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van der Stuijt W, Kooiman KM, de Veld JA, Pepplinkhuizen S, Olde Nordkamp LRA, Oudijk MA, Wilde AAM, Smeding L, Knops RE. Is it safe to give birth with an activated implantable cardioverter-defibrillator: A multicentre observational study. BJOG 2024; 131:1290-1295. [PMID: 38326282 DOI: 10.1111/1471-0528.17777] [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] [Received: 09/15/2023] [Revised: 01/17/2024] [Accepted: 01/21/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE Data and guidelines are lacking, so implantable cardioverter-defibrillators (ICDs) are often deactivated during labour to prevent inappropriate shocks. This study aimed to ascertain the safety of an activated ICD during labour. DESIGN An observational study was performed. SETTING Dutch hospitals. POPULATION OR SAMPLE A total of 41 childbirths were included of 26 patients who gave birth between February 2009 and November 2018 after receiving an ICD in our tertiary hospital. Five of these childbirths were attended by the research team between December 2018 and August 2020, during which the ICD remained active. METHODS Groups were made based on ICD status during labour. Patients who gave birth with an activated ICD at least once were stratified to the activated ICD group. Patients' files were checked and patients received a questionnaire about childbirth perceptions and treatment preferences. The differences in ordinal data resulting from the questionnaire were calculated using a chi-square or Fisher's exact test. MAIN OUTCOME MEASURES Primary outcome was inappropriate ICD therapy and occurrence of ventricular arrhythmias requiring treatment. RESULTS During the 41 childbirths, no inappropriate shocks or ventricular arrhythmias occurred during labour. All patients in the activated ICD group (n = 13) preferred this setting, while 8 of the 13 patients in the deactivated ICD group preferred activation (p = 0.002). Reasons included avoiding hemodynamic monitoring, magnet placement, or labour induction to facilitate technician availability. CONCLUSIONS This study shows no evidence that labour and birth in women with an activated ICD are unsafe, as there were no ventricular arrhythmias or inappropriate therapy. In addition, most patients prefer an activated ICD during labour.
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Affiliation(s)
- Willeke van der Stuijt
- Heart Centre: Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Kirsten M Kooiman
- Heart Centre: Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Jolien A de Veld
- Heart Centre: Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Shari Pepplinkhuizen
- Heart Centre: Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Louise R A Olde Nordkamp
- Heart Centre: Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Martijn A Oudijk
- Department of Obstetrics and Gynaecology, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Arthur A M Wilde
- Heart Centre: Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Lonneke Smeding
- Heart Centre: Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - Reinoud E Knops
- Heart Centre: Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
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2
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Baskar S, Berul CI. Compliance and complications in catecholaminergic polymorphic ventricular tachycardia. Heart Rhythm 2024:S1547-5271(24)02500-1. [PMID: 38657784 DOI: 10.1016/j.hrthm.2024.04.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Shankar Baskar
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - Charles I Berul
- Children's National Hospital, George Washington University School of Medicine, Washington, District of Columbia
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3
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Silvetti MS, Colonna D, Gabbarini F, Porcedda G, Rimini A, D’Onofrio A, Leoni L. New Guidelines of Pediatric Cardiac Implantable Electronic Devices: What Is Changing in Clinical Practice? J Cardiovasc Dev Dis 2024; 11:99. [PMID: 38667717 PMCID: PMC11050217 DOI: 10.3390/jcdd11040099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/15/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024] Open
Abstract
Guidelines are important tools to guide the diagnosis and treatment of patients to improve the decision-making process of health professionals. They are periodically updated according to new evidence. Four new Guidelines in 2021, 2022 and 2023 referred to pediatric pacing and defibrillation. There are some relevant changes in permanent pacing. In patients with atrioventricular block, the heart rate limit in which pacemaker implantation is recommended was decreased to reduce too-early device implantation. However, it was underlined that the heart rate criterion is not absolute, as signs or symptoms of hemodynamically not tolerated bradycardia may even occur at higher rates. In sinus node dysfunction, symptomatic bradycardia is the most relevant recommendation for pacing. Physiological pacing is increasingly used and recommended when the amount of ventricular pacing is presumed to be high. New recommendations suggest that loop recorders may guide the management of inherited arrhythmia syndromes and may be useful for severe but not frequent palpitations. Regarding defibrillator implantation, the main changes are in primary prevention recommendations. In hypertrophic cardiomyopathy, pediatric risk calculators have been included in the Guidelines. In dilated cardiomyopathy, due to the rarity of sudden cardiac death in pediatric age, low ejection fraction criteria were demoted to class II. In long QT syndrome, new criteria included severely prolonged QTc with different limits according to genotype, and some specific mutations. In arrhythmogenic cardiomyopathy, hemodynamically tolerated ventricular tachycardia and arrhythmic syncope were downgraded to class II recommendation. In conclusion, these new Guidelines aim to assess all aspects of cardiac implantable electronic devices and improve treatment strategies.
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Affiliation(s)
- Massimo Stefano Silvetti
- Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, European Reference Network for Rare and Low Prevalence Complex Disease of the Heart (ERN GUARD-Heart), 00100 Rome, Italy
| | - Diego Colonna
- Adult Congenital Heart Disease Unit, Monaldi Hospital, 80131 Naples, Italy;
| | - Fulvio Gabbarini
- Paediatric Cardiology and Adult Congenital Heart Disease Unit, Regina Margherita Hospital, 10126 Torino, Italy;
| | - Giulio Porcedda
- Paediatric Cardiology Unit, A. Meyer Children’s Hospital, 50139 Florence, Italy;
| | - Alessandro Rimini
- Paediatric Cardiology Unit, G. Gaslini Children’s Hospital IRCCS, 16147 Genoa, Italy;
| | - Antonio D’Onofrio
- Departmental Unit of Electrophysiology, Evaluation and Treatment of Arrhythmia, Monaldi Hospital, 80131 Naples, Italy;
| | - Loira Leoni
- Cardiology Unit, Department of Cardio-Thoracic-Vascular Science and Public Health, Padua University Hospital (ERN GUARD-Heart), 35121 Padua, Italy;
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4
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Ramdat