分区：
文献类型：
--
作者：
Tonegawa-Kuji, Reina;Inoue, Yuko Y.;Kusano, Kengo
背景现有证据表明，与经静脉埋藏式心脏复律除颤器(TV-ICD)相比，皮下埋藏式心脏复律除颤器(S-ICD)的治疗特点、发展趋势和围术期疗效比较缺乏。目的本研究的目的是利用一个全国性的数据库，对目前S-ICD治疗的特点进行回顾性分析。共分析了8,690例ICD患者(中位年龄65[52-72]岁；男性6,902例；2021例S-ICD患者)。室颤史(优势比[OR]2.45；95%可信区间[CI]2.04~2.93)、非持续性室性心动过速(OR 1.73；95%CI 1.36~2.21)、Brugada综合征(OR 3.14；95%CI 2.48~4.00)、透析治疗(OR 2.02；95%CI 1.44~2.82)是S-ICD选择混合模型Logistic回归分析的独立预测因素。植入S-ICD的比例一直在增加(P<；.001)，特别是在BRS患者(P<；.001)和透析患者(P=.04)。在1：1倾向匹配队列中，S介入术后并发症发生率较低(1.3%)，与1：1倾向匹配队列中TV-ICD相似(1.5%比2.3%；OR 0.65；95%可信区间0.38~1.10)。结论S介入术后并发症更易发生于年龄较小、有室颤病史、室性心动过速、BRS和透析治疗史的患者。植入S-ICD的比例增加，尤其是在BRS患者。S-ICD受者住院期间并发症发生率低。
BACKGROUND Current evidence describing the characteristics of subcutaneous implantable cardioverter-defibrillator (S-ICD) therapy, its trend, and perioperative outcomes compared with transvenous implantable cardioverter-defibrillator (TV-ICD) based on a real-world, large-scale database is scarce.OBJECTIVE The purpose of this study was to identify the characteristics of current S-ICD therapy using a nationwide database.METHODS A retrospective analysis of ICD implantation was performed using a nationwide database obtained between 2016 and 2020. A total of 8690 patients implanted with ICD (median age 65 [52-72] year; 6902 men; 2021 S-ICD recipients) were analyzed.RESULTS Younger patients were more prone to have S-ICD (P < .001). A history of ventricular fibrillation (VF) (odds ratio [OR] 2.45; 95% confidence interval [CI] 2.04-2.93), nonsustained ventricular tachycardia (VT) (OR 1.73; 95% CI 1.36-2.21), Brugada syndrome (BrS) (OR 3.14; 95% CI 2.48-4.00), and dialysis treatment (OR 2.02; 95% CI 1.44-2.82) were independent predictors of S-ICD selection on mixed-model logistic analysis. The proportion of S-ICD implantations has been increasing (P < .001), especially in patients with BrS (P < .001) and dialysis (P = .04). The proportion of combined complications after S-ICD implantation was low (1.3%) in the unmatched cohort and was comparable to TV-ICD in the 1:1 propensity-matched cohort of 3354 patients (1.5% vs 2.3%; OR 0.65; 95% CI 0.38-1.10).CONCLUSION S-ICD was more likely to be implanted in younger patients and those with a history of VF, nonsustained VT, BrS, and dialysis treatment. The proportion of S-ICD implantation increased, especially in patients with BrS. The incidence of in-hospital complications was low in S-ICD recipients.