Обзор американских кардиологических журналов за неделю (ссылки)

[Chevychelov]

Title: An Entirely Subcutaneous Implantable Cardioverter-Defibrillator
Topic: Arrhythmias
Date Posted: 5/12/2010 4:00:00 PM
Author(s): Bardy GH, Smith WM, Hood MA, et al.
Citation: N Engl J Med 2010;May 12:[Epub ahead of print].
Clinical Trial: No
Study Question: How effectively does a subcutaneous implantable cardioverter-defibrillator (ICD) system detect and terminate ventricular tachycardia (VT) and ventricular fibrillation (VF)?
Methods: This study describes the results of two short-term trials of a subcutaneous electrode system and two long-term trials of the subcutaneous ICD system. In the short-term trials, the best electrode configuration was identified in 78 patients and then compared to a transvenous ICD system in 49 patients. In the long-term trials, 61 patients underwent implantation of the subcutaneous ICD. The subcutaneous ICD system consisted of a pulse generator implanted in the anterior axillary region and a parasternal 8-cm tripolar electrode. The pulse generator delivered 80-J shocks, had a rate cut-off of 170 bpm, and was able to pace for ≤30 seconds after a shock if there was a >3.5 second pause after a shock.
Results: The mean defibrillation threshold was 11.1 J with the transvenous ICD and 31.1 J with the subcutaneous ICD. Among the 61 patients who received the subcutaneous ICD, two consecutive episodes of induced VF were successfully sensed and terminated by 65-J shocks in all but one patient. During a mean of 10 months of follow-up, a total of 12 episodes of VT in three patients were detected and successfully terminated by the subcutaneous ICD. Complications included lead dislodgement requiring repositioning in four patients.
Conclusions: The subcutaneous ICD system tested in this study accurately senses and terminates VT/VF in approximately 98% of patients.
Perspective: Elimination of radiation exposure and the need for vascular access make the subcutaneous ICD an attractive option. However, it is not capable of long-term pacing, antitachycardia pacing, or detection of VT <170 bpm. Further evaluation is needed to determine its clinical reliability and utility. Fred Morady, M.D., F.A.C.C.

Title: 22q11.2 Deletion Syndrome Is Under-Recognised in Adult Patients With Tetralogy of Fallot and Pulmonary Atresia
Topic: Congenital Heart Disease
Date Posted: 5/12/2010
Author(s): van Engelen K, Topf A, Keavney BD, et al.
Citation: Heart 2010;96:621-624.
Clinical Trial: No
Study Question: What is the prevalence of 22q11.2 Deletion Syndrome (22q11.2DS) in adults with pulmonary atresia with ventricular septal defect (PA/VSD) and tetralogy of Fallot (TOF)?
Methods: A review of the Dutch CONCOR (CONgenital CORvitia) registry was performed. The CONCOR registry includes both a clinical database and a DNA bank. The registry was searched for patients with TOF and PA/VSD, with DNA available for analysis. Multiplex ligation-dependent probe amplification was used to detect 22q11.2 microdeletions.
Results: A total of 558 patients (479 with TOF and 79 with PA/VSD) with a median age of 34.7 years were studied. In addition to 20 patients already known to be positive, 24 (54%) patients were found to have a previously unidentified 22q11.2 microdeletion. The prevalence of 22q11.2 deletion was 6.5% in patients with TOF and 16.5% in patients with PA/VSD.
Conclusions: 22q11.2 deletion is undiagnosed in more than one half of adult patients. Testing for 22q11.2 deletion should be considered.
Perspective: This study reports both the incidence of 22q11.2 deletion syndrome and the degree to which it remains diagnosed in adults with TOF and PA/VSD. The prevalence is similar to what has been previously reported (Beauchesne LM, et al., J Am Coll Cardiol 2005;45:595-8). Testing for 22q11.2 deletion should be considered in all adults, particularly those considering having children, given the 50% chance of transmission to offspring. Timothy B. Cotts, M.D., F.A.C.C.