BACKGROUND Subcutaneous implantable cardioverter defibrillators (S-ICDs) are an attractive alternative to transvenous ICDs among those not requiring pacing. However, the risks of damage to the S-ICD electrode during sternotomy and adverse interactions with sternal wires remain unclear. We sought to determine the rates of damage to the S-ICD lead during sternotomy, inappropriate shocks from electrical noise due to interaction with sternal wires, and failure to terminate spontaneous or induced ventricular arrhythmias. METHODS Retrospective, multicenter study of patients undergoing sternotomy before or after S-ICD implantation. Clinical, procedural, and device-related data were collected by each center and analyzed by the coordinating center. These data were compared with a historical control cohort of nonsternotomy patients. RESULTS Of 196 identified patients (52±16 years, 47 women), 166 underwent S-ICD implantation after sternotomy and 30 sternotomy after S-ICD. There was no damage to any lead among those who underwent sternotomy after S-ICD. Defibrillation threshold testing was performed in 63% at implant, with 91% first shock success. During a median follow-up of 29 months (range, 1-188), S-ICD first shocks successfully terminated spontaneous ventricular arrhythmias in 31 of 32 patients (97%). Inappropriate shocks occurred in 22 patients, most commonly related to T wave oversensing (n=14). Compared with the nonsternotomy controls, there were no differences in rates of first shock success for induced or spontaneous arrhythmias or rate of inappropriate shocks. CONCLUSIONS Sternotomy before or after S-ICD does not confer additional risk relative to a historical control group without sternotomy.

中文翻译：

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正中胸骨切开术对皮下植入式心脏复律除颤器安全性和有效性的影响。

背景技术对于不需要起搏的患者来说，皮下植入式心脏复律除颤器（S-ICD）是经静脉 ICD 的有吸引力的替代品。然而，胸骨切开术期间 S-ICD 电极损坏的风险以及与胸骨线的不良相互作用仍不清楚。我们试图确定胸骨切开术期间 S-ICD 导线的损坏率、由于与胸骨线相互作用而产生的电噪声引起的不当电击以及未能终止自发性或诱发性室性心律失常的发生率。方法 对 S-ICD 植入前后接受胸骨切开术的患者进行回顾性、多中心研究。每个中心收集临床、程序和设备相关数据，并由协调中心进行分析。将这些数据与非胸骨切开术患者的历史对照队列进行比较。结果 在 196 名确定的患者（52±16 岁，47 名女性）中，166 名患者在胸骨切开术后接受了 S-ICD 植入，30 名患者在 S-ICD 后接受了胸骨切开术。S-ICD 后接受胸骨切开术的患者中没有出现任何导线损坏。63% 的患者在植入时进行了除颤阈值测试，其中 91% 的患者首次电击成功。在中位随访 29 个月（范围 1-188）期间，S-ICD 首次电击成功终止了 32 名患者中的 31 名患者的自发性室性心律失常（97%）。22 名患者发生了不适当的电击，最常见的是与 T 波过度感应有关 (n=14)。与非胸骨切开术对照组相比，诱发或自发性心律失常的首次电击成功率或不适当电击率没有差异。结论 相对于没有胸骨切开术的历史对照组，S-ICD 之前或之后的胸骨切开术不会带来额外的风险。