Title: Subcutaneous Defibrillator
题目：皮下除颤器
Author 作者: Semhar Tewelde
江利冰 译 肖锋 校

- The implantable cardioverter-defibrillator (ICD) has evolved from devices through epicardial patch electrodes introduced by thoracotomy to transvenous leads advanced to the right ventricle
植入型心律转复除颤器已经从开胸置入心外膜电极片发展至经静脉置入右心室。
- Transvenous ICD (T-ICD) reduced the morbidity associated w/thoracotomy implants, however involves potential complications including: hemopericardium, hemothorax, pneumothorax, lead dislodgement, lead malfunction, device-related infection, and venous occlusion
经静脉植入心律转复除颤器 (T-ICD) 减少了开胸置入相关的并发症，但是仍然涉及到潜在的并发症包括：心包积血，血胸，气胸，导线移位，导线失灵，器械相关性感染以及静脉栓塞。
- Subcutaneous ICD (S-ICD) offers the advantage of eliminating the need for intravenous & intracardiac leads. Clinical trials have proven its effectiveness in detecting and treating ventricular fibrillation/tachycardia; however its major disadvantage is its inability to provide bradycardia rate support and anti-tachycardia pacing to terminate ventricular tachycardia
皮下植入式心律转复除颤器 (S-ICD) 具有的优势是消除了静脉内和开胸放置导线。临床试验已经证实其可以有效的探测和治疗室性颤动/室性心动过速；但是它最大的劣势就是无法提供心动过缓的支持以及无法提供抗心动过速起搏从而终止室性心动过速。
- No study has directly compared the T-ICD & the S-ICD, however clinical data suggests that its use be considered in relatively younger patients (i.e., age <40 years), those at increased risk for bacteremia, patients with indwelling intravascular hardware at risk for endovascular infection, or in patients with compromised venous access
目前还没有临床研究直接对T-ICD和 S-ICD进行比较，但是临床数据提示在以下情况下可以考虑使用S-ICD：相对年轻的患者（比如年龄小于40岁），存在发生菌血症的高危风险，存在血管内留置装置，从而具有血管内感染高风险的患者，以及静脉通路受损的患者。
References 参考文献
Aziz S, Leon A, El-Chami MF. The Subcutaneous Defibrillator:: A Review of the Literature[J]. JACC Vol 63, Issue 15, Pages 1473-1479