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Kumthekar R, Webster G. Prediction of Sudden Death Risk in Patients with Congenital Heart Diseases. Card Electrophysiol Clin 2023; 15:493-503. [PMID: 37865522 DOI: 10.1016/j.ccep.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Risk stratification for sudden death should be discussed with patients with congenital heart disease at each stage of personal and cardiac development. For most patients, risk is low through teenage years and the critical factors to consider are anatomy, ventricular function, and symptoms. By adulthood, these are supplemented by screening for atrial arrhythmias, ventricular arrhythmias, and pulmonary hypertension. Therapies include medication, ablation, and defibrillator placement.
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Affiliation(s)
- Rohan Kumthekar
- Division of Cardiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; Department of Pediatrics, The Ohio State University College of Medicine, 370 W. 9th Avenue, Columbus, OH, USA
| | - Gregory Webster
- Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Box 21, Chicago, IL 60611, USA.
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2
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Chubb H, Motonaga KS. Cardiac resynchronization and implantable defibrillators in adults with congenital heart disease. Heart Fail Rev 2019; 25:657-670. [PMID: 31754907 DOI: 10.1007/s10741-019-09886-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillators (ICDs) are well-established therapies for adult patients with heart failure that have been shown to improve morbidity and mortality. However, the benefits and indications for use in adults with congenital heart disease (ACHD) are less defined with no significant large prospective studies in this population. There are, however, multiple retrospective studies that demonstrate the efficacy of these devices in the ACHD population. These indicate a role for both CRT and ICDs in select patients with ACHD. The clinician and patient must balance the risks and benefits, summarized in complex evidence that reflects the heterogeneity of the ACHD patient group, and apply them in a patient-specific manner to optimize the utility of CRT and ICDs.
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Affiliation(s)
- Henry Chubb
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, CA, USA. .,Division of Pediatric Cardiothoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA, USA. .,Heart Center Research Core, Stanford University, 780 Welch Road, Palo Alto, CA, 94304-5701, USA.
| | - Kara S Motonaga
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, CA, USA
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3
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Krause U, Müller MJ, Wilberg Y, Pietzka M, Backhoff D, Ruschewski W, Paul T. Transvenous and non-transvenous implantable cardioverter-defibrillators in children, adolescents, and adults with congenital heart disease: who is at risk for appropriate and inappropriate shocks? Europace 2018; 21:106-113. [DOI: 10.1093/europace/euy219] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 09/13/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ulrich Krause
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University Göttingen, Robert-Koch-Str. 40, Göttingen, Germany
| | - Matthias J Müller
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University Göttingen, Robert-Koch-Str. 40, Göttingen, Germany
| | - Yannic Wilberg
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University Göttingen, Robert-Koch-Str. 40, Göttingen, Germany
| | - Matthias Pietzka
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University Göttingen, Robert-Koch-Str. 40, Göttingen, Germany
| | - David Backhoff
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University Göttingen, Robert-Koch-Str. 40, Göttingen, Germany
| | - Wolfgang Ruschewski
- Department of Thoracic and Cardiovascular Surgery, University Medical Center, Georg-August-University Göttingen, Germany
| | - Thomas Paul
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University Göttingen, Robert-Koch-Str. 40, Göttingen, Germany
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4
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Stewart MH, Macicek SL, Morin DP. Implantable Cardioverter-defibrillators in Adult Congenital Heart Disease. J Innov Card Rhythm Manag 2018; 9:3172-3181. [PMID: 32494493 PMCID: PMC7252815 DOI: 10.19102/icrm.2018.090601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 11/29/2017] [Indexed: 11/30/2022] Open
Abstract
With improved surgical techniques and medical therapies, many patients who are born with complex congenital heart defects are now living well into adulthood. As these patients age, an increasingly common cause of mortality is sudden cardiac death (SCD) from ventricular tachyarrhythmias. The implantable cardioverter-defibrillator (ICD) is a therapy with the ability to prevent some of these deaths; however, there are many diagnostic and technical challenges that remain in the congenital heart disease (CHD) population. We performed a literature review, searching PubMed for articles that examined the role of ICDs in CHD. We herein present the evidence for when to place an ICD in CHD patients, stratified by subtype as relevant. Then, we discuss the technical challenges and complications that are unique to this patient population. We conclude that, despite active work in the area, more research is needed given the small event rates and clinical variability within CHD populations.
