植入式心脏转换器除器疗法在儿童患者中用于初级或二级预防
Jani Thuraiaiyah1, Berit Thornvig Philbert1, Annette Schophuus Jensen1
1Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Inge Lehmanns Vej 7, 2100 Copenhagen, Denmark.
概括
接受植入式心脏变压器 (ICD) 的儿科患者有很高的适当治疗和并发症率,无论ICD是用于初级还是二级预防. 在这项研究中的两个预防组中,这些结果是相似的.
科学领域:
- 儿童心脏病学 儿童心脏病学
- 电子生理学 电子生理学
- 医疗器械 医疗器械
背景情况:
- 植入式心脏转换器-除器 (ICD) 对于治疗儿童危及生命的心律失常至关重要,但由于预期寿命延长和并发症风险,关于其植入的决定是复杂的.
- 虽然ICD的二次预防指示已经确立,但初级预防需要仔细评估风险和益处,考虑突发心脏病死亡与设备相关的并发症.
- 年轻的患者将从ICD中获得最多的寿命,这强调了了解这一群体的结果的重要性.
研究的目的:
- 为了比较接受ICD用于初级和二级预防突然心脏死亡的儿科患者的结果.
- 分析患有ICD的儿童的并发症率,适当治疗和死亡率.
主要方法:
- 一项回顾性全国性队列研究分析了1982年至2021年间在ICD植入时15岁或更年轻的丹麦ICD注册表中的数据.
- 人口统计数据,并发症 (感染,失败,重新手术,心律失常相关死亡率) 和死亡率的数据是从医疗记录中提取的.
- 主要终点是第一次出现适当的治疗 (冲击或抗心动节拍) 对于心室心动节拍或动.
主要成果:
- 在72名儿科患者中,23人接受了ICD用于初级预防和49人接受了二级预防,随访时间中位数为9.0年.
- 适当治疗的10年累计发病率为70%,并发症率为41%,不适当治疗率为15%.
- 在初级和二级预防组之间没有观察到适当治疗,并发症或死亡率的显著差异.
结论:
- 在儿童中,ICD更常用于二次预防 (三分之二的病例).
- 与成年人相比,儿童患者的适当治疗和并发症率更高,尽管不适当的治疗率仍然很低.
- 对于儿童的ICD植入的结果在初级和二级预防指示中似乎相似.
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