Progressive Anatomical Evolution Leading to Loss of S-ICD Eligibility in Hypertrophic Cardiomyopathy: A Case Report.

IF 1.7 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Pace-Pacing and Clinical Electrophysiology Pub Date : 2025-04-01 Epub Date: 2025-03-03 DOI:10.1111/pace.15169
Luca Avolio, Paolo Zappulla, Daniela Dugo, Maria Teresa Cannizzaro, Angelo Di Grazia, Davide Capodanno
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引用次数: 0

Abstract

Subcutaneous implantable cardioverter defibrillators (S-ICDs) are designed to avoid complications from transvenous leads, but patient selection requires careful screening, especially in conditions like hypertrophic cardiomyopathy (HCM) with frequent conduction abnormalities. A 27-year-old male with HCM underwent S-ICD implantation in 2015 after successful screening. In 2020, inappropriate shocks due to T-wave oversensing led to vector adjustments. By 2022, further shocks and failed re-screening revealed ineligibility for S-ICD due to low R/T ratios in multiple vectors. Imaging and ECG comparisons from 2015 to 2022 showed disease progression, with increased fibrosis and conduction abnormalities. As a result, a transvenous ICD was implanted. This case underscores how HCM progression, associated with fibrosis and ECG changes, can render S-ICD unsuitable over time. It highlights the importance of periodic reassessment in high-risk patients, as disease progression can compromise S-ICD eligibility, necessitating alternative solutions for inappropriate shocks.

导致肥厚型心肌病患者丧失 S-ICD 资格的渐进式解剖演变:病例报告。
皮下植入式心律转复除颤器(s - icd)的设计是为了避免经静脉导联的并发症,但患者的选择需要仔细筛选,特别是在肥厚性心肌病(HCM)等经常传导异常的情况下。一名27岁男性HCM患者在2015年筛查成功后接受了S-ICD植入。2020年,由于t波超感导致的不适当冲击导致矢量调整。到2022年,进一步的冲击和失败的重新筛查表明,由于多种载体的低R/T比率,不适合进行S-ICD。2015年至2022年的影像学和心电图比较显示疾病进展,纤维化和传导异常增加。因此,我们植入了经静脉ICD。该病例强调了HCM的进展,与纤维化和ECG变化相关,随着时间的推移可能导致S-ICD不合适。它强调了对高危患者进行定期重新评估的重要性,因为疾病进展可能会影响S-ICD的适格性,因此需要对不适当的电击采取替代方案。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Pace-Pacing and Clinical Electrophysiology
Pace-Pacing and Clinical Electrophysiology 医学-工程:生物医学
CiteScore
2.70
自引率
5.60%
发文量
209
审稿时长
2-4 weeks
期刊介绍: Pacing and Clinical Electrophysiology (PACE) is the foremost peer-reviewed journal in the field of pacing and implantable cardioversion defibrillation, publishing over 50% of all English language articles in its field, featuring original, review, and didactic papers, and case reports related to daily practice. Articles also include editorials, book reviews, Musings on humane topics relevant to medical practice, electrophysiology (EP) rounds, device rounds, and information concerning the quality of devices used in the practice of the specialty.
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