Subcutaneous Implantable Cardioverter Defibrillator: Early Experience

Abstract Introduction: The implantable cardioverter defibrillator had been increasing the survival of patients at high risk for sudden cardiac death. The subcutaneous implantable cardioverter defibrillator was developed to mitigate the complications inherent to lead placement into cardiovascular system. Objective: To report the initial experience of 18 consecutive cases of subcutaneous implantable cardioverter defibrillator implantation showing the indications, potential pitfalls and perioperative complications. Methods: Between September 2016 and March 2017, 18 patients with indication for primary and secondary prevention of sudden cardiac death, with no concomitant indication for artificial cardiac pacing, were included. Results: The implantation of the subcutaneous implantable cardioverter defibrillator successfully performed in 18 patients. It was difficult to place the subcutaneous lead at the parasternal line in two patients. One patient returned a week after the procedure complaining about an increase in pain intensity at pulse generator pocket site, which was associated with edema, temperature rising and hyperemia. Two patients took antialgic medication for five days after surgery. A reintervention was necessary in one patient to replace the lead in order to correct inappropriate shocks caused by myopotential oversensing. Conclusion: In our initial experience, although the subcutaneous implantable cardioverter defibrillator implantation is a less-invasive, simple-accomplishment procedure, it resulted in a bloodier surgery perhaps requiring an operative care different from the conventional. Inappropriate shock by oversensing is a reality in this system, which should be overcame in order not to become a limiting issue for its indication.

摘要 引言：植入式心律转复除颤器（implantable cardioverter defibrillator, ICD）可提升心脏性猝死高危患者的生存率。皮下植入式心律转复除颤器（subcutaneous implantable cardioverter defibrillator, S-ICD）应运而生，旨在规避经血管途径植入导线时固有存在的并发症。目的：报道18例连续接受皮下植入式心律转复除颤器植入患者的初步临床经验，阐述其适应证、潜在操作难点及围手术期并发症。方法：2016年9月至2017年3月期间，纳入18例具备心脏性猝死一级、二级预防适应证，且无人工心脏起搏伴随适应证的患者。结果：18例患者均成功完成皮下植入式心律转复除颤器植入手术。其中2例患者的皮下导线难以放置于胸骨旁线位置。1例患者于术后1周复诊，主诉脉冲发生器囊袋部位疼痛加剧，伴随水肿、体温升高及充血表现。2例患者术后服用镇痛药物时长为5天。1例患者需接受再次手术以更换导线，纠正因肌电位过感知引发的不适当电击事件。结论：基于本次初步临床经验，尽管皮下植入式心律转复除颤器植入术属于微创、操作简便的术式，但术中出血量可能更高，或许需要采用与传统植入式心律转复除颤器不同的围手术期护理方案。该系统仍存在因感知异常引发不适当电击的问题，需加以解决以避免其成为限制该技术临床应用的瓶颈。