超性心肌病中的S-ICD:没有增加不适当的冲击,并发症更少,而不是通过静脉输送系统
Christopher Monkhouse1,2, James Malcolmson1,2, Edward Maclean1,2
1Barts Heart Centre, West Smithfield, London, UK.
Pacing and clinical electrophysiology : PACE
|January 19, 2026
概括
皮下植入式心脏转移器除器 (S-ICD) 与输血性心脏转移器 (TV-ICD) 相比,在高性心肌病 (HCM) 患者中出现的并发症较少. 多事件分析证实S-ICDs降低了累积并发症风险,提供了潜在的更好的好处/风险比率.
科学领域:
- 心脏病学 心脏病学
- 医疗器械 医疗器械
- 生物医学工程 生物医学工程
背景情况:
- 超性心肌病 (HCM) 患者面临着植入式心转动器除器 (ICD) 的长期风险,包括并发症和不适当的治疗 (IT).
- 皮下ICDs (S-ICDs) 消除了跨静脉ICDs (TV-ICDs) 的血管风险,但IT率仍然令人担忧.
- 评估累积并发症风险对于优化HCM中ICD选择至关重要.
研究的目的:
- 在HCM患者中比较S-ICD和TV-ICD之间的并发症率和累积风险.
- 评估设备类型对治疗率和死亡率的影响.
- 通过多事件分析,提供对累积并发症负担的新评估.
主要方法:
- 对611名接受ICD治疗的HCM患者进行了回顾性观察研究 (2006-2022年).
- 使用考克斯比例危险模型和多事件统计模型进行比较结果分析.
- 倾向性得分匹配以调整基线差异.
主要成果:
- S-ICD接受者 (n=141) 经历的并发症明显少于TV-ICD接受者 (HR 0.309,p=0.035).
- 多事件分析显示,TV-ICD患者的并发症累积增加 (HR 0.258,p=0.004),S-ICD患者没有多重并发症.
- 在匹配组之间没有观察到治疗率或死亡率的显著差异.
结论:
- 与HCM患者的TV-ICD相比,S-ICD与更少的并发症有关,这一发现被多事件分析放大.
- 尽管有类似的不适当治疗率,但S-ICDs可能会提供更好的益处/风险比率.
- 在HCM患者中,应鼓励S-ICD使用的共享决策.
相关概念视频
Cardiomyopathy III: Hypertrophic Cardiomyopathy
418
Hypertrophic cardiomyopathy, or HCM, is an autosomal dominant genetic disorder characterized by asymmetric left ventricular hypertrophy without ventricular dilation. It is more common in men and is typically diagnosed in young, athletic adults.EtiologyHCM is primarily genetic and is caused by mutations in genes encoding sarcomeric proteins. Researchers have identified over 1400 mutations across at least 11 different genes. Among these, the most frequently occurring mutations are found in the...
418
Peritoneal Dialysis II: Peritoneal Dialysis Systems and Complications
590
Peritoneal dialysis (PD) is a medical process that removes waste products and excess fluid from the body using the peritoneal membrane as a natural filter.Peritoneal Dialysis MethodsSeveral methods can be used for peritoneal dialysis, including Acute Intermittent Peritoneal Dialysis, Continuous Ambulatory Peritoneal Dialysis, and Automated Peritoneal Dialysis, also known as Continuous Cyclic Peritoneal Dialysis.Acute Intermittent Peritoneal Dialysis (AIPD) is used for patients with uremic...
590
Cardiomyopathy II: Dilated Cardiomyopathy
489
Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
489
Cardiomyopathy IV: Restrictive Cardiomyopathy
481
Restrictive cardiomyopathy (RCM) is a rare heart muscle disease characterized by impaired ventricular filling due to stiffened ventricular walls, leading to significant diastolic dysfunction.EtiologyRestrictive cardiomyopathy can arise from both inherited and acquired diseases, many of which are systemic. It is categorized into four main types: infiltrative, storage, non-infiltrative, and endomyocardial diseases.Infiltrative diseases, such as amyloidosis, lead to RCM by depositing amyloid...
481
Cardiomyopathy I: Introduction and Classification
517
Cardiomyopathy, or CMP, is a group of diseases affecting the myocardial structure, impairing its ability to pump blood effectively. This condition can lead to arrhythmias, heart failure, or sudden cardiac death.Cardiomyopathies are classified into primary and secondary categories:Primary Cardiomyopathy refers to conditions involving only the heart muscle that are often idiopathic (of unknown cause) or genetic. They primarily affect the myocardium without the involvement of other systemic...
517
Cardiomyopathy VI: Nursing Management
318
Assessment: Nursing management of patients with cardiomyopathy begins with a thorough assessment of the patient's history, including a family history of cardiomyopathy or sudden cardiac death, personal history of heart disease, hypertension, diabetes, and any alcohol consumption or drug use.During the physical examination, assess vital signs, look for signs of heart failure (such as edema, jugular venous distention, and cyanosis), auscultate for abnormal heart sounds (like murmurs and gallops),...
318