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Affiliation(s)
- Merrill H Stewart
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA, USA
| | - Scott L Macicek
- Department of Pediatric Cardiology, Ochsner Medical Center, New Orleans, LA, USA
| | - Daniel P Morin
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA, USA.,Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA, USA
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Goldstein SA, Ward CC, Al-Khatib SM. The Use of Implantable Cardioverter-defibrillators in the Prevention of Sudden Cardiac Death: A Focus on Congenital Heart Disease and Inherited Arrhythmia Syndromes. J Innov Card Rhythm Manag 2018; 9:2996-3005. [PMID: 32494470 PMCID: PMC7252881 DOI: 10.19102/icrm.2018.090103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 08/23/2017] [Indexed: 12/18/2022] Open
Abstract
Some congenital heart diseases (CHDs) and inherited arrhythmia syndromes are associated with an increased risk of sudden cardiac death (SCD). Appropriate selection criteria for implantable cardioverter-defibrillator (ICD) implantation in these patients are poorly defined due to a paucity of data available from randomized clinical trials, leading to current guidelines relying more on non-randomized studies and expert opinions to make their recommendations. This review describes available evidence-based risk stratification methods for identifying patients at risk for SCD, as well as current guideline-driven management strategies for the use of ICDs in patients with CHD and inherited arrhythmia syndromes.
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Affiliation(s)
| | - Cary C Ward
- Division of Cardiology, Duke University Hospital, Durham, NC, USA.,Duke Clinical Research Institute, Duke University Hospital, Durham, NC, USA
| | - Sana M Al-Khatib
- Division of Cardiology, Duke University Hospital, Durham, NC, USA.,Duke Clinical Research Institute, Duke University Hospital, Durham, NC, USA
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Garnreiter JM. Inappropriate ICD Shocks in Pediatric and Congenital Heart Disease Patients. J Innov Card Rhythm Manag 2017; 8:2898-2906. [PMID: 32494433 PMCID: PMC7252892 DOI: 10.19102/icrm.2017.081104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 07/18/2017] [Indexed: 11/06/2022] Open
Abstract
Although implantable cardioverter-defibrillators (ICDs) have proven to be life-saving devices, there are frequent complications associated with their use, especially in the pediatric and congenital heart disease populations. Inappropriate shocks are a particularly frequent complication in these groups. This review discusses the causes and implications of inappropriate ICD shocks, and presents potential interventions that may assist in safely reducing the rates of inappropriate shocks in pediatric and congenital heart disease patients with ICDs.
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Affiliation(s)
- Jason M Garnreiter
- Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, MO, USA
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Ávila P, Chaix MA, Mondésert B, Khairy P. Sudden Cardiac Death in Adult Congenital Heart Disease. Card Electrophysiol Clin 2017; 9:225-234. [PMID: 28457237 DOI: 10.1016/j.ccep.2017.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Sudden death of presumed arrhythmic etiology is a leading cause of mortality in adults with congenital heart disease. Anticipated benefits of the implantable cardioverter-defibrillator (ICD) must be weighed against high complication rates. Without robust evidence from randomized trials, caregivers face difficult decisions in selecting appropriate candidates. Although secondary prevention indications are often clear-cut, risk stratification for primary prevention ICDs is more challenging. Factors associated with sudden death in patients with tetralogy of Fallot are reasonably consistent across studies. In contrast, identification of high-risk patients with systemic right ventricles or univentricular hearts remains controversial.
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Affiliation(s)
- Pablo Ávila
- Department of Cardiology, Instituto de Investigación Sanitaria, Hospital Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Marie-A Chaix
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street East, Montreal H1T 1C8, Canada
| | - Blandine Mondésert
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street East, Montreal H1T 1C8, Canada
| | - Paul Khairy
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street East, Montreal H1T 1C8, Canada.
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8
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Chubb H, O'Neill M, Rosenthal E. Pacing and Defibrillators in Complex Congenital Heart Disease. Arrhythm Electrophysiol Rev 2016; 5:57-64. [PMID: 27403295 DOI: 10.15420/aer.2016.2.3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Device therapy in the complex congenital heart disease (CHD) population is a challenging field. There is a myriad of devices available, but none designed specifically for the CHD patient group, and a scarcity of prospective studies to guide best practice. Baseline cardiac anatomy, prior surgical and interventional procedures, existing tachyarrhythmias and the requirement for future intervention all play a substantial role in decision making. For both pacing systems and implantable cardioverter defibrillators, numerous factors impact on the merits of system location (endovascular versus non-endovascular), lead positioning, device selection and device programming. For those with Fontan circulation and following the atrial switch procedure there are also very specific considerations regarding access and potential complications. This review discusses the published guidelines, device indications and the best available evidence for guidance of device implantation in the complex CHD population.
