植入式心律转复-除颤器系统的安全性和耐受性

IF 0.3 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS
A. Vereshchagina, T. Uskach, O. Sapelnikov, V. A. Amanatova, I. Grishin, A. A. Kulikov, V. S. Kostin, R. Akchurin
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All patients underwent a standard preoperative examination (routine blood tests, chest X-ray, transthoracic echocardiography), quality-of-life questionnaires and transesophageal echocardiography. At follow-up, patients were examined after 6 months after implantation, the device was interrogated and a quality-of-life questionnaire was completed. All episodes of shock therapy and complications were documented.Results. Male patients predominated (84%), with a mean age of 57 [43;62] years. Left ventricular ejection fraction was 30% [26;34]. The mean QRS duration was 100 [94;108] msec. According to the of 24-hour Holter ECG monitoring, episodes of unstable VT were recorded in 42.4% of patients. The most common indications for S-ICD implantation were dilated (33%) and ischemic cardiomyopathy (42%). Primary prevention was indicated in 97% of patients. At the end of the implantation of the S-ICD, the patients underwent a defibrillation test and device configuration. In 63.6% of cases, during automatic tuning, the device selected the primary perception vector. In 27.2% of patients, optimal recognition of the subcutaneous signal was observed in the secondary vector, and in 9.2% of patients, the alternative vector was favorable. All patients underwent two-zone programming. The conditional shock zone was programmed at an average rate of 192 beats/min (range 180-210 beats/min) and the shock zone was programmed at an average rate of 222 beats/min (range 220-240 beats/min). Perioperative complications occurred in two patients. During the follow-up period, no shocks were recorded in 27 patients. Adequate shocks for 6 months were recorded in two patients. During 6 months of observation, one lethal outcome was noted due to complications of viral pneumonia. During the observation period, there were no rehospitalizations for cardiovascular diseases.Conclusion. 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引用次数: 0

摘要

的目标。目的:研究皮下植入式心律转复除颤器(S-ICD)植入术后的安全性和耐受性。材料和方法。结果对33例植入式S-ICD患者随访6个月。纳入观察性研究的标准是:年龄大于18岁,有一级或二级预防心源性猝死的适应症。排除标准为经静脉ICD植入指征(持续单型室性心动过速,需要抗心动过缓或再同步治疗的患者),以及QRS复合体超过130 msec的患者。所有患者都进行了标准的术前检查(常规血液检查、胸部x线检查、经胸超声心动图)、生活质量问卷调查和经食管超声心动图检查。在随访中,患者在植入后6个月接受检查,询问设备并完成生活质量问卷。所有休克治疗的发作和并发症都被记录下来。男性患者占多数(84%),平均年龄57岁[43;62]岁。左室射血分数30%[26;34]。QRS平均持续时间为100 [94;108]msec。24小时动态心电图监测显示,42.4%的患者出现不稳定型室速发作。S-ICD植入最常见的适应症是扩张性心肌病(33%)和缺血性心肌病(42%)。97%的患者需要一级预防。在S-ICD植入结束时,患者进行除颤试验和设备配置。在63.6%的情况下,在自动调谐过程中,设备选择了主要感知向量。在27.2%的患者中,第二载体对皮下信号的识别效果最佳,在9.2%的患者中,替代载体对皮下信号的识别效果良好。所有患者都进行了双区编程。条件休克区以192次/分(180-210次/分)的平均速率编程,休克区以222次/分(220-240次/分)的平均速率编程。2例患者出现围手术期并发症。在随访期间,27例患者无电击记录。2例患者记录了6个月的适当电击。在6个月的观察中,有一个致命的结果是由于病毒性肺炎的并发症。观察期内无心血管疾病再住院病例。使用S-ICD,即使是不需要抗心动过缓起搏的结构性心肌疾病患者,也能有效预防SCD。临床实践中不充分出院的数量和并发症的数量与多中心研究的数据相当。S-ICD植入不伴有生活质量下降。仔细选择候选者,以及最先进的设备编程,是S-ICD应用选择和成功的重要参数。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Safety and Tolerability of Implanted Subcutaneous Cardioverter-Defibrillator Systems
Aim. To study the safety and tolerability of the subcutaneous implantable cardioverter defibrillator (S-ICD) after implantation.Material and methods. The results of 33 patients with implanted S-ICD 6 months follow-up. The criteria for inclusion in the observational study were: age over 18 years, indications for primary or secondary prevention of sudden cardiac death. The exclusion criteria were indications for implantation of transvenous ICD (patients with sustained monomorphic ventricular tachycardia, the need for anti-bradycardia or resynchronization therapy), as well as patients with a QRS complex of more than 130 msec. All patients underwent a standard preoperative examination (routine blood tests, chest X-ray, transthoracic echocardiography), quality-of-life questionnaires and transesophageal echocardiography. At follow-up, patients were examined after 6 months after implantation, the device was interrogated and a quality-of-life questionnaire was completed. All episodes of shock therapy and complications were documented.Results. Male patients predominated (84%), with a mean age of 57 [43;62] years. Left ventricular ejection fraction was 30% [26;34]. The mean QRS duration was 100 [94;108] msec. According to the of 24-hour Holter ECG monitoring, episodes of unstable VT were recorded in 42.4% of patients. The most common indications for S-ICD implantation were dilated (33%) and ischemic cardiomyopathy (42%). Primary prevention was indicated in 97% of patients. At the end of the implantation of the S-ICD, the patients underwent a defibrillation test and device configuration. In 63.6% of cases, during automatic tuning, the device selected the primary perception vector. In 27.2% of patients, optimal recognition of the subcutaneous signal was observed in the secondary vector, and in 9.2% of patients, the alternative vector was favorable. All patients underwent two-zone programming. The conditional shock zone was programmed at an average rate of 192 beats/min (range 180-210 beats/min) and the shock zone was programmed at an average rate of 222 beats/min (range 220-240 beats/min). Perioperative complications occurred in two patients. During the follow-up period, no shocks were recorded in 27 patients. Adequate shocks for 6 months were recorded in two patients. During 6 months of observation, one lethal outcome was noted due to complications of viral pneumonia. During the observation period, there were no rehospitalizations for cardiovascular diseases.Conclusion. The use of S-ICD, even in patients with structural myocardial disease who do not require antibradycardia pacing, is effective in preventing SCD. The number of inadequate discharges and the number of complications in clinical practice is comparable to the data of multicenter studies. S-ICD implantation was not accompanied by a decrease in quality of life. Careful selection of candidates, along with state-of-the-art device programming, is an important parameter for the selection and success of S-ICD application.
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来源期刊
Rational Pharmacotherapy in Cardiology
Rational Pharmacotherapy in Cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
1.00
自引率
50.00%
发文量
79
审稿时长
6 weeks
期刊介绍: The primary goals of the Journal are consolidation of information on scientific and practical achievements in pharmacotherapy and prevention of cardiovascular diseases and continuing education of cardiologists and internists. The scientific concept of the edition suggests the publication of information on current achievements in cardiology, the results of national and international clinical trials. The Journal publishes original articles on the results of clinical trials designed to study the effectiveness and safety of drugs, analysis of clinical practice and its compliance with national and international recommendations, expert s’ opinions on a wide range of cardiology issues, associated conditions and clinical pharmacology. There is a heading “Preventive cardiology and public health” in the Journal to stimulate research interest in this highly demanded area. Memories of the outstanding people in medicine including cardiology, which are of great interest to historians of medicine, are published in "Our Mentors” heading.
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