肥厚型心肌病中皮下与经静脉植入式心律转复除颤器的比较:系统回顾和荟萃分析。

IF 2.1 3区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Cardiovascular diagnosis and therapy Pub Date : 2024-06-30 Epub Date: 2024-06-27 DOI:10.21037/cdt-24-15
Antônio da Silva Menezes Júnior, Izadora Caiado Oliveira, André Maroccolo de Sousa, Ricardo Figueiredo Paro Piai, Vinícius Martins Rodrigues Oliveira
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引用次数: 0

摘要

背景:皮下植入式心律转复除颤器(S-ICD)是经静脉植入式心律转复除颤器(TV-ICD)的替代方案。S-ICD 可降低经静脉置入导联的风险。然而,要确定 S-ICD 对肥厚型心肌病 (HCM) 患者有何影响,还需要进一步的研究。在这项研究中,我们调查了 S-ICD 与 TV-ICD 在 HCM 中的疗效和安全性比较:2023 年 12 月 6 日,我们对 PubMed、Embase、Scopus 和 Cochrane 数据库进行了全面检索,以确定 2004 年至 2023 年期间发表的关于 HCM 患者中 S-ICD 与 TV-ICD 比较的随机临床试验 (RCT) 和观察性研究。无语言限制。主要结果是适当冲击(AS),次要结果是不适当冲击(IAS)和设备相关并发症。采用随机效应模型对比值比 (OR) 和 95% 置信区间 (CI) 进行了汇总。采用 ROBINS-I 工具评估研究的偏倚风险:搜索共获得 1,114 条记录。共纳入了 7 项研究,包括 4,347 名 HCM 患者,其中 3,325 人(76.0%)使用 TV-ICD,1,022 人(22.6%)使用 S-ICD。其中有 2,564 名男性(58.9%)。年龄在 39.1 岁至 49.4 岁之间。与 TV-ICD 组相比,S-ICD 组的设备相关并发症发生率明显较低(OR 0.52;95% CI:0.30-0.89;P=0.02;I2=4%)。相反,在 AS(OR 0.49;95% CI:0.22-1.08;P=0.08;I2=75%)和 IAS(OR 1.03;95% CI:0.57-1.84;P=0.93;I2=65%)的发生率方面,两种设备模式之间没有明显的统计学差异。在对研究的总体偏倚风险进行分析时,我们发现42%的研究存在几种偏倚风险,28%存在中度偏倚风险,14%存在低度偏倚风险:结论:在 HCM 患者中,S-ICD 与设备相关问题的发生率低于 TV-ICD。各组的 AS 和 IAS 发生率相似。这些发现可能有助于临床医生确定最适合治疗 HCM 患者的设备。
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Subcutaneous versus transvenous implantable cardioverter defibrillator in hypertrophic cardiomyopathy: a systematic review and meta-analysis.

Background: A subcutaneous implantable cardioverter-defibrillator (S-ICD) is an alternative to a transvenous implantable cardio defibrillator (TV-ICD). An S-ICD reduces the risk of transvenous lead placement. However, further research is required to determine how S-ICDs affect patients with hypertrophic cardiomyopathy (HCM). In this study, we investigated the comparative efficacy and safety of S-ICDs versus TV-ICDs in HCM.

Methods: On December 6th, 2023, we performed a comprehensive search of the PubMed, Embase, Scopus, and Cochrane databases to identify randomized clinical trials (RCTs) and observational studies comparing S-ICDs with TV-ICDs in HCM patients published from 2004 until 2023. No language restrictions were applied. The primary outcome was appropriate shocks (AS), with inappropriate shocks (IAS), and device-related complications considered as secondary outcomes. Odds ratios (ORs) and 95% confidence intervals (CIs) were pooled using a random effects model. The ROBINS-I tool was used to assess the risk of bias of the studies.

Results: The search yielded 1,114 records. Seven studies comprising 4,347 HCM patients were included, of whom 3,325 (76.0%) had TV-ICDs, and 1,022 (22.6%) had S-ICDs. There were 2,564 males (58.9%). The age range was from 39.1 to 49.4 years. Compared with the TV-ICD group, the S-ICD cohort had a significantly lower incidence of device-related complications (OR 0.52; 95% CI: 0.30-0.89; P=0.02; I2=4%). Contrastingly, there were no statistically significant differences in the occurrences of AS (OR 0.49; 95% CI: 0.22-1.08; P=0.08; I2=75%) and IAS (OR 1.03; 95% CI: 0.57-1.84; P=0.93; I2=65%) between the two device modalities. In the analysis of the overall risk of bias in the studies, we found 42% of them with several, 28% with moderate, and 14% with low risk of bias.

Conclusions: In HCM patients, S-ICDs were associated with a lower incidence of device-associated problems than TV-ICDs. AS and IAS incidence rates were similar between groups. These findings may assist clinicians in determining the most suitable device for treating patients with HCM.

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来源期刊
Cardiovascular diagnosis and therapy
Cardiovascular diagnosis and therapy Medicine-Cardiology and Cardiovascular Medicine
CiteScore
4.90
自引率
4.20%
发文量
45
期刊介绍: The journal ''Cardiovascular Diagnosis and Therapy'' (Print ISSN: 2223-3652; Online ISSN: 2223-3660) accepts basic and clinical science submissions related to Cardiovascular Medicine and Surgery. The mission of the journal is the rapid exchange of scientific information between clinicians and scientists worldwide. To reach this goal, the journal will focus on novel media, using a web-based, digital format in addition to traditional print-version. This includes on-line submission, review, publication, and distribution. The digital format will also allow submission of extensive supporting visual material, both images and video. The website www.thecdt.org will serve as the central hub and also allow posting of comments and on-line discussion. The web-site of the journal will be linked to a number of international web-sites (e.g. www.dxy.cn), which will significantly expand the distribution of its contents.
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