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Affiliation(s)
- Henry Chubb
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK; Department of Congenital Heart Disease, Evelina Children's Hospital, London, UK
| | - Mark O'Neill
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK; Adult Congenital Heart Disease Group, Departments of Cardiology at Guy's and St Thomas' NHS Foundation Trust and Evelina Children's Hospital, London, UK
| | - Eric Rosenthal
- Department of Congenital Heart Disease, Evelina Children's Hospital, London, UK; Adult Congenital Heart Disease Group, Departments of Cardiology at Guy's and St Thomas' NHS Foundation Trust and Evelina Children's Hospital, London, UK
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9
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Khairy P. Ventricular arrhythmias and sudden cardiac death in adults with congenital heart disease. Heart 2016; 102:1703-1709. [DOI: 10.1136/heartjnl-2015-309069] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 05/09/2016] [Indexed: 11/04/2022] Open
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10
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Chubb H, Rosenthal E. Implantable cardioverter-defibrillators in congenital heart disease. Herzschrittmacherther Elektrophysiol 2016; 27:95-103. [PMID: 27250725 PMCID: PMC4894938 DOI: 10.1007/s00399-016-0437-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 05/06/2016] [Indexed: 01/28/2023]
Abstract
Implantable cardioverter-defibrillators (ICD) have an important role in reducing sudden cardiac death in patients with congenital heart disease (CHD); however, the benefit of ICDs needs to be weighed up against both short-term and long-term adverse effects, which are difficult to evaluate in the heterogeneous CHD population. A tailored approach, taking into account risk stratification and patient-specific factors, is needed to select the most appropriate strategy. This review discusses primary and secondary ICD indications, implantation approaches and long-term follow-up. Recent publications have shed light on the concerns of system longevity, lead extractions, inappropriate shocks and impact on the quality of life. All of these factors require consideration prior to commitment to this long-term treatment strategy.
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Affiliation(s)
- H Chubb
- Department of Paediatric Cardiology, Evelina London Children's Hospital, Westminster Bridge Road, SE1 7EH, London, UK
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - E Rosenthal
- Department of Paediatric Cardiology, Evelina London Children's Hospital, Westminster Bridge Road, SE1 7EH, London, UK.
- Adult Congenital Heart Disease Group, Departments of Cardiology at Guy's and St Thomas' NHS Foundation Trust & Evelina London Children's Hospital, London, UK.
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11
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Stout KK, Broberg CS, Book WM, Cecchin F, Chen JM, Dimopoulos K, Everitt MD, Gatzoulis M, Harris L, Hsu DT, Kuvin JT, Law Y, Martin CM, Murphy AM, Ross HJ, Singh G, Spray TL. Chronic Heart Failure in Congenital Heart Disease. Circulation 2016; 133:770-801. [DOI: 10.1161/cir.0000000000000352] [Citation(s) in RCA: 219] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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12
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Khairy P, Van Hare GF, Balaji S, Berul CI, Cecchin F, Cohen MI, Daniels CJ, Deal BJ, Dearani JA, Groot ND, Dubin AM, Harris L, Janousek J, Kanter RJ, Karpawich PP, Perry JC, Seslar SP, Shah MJ, Silka MJ, Triedman JK, Walsh EP, Warnes CA. PACES/HRS expert consensus statement on the recognition and management of arrhythmias in adult congenital heart disease: developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American College of Cardiology (ACC), the American Heart Association (AHA), the European Heart Rhythm Association (EHRA), the Canadian Heart Rhythm Society (CHRS), and the International Society for Adult Congenital Heart Disease (ISACHD). Can J Cardiol 2014; 30:e1-e63. [PMID: 25262867 DOI: 10.1016/j.cjca.2014.09.002] [Citation(s) in RCA: 151] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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13
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Khairy P, Van Hare GF, Balaji S, Berul CI, Cecchin F, Cohen MI, Daniels CJ, Deal BJ, Dearani JA, Groot ND, Dubin AM, Harris L, Janousek J, Kanter RJ, Karpawich PP, Perry JC, Seslar SP, Shah MJ, Silka MJ, Triedman JK, Walsh EP, Warnes CA. PACES/HRS Expert Consensus Statement on the Recognition and Management of Arrhythmias in Adult Congenital Heart Disease: developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American College of Cardiology (ACC), the American Heart Association (AHA), the European Heart Rhythm Association (EHRA), the Canadian Heart Rhythm Society (CHRS), and the International Society for Adult Congenital Heart Disease (ISACHD). Heart Rhythm 2014; 11:e102-65. [PMID: 24814377 DOI: 10.1016/j.hrthm.2014.05.009] [Citation(s) in RCA: 380] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Indexed: 02/07/2023]
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14
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Diagnostic Tools for Arrhythmia Detection in Adults with Congenital Heart Disease and Heart Failure. Heart Fail Clin 2014; 10:57-67. [DOI: 10.1016/j.hfc.2013.09.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Motonaga KS, Khairy P, Dubin AM. Electrophysiologic Therapeutics in Heart Failure in Adult Congenital Heart Disease. Heart Fail Clin 2014; 10:69-89. [DOI: 10.1016/j.hfc.2013.09.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Recommendations for the Programming of Implantable Cardioverter-Defibrillators in New Zealand. Heart Lung Circ 2012; 21:765-77. [DOI: 10.1016/j.hlc.2012.07.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 07/17/2012] [Accepted: 07/21/2012] [Indexed: 11/23/2022]
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18
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Antitachycardia pacing reduces appropriate and inappropriate shocks in children and congenital heart disease patients. Heart Rhythm 2012; 9:1829-34. [DOI: 10.1016/j.hrthm.2012.06.042] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Indexed: 11/19/2022]
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19
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Update on the Use and Outcomes of Implantable Cardioverter Defibrillators in Pediatric Patients. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2012; 14:435-42. [DOI: 10.1007/s11936-012-0202-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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"Magnetic attraction" in the pediatric emergency department: the case of a malfunctioning implantable cardioverter-defibrillator. Pediatr Emerg Care 2012; 28:562-5. [PMID: 22668661 DOI: 10.1097/pec.0b013e318258be04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The use of implantable cardioverter-defibrillators (ICDs) in pediatric patients has increased substantially over the past 3 decades. We report the case of a 15-year-old boy with congenital heart disease who presented with recurrent inappropriate ICD shocks due to a lead malfunction. Inaccessibility of a magnet to inactivate shock therapy in the pediatric emergency department (PED) resulted in numerous additional inappropriate shocks. Herein, we provide a brief overview of ICD care relevant to the PED. The complexities of these devices and their associated therapies require pediatric emergency physicians caring for these patients to recognize basic ICD functions and troubleshoot malfunctions to provide timely management. In particular, it is essential that PEDs be equipped with magnets and that physicians are trained in their appropriate use.
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Koneru JN, Swerdlow CD, Wood MA, Ellenbogen KA. Minimizing Inappropriate or “Unnecessary” Implantable Cardioverter-Defibrillator Shocks. Circ Arrhythm Electrophysiol 2011; 4:778-90. [DOI: 10.1161/circep.110.961243] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jayanthi N. Koneru
- From the Virginia Commonwealth University, Richmond, VA (J.N.K., M.A.W., K.A.E.), and Cedars Sinai Medical Center, Los Angeles, CA (C.D.S.)
| | - Charles D. Swerdlow
- From the Virginia Commonwealth University, Richmond, VA (J.N.K., M.A.W., K.A.E.), and Cedars Sinai Medical Center, Los Angeles, CA (C.D.S.)
| | - Mark A. Wood
- From the Virginia Commonwealth University, Richmond, VA (J.N.K., M.A.W., K.A.E.), and Cedars Sinai Medical Center, Los Angeles, CA (C.D.S.)
| | - Kenneth A. Ellenbogen
- From the Virginia Commonwealth University, Richmond, VA (J.N.K., M.A.W., K.A.E.), and Cedars Sinai Medical Center, Los Angeles, CA (C.D.S.)
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Le Gloan L, Mercier LA, Dore A, Marcotte F, Ibrahim R, Mongeon FP, Asgar A, Miro J, Poirier N, Khairy P. Recent advances in adult congenital heart disease. Circ J 2011; 75:2287-95. [PMID: 21881245 DOI: 10.1253/circj.cj-11-0601] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
As a result of major achievements in pediatric cardiac care, a growing number of patients with congenital heart disease (CHD) are flourishing well into adulthood. This heterogeneous and aging population of patients, many of whom represent the first generation of middle-age survivors, faces unique issues and challenges. As a field, adult CHD has evolved markedly during the past decade on several fronts, including imaging, arrhythmia management, percutaneous interventions, surgical techniques, research, and multidisciplinary care that extends beyond the cardiac realm. This review highlights recent advances across the wide spectrum of key issues encountered by adults with CHD.
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Affiliation(s)
- Laurianne Le Gloan
- Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montréal, Canada
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