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Abstract：
Subcutaneous-implantable cardiac defibrillators (S-ICDs) are used increasingly to prevent sudden cardiac death in young patients. This study was set up to gain insight in the indications for S-ICD, possible complications, and their predictors and follow-up results.
A multicentre, observational, retrospective, non-randomized, standard-of-care registry on S-ICD outcome in young patients with congenital heart diseases (CHDs), inherited arrhythmias (IAs), idiopathic ventricular fibrillation (IVF), and cardiomyopathies (CMPs). Anthropometry was registered as well as implantation technique, mid-term device-related complications, and incidence of appropriate/inappropriate shocks (IASs). Data are reported as median (interquartile range) or mean ± standard deviation. Eighty-one patients (47% CMPs, 20% CHD, 21% IVF, and 12% IA), aged 15 (14-17) years, with body mass index (BMI) 21.8 ± 3.8 kg/m2, underwent S-ICD implantation (primary prevention in 59%). This was performed with two-incision technique in 81% and with a subcutaneous pocket in 59%. Shock and conditional zones were programmed at 250 (200-250) and 210 (180-240) b.p.m., respectively. No intraoperative complications occurred. Follow up was 19 (6-35) months: no defibrillation failure occurred, 17% of patients received appropriate shocks, 13% of patients received IAS (supraventricular tachycardias 40%, T-wave oversensing 40%, and non-cardiac oversensing 20%). Reprogramming, proper drug therapy, and surgical revision avoided further IAS. Complications requiring surgical revision occurred in 9% of patients, with higher risks in patients with three-incision procedures [hazard ratio (HR) 4.3, 95% confidence interval (95% CI) 0.5-34, P = 0.038] and BMI < 20 (HR 5.1, 95% CI 1-24, P = 0.031).
This multicentre European paediatric registry showed good S-ICD efficacy and safety in young patients. Newer implantation techniques and BMI > 20 showed better outcome.
A multicentre, observational, retrospective, non-randomized, standard-of-care registry on S-ICD outcome in young patients with congenital heart diseases (CHDs), inherited arrhythmias (IAs), idiopathic ventricular fibrillation (IVF), and cardiomyopathies (CMPs). Anthropometry was registered as well as implantation technique, mid-term device-related complications, and incidence of appropriate/inappropriate shocks (IASs). Data are reported as median (interquartile range) or mean ± standard deviation. Eighty-one patients (47% CMPs, 20% CHD, 21% IVF, and 12% IA), aged 15 (14-17) years, with body mass index (BMI) 21.8 ± 3.8 kg/m2, underwent S-ICD implantation (primary prevention in 59%). This was performed with two-incision technique in 81% and with a subcutaneous pocket in 59%. Shock and conditional zones were programmed at 250 (200-250) and 210 (180-240) b.p.m., respectively. No intraoperative complications occurred. Follow up was 19 (6-35) months: no defibrillation failure occurred, 17% of patients received appropriate shocks, 13% of patients received IAS (supraventricular tachycardias 40%, T-wave oversensing 40%, and non-cardiac oversensing 20%). Reprogramming, proper drug therapy, and surgical revision avoided further IAS. Complications requiring surgical revision occurred in 9% of patients, with higher risks in patients with three-incision procedures [hazard ratio (HR) 4.3, 95% confidence interval (95% CI) 0.5-34, P = 0.038] and BMI < 20 (HR 5.1, 95% CI 1-24, P = 0.031).
This multicentre European paediatric registry showed good S-ICD efficacy and safety in young patients. Newer implantation techniques and BMI > 20 showed better outcome.
摘要：
目的：皮下植入心脏除颤器（S-ICD）越来越多地用于预防年轻患者的心源性猝死。这项研究是为了深入了解S-ICD的适应症，可能的并发症,以及它们的预测因素和后续结果。
结果：多中心，观察,回顾性,非随机化，关于年轻先天性心脏病（CHD）患者S-ICD结局的护理标准注册表，遗传性心律失常（IAs），特发性心室纤颤(IVF),和心肌病（CMP）。注册了人体测量学以及植入技术，中期器械相关并发症,以及适当/不适当电击(IAS)的发生率。数据报告为中值(四分位间距)或平均值±标准偏差。81名患者（47%的CMPs，20%CHD,21%IVF,和12%IA)，15岁（14-17岁），体重指数（BMI）21.8±3.8kg/m2，接受了S-ICD植入（59％的一级预防）。81%的患者采用双切口技术，59%的患者采用皮下口袋。冲击和条件区编程为250(200-250)和210(180-240)b.p.m.，分别。术中无并发症发生。随访19（6～35）个月：无除颤失败，17%的患者接受了适当的电击，13％的患者接受了IAS（室上性心动过速40％，T波过感知40%,和非心脏过度感知20%)。重新编程,适当的药物治疗，和手术翻修避免了进一步的IAS。需要手术翻修的并发症发生在9%的患者中，三切口手术患者的风险较高[风险比（HR）4.3，95％置信区间（95％CI）0.5-34，P=0.038]和BMI<20（HR5.1，95％CI1-24，P=0.031）。
结论：这项多中心欧洲儿科注册在年轻患者中显示出良好的S-ICD疗效和安全性。较新的植入技术和BMI>20显示出更好的结果。
结果：多中心，
结论：这项多中心欧洲儿科注册在年轻患者中显示出良好的S-ICD疗效和安全性。
