Kazan medical journalKazan medical journalКазанский медицинский журнал0368-48142587-9359Eco-Vector10971910.17816/KMJ109719ReviewsОбзорыReview ArticleFeatures of subcutaneous cardioverter-defibrillators implantationОсобенности имплантации подкожных кардиовертеров-дефибрилляторовhttps://orcid.org/0000-0002-3405-1063AmiraslanovAnar Yu.АмираслановАнар Юсифович
Russian Federation

M.D., D. Sci. (Med.), Cardiovascular Surgeon

канд. мед. наук, сердечно-сосудистый хирург

anar_amiraslanov@list.ruhttps://orcid.org/0000-0001-7065-0250ArtyukhinaElena A.АртюхинаЕлена Александровна
Russian Federation

M.D., D. Sci. (Med.), Head of the Depart., Depart. of Electrophysiological X-Ray Endovascular Methods for Diagnosis and Treatment of Arrhythmias; Prof., Depart. of Angiology, Cardiovascular, Endovascular Surgery and Arrhythmology

докт. мед. наук, зав. отд. электрофизиологических рентгенэндоваскулярных методов диагностики и лечения аритмий; проф., каф. ангиологии, сердечно-сосудистой, эндоваскулярной хирургии и аритмологии

artelena.71@mail.ruhttps://orcid.org/0000-0003-1791-9163RevishviliAmiran Sh.РевишвилиАмиран Шотаевич
Russian Federation

M.D., D. Sci. (Med.), Prof., Academician of the Russian Academy of Sciences, Head; Head of the Depart., Depart. of Angiology, Cardiovascular, Endovascular Surgery and Arrhythmology

докт. мед. наук, проф., академик РАН, директор; зав. каф., каф. ангиологии, сердечно-сосудистой, эндоваскулярной хирургии и аритмологии

vishnevskogo@ixv.ruScientific Medical Research Center of Surgery named after A.V. VishnevskyНаучный медицинский исследовательский центр хирургии им. А.В. ВишневскогоRussian Medical Academy of Continuous Professional EducationРоссийская медицинская академия непрерывного профессионального образования200420232605202310433673801008202214032023Copyright ©; 2023, Eco-VectorCopyright ©; 2023, Эко-Вектор2023Eco-VectorЭко-Векторhttps://kazanmedjournal.ru/kazanmedj/article/view/109719

According to global statistics, 25% of deaths every year are cases of sudden cardiac death. Implantation of cardioverter-defibrillators is currently used as its prevention. In the coming years, the world is projected to see an increase in the number of implantations of cardioverter-defibrillators in high-income countries, as well as an expansion of the range of medical devices offered, including subcutaneous cardioverter-defibrillators, which are currently being considered as a promising alternative. We systematized the literature data presented in various international studies evaluating the efficacy and safety of the use of subcutaneous cardioverter-defibrillators. A review of the medical literature published in the period from 2015 to 2022 was carried out using the information and analytical systems MEDLINE, Scopus, Clinicaltrials.gov, Google Scholar and Web of Science. The review was performed in accordance with the checklist of preferred reporting items for systematic reviews and meta-analyses. 398 original publications were selected, of which 50 original scientific articles on the research topic were included in the analysis. Modern international studies have demonstrated the efficacy and safety of the use of subcutaneous implantable cardioverter defibrillators. An improvement in the performance of unmotivated discharges over time was noted, which was associated with the improvement of implantable cardioverter-defibrillators. The operating time for implantation of subcutaneous cardioverter-defibrillators was significantly less compared to transvenous cardioverter-defibrillators. Subcutaneous cardioverter-defibrillators were associated with a lower incidence of perioperative complications and high efficacy of shock therapy. Subcutaneous cardioverter-defibrillators were as effective as transvenous implantable cardioverter-defibrillators and did not have the risk of complications associated with implantation of endocardial electrodes. The main limitations of the technique were the impossibility of pacing and the absence of antitachycardic stimulation.

Согласно общемировой статистике, ежегодно 25% смертей составляют случаи внезапной сердечной смерти. В качестве её профилактики в настоящее время применяют имплантацию кардиовертеров-дефибрилляторов. В ближайшие годы в мире прогнозируется увеличение количества выполненных имплантаций кардио­вертеров-дефибрилляторов в странах с высоким уровнем дохода, а также расширение спектра предлагаемых медицинских изделий, включая подкожные кардиовертеры-дефибрилляторы, которые в настоящее время рассматривают в качестве перспективной альтернативы. Мы систематизировали данные литературы, представленные в различных международных исследованиях, оценивающих эффективность и безопасность применения подкожных кардиовертеров-дефибрилляторов. Проведён обзор медицинской литературы, опубликованной в период с 2015 по 2022 г., с использованием информационно-аналитических систем MEDLINE, Scopus, Clinicaltrials.gov, Google Scholar и Web of Science. Обзор выполнен в соответствии с контрольным перечнем предпочтительных элементов отчётности для систематических обзоров и метаанализов. Было отобрано 398 оригинальных публикаций, из них в анализ включено 50 оригинальных научных статей по теме исследования. Современные международные исследования продемонстрировали эффективность и безопасность применения подкожных имплантируемых кардиовертеров-дефибрилляторов. Отмечено улучшение показателей немотивированных разрядов с течением времени, что связано с усовершенствованием имплантируемых кардиовертеров-дефибрилляторов. Операционное время имплантации подкожных кардиовертеров-дефибрилляторов было значимо меньше по сравнению с трансвенозными кардиовертерами-дефибрилляторами. Подкожные кардиовертеры-дефибрилляторы ассоциированы с меньшей частотой периоперационных осложнений и высокой эффективностью шоковой терапии. Подкожные кардиовертеры-дефибрилляторы обладают не меньшей эффективностью по сравнению с трансвенозными имплантируемыми кардиовертерами-дефибрилляторами и лишены риска осложнений, связанных с имплантацией эндокардиальных электродов. Основные ограничения методики — невозможность электрокардиостимуляции и отсутствие антитахикардитической стимуляции.

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