Subcutaneous Implantable Defibrillator Therapy in Patients With Brugada Syndrome: Data From a Large Multicenter Registry.

IF 8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Clinical electrophysiology Pub Date : 2025-03-23 DOI:10.1016/j.jacep.2025.03.003

Federico Migliore, Luca Ottaviano, Alberto Arestia, Gerardo Nigro, Antonio Dello Russo, Stefano Viani, Valter Bianchi, Antonio Bisignani, Paolo Pieragnoli, Gennaro Vitulano, Roberto Rordorf, Pietro Francia, Erika Taravelli, Ennio Pisanò, Carlo Lavalle, Roberta Brambilla, Matteo Ziacchi, Antonio Rapacciuolo, Miguel Viscusi, Paolo De Filippo, Carmelo La Greca, Patrizia Pepi, Pasquale Notarstefano, Antonio Curcio, Raimondo Pittorru, Nicolò Martini, Alessandro Seganti, Carlo Napolitano, Mariolina Lovecchio, Sergio Valsecchi, Gianluca Botto, Silvia G Priori

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引用次数: 0

Abstract

Background: The implantable cardioverter-defibrillator (ICD) is recognized as the most effective life-saving therapy in patients with Brugada syndrome (BrS). However, transvenous ICD is associated with a notable rate of complications over time. The subcutaneous implantable cardioverter-defibrillator (S-ICD) has emerged as a promising alternative to the transvenous ICD. Nevertheless, long-term data from large cohorts of BrS patients with S-ICDs are lacking.

Objectives: This multicenter study aimed to assess the long-term outcomes of S-ICD therapy in patients with BrS.

Methods: The study included 450 consecutive BrS patients (mean age 43 ± 12; 86% male) who underwent S-ICD implantation between 2014 and 2024.

Results: During a median follow-up of 52 months (25th-75th percentile: 29-72), appropriate shocks were delivered in 3% of patients (1.2%; 95% CI: 0.2-2.2, at 12 months), with a first-shock success rate of 90% (100% with 2 shocks). Inappropriate shocks occurred in 7% of patients (1.4%; 95% CI: 0.3-2.5, at 12 months). Shock zone programmed at 250 beats/min (HR: 0.40; 95% CI: 0.18-0.89; P = 0.025) and more than 1 suitable vector on screening (HR: 0.39; 95% CI: 0.17-0.87; P = 0.023) were independent protective factors against inappropriate shock. Device-related complications were reported in 4% of patients (2.5%; 95% CI: 1.0-3.9 at 12 months). The need for antibradycardia pacing was reported in 3 patients (0.7%). No device explantation because of the need for antitachycardia pacing was noted.

Conclusions: Our findings support the S-ICD as a viable alternative to the transvenous ICD for preventing sudden cardiac death in BrS patients without pacing indication (Arrhythmias Detection in a Real World Population [RHYTHM DETECT]; NCT02275637).

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Brugada综合征患者皮下植入式除颤器治疗：来自大型多中心注册的数据。

背景：植入式心律转复除颤器（ICD）被认为是Brugada综合征（BrS）患者最有效的救命疗法。然而，随着时间的推移，经静脉ICD与显著的并发症率相关。皮下植入式心律转复除颤器（S-ICD）已成为一种有前途的替代经静脉ICD。然而，缺乏大量BrS合并s - icd患者的长期数据。目的：本多中心研究旨在评估S-ICD治疗BrS患者的长期疗效。方法：纳入连续450例BrS患者(平均年龄43±12岁；（86%为男性），在2014年至2024年间接受了S-ICD植入。结果：在52个月的中位随访期间（25 -75百分位：29-72），3%的患者接受了适当的电击(1.2%；95% CI: 0.2-2.2, 12个月时)，第一次电击成功率为90%（两次电击成功率为100%）。7%的患者发生了不适当的电击(1.4%；95% CI: 0.3-2.5, 12个月时)。冲击区设定为250次/分钟(HR: 0.40；95% ci: 0.18-0.89；P = 0.025)，且筛选出1个以上合适载体(HR: 0.39；95% ci: 0.17-0.87；P = 0.023)是预防不当休克的独立保护因素。4%的患者报告了器械相关并发症(2.5%；95% CI: 1.0-3.9（12个月时）。3例（0.7%）患者需要抗心动过缓起搏。由于需要抗心动过速起搏，没有注意到器械外植。结论：我们的研究结果支持S-ICD作为经静脉ICD的可行替代方案，用于预防无起搏指征的BrS患者心源性猝死(心律失常检测在现实世界人群中[RHYTHM DETECT]；NCT02275637)。

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

JACC. Clinical electrophysiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

10.30

自引率

5.70%

发文量

250

期刊介绍： JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.