Heart：超半数ICD置入者适宜初始S-ICD置入

　　荷兰一项研究表明，超过半数的置入型心律转复除颤器（ICD）患者适合初始接受皮下ICD（S-ICD）治疗，并且数项基线临床特征有助于选择适宜患者。论文于5月23日在线发表于《心脏》（Heart）。

　　此项回顾性队列研究共纳入1345例接受单腔或双腔ICD治疗的患者，并进行了为期5年的随访。以随访期间未到达下述终点之一定义适合S-ICD治疗：心房和/或右室起搏适应证；无后续休克的成功抗心动过速性起搏；升级至CRT-D设备。

　　结果显示，在中位3.4年随访其中，463例（34%）患者达到一项终点。5年之后，适合初始S-ICD治疗的ICD置入者的累积发生率为55.5%。不适合S-ICD治疗的显著预测因素包括二级预防、严重心衰和QRS持续时间延长。

Suitability for subcutaneous defibrillator implantation: results based on data from routine clinical practice

Objective 

To assess the proportion of current implantable cardioverter defibrillator (ICD) recipients who would be suitable for a subcutaneous lead ICD (S-ICD).

Design 

A retrospective cohort study.

Setting 

Tertiary care facility in the Netherlands.

Patients 

All patients who received a single- or dual-chamber ICD in the Leiden University Medical Center between 2002 and 2011. Patients with a pre-existent indication for cardiac pacing were excluded.

Main outcome measure 

Suitability for an S-ICD defined as not reaching one of the following endpoints during follow-up: (1) an atrial and/or right ventricular pacing indication, (2) successful antitachycardia pacing without a subsequent shock or (3) an upgrade to a CRT-D device.

Results 

During a median follow-up of 3.4 years (IQR 1.7–5.7 years), 463 patients (34% of the total population of 1345 patients) reached an endpoint. The cumulative incidence of ICD recipients suitable for an initial S-ICD implantation was 55.5% (95% CI 52.0% to 59.0%) after 5 years. Significant predictors for the unsuitability of an S-ICD were: secondary prevention, severe heart failure and prolonged QRS duration.

Conclusions 

After 5 years of follow-up, approximately 55% of the patients would have been suitable for an S-ICD implantation. Several baseline clinical characteristics were demonstrated to be useful in the selection of patients suitable for an S-ICD implantation.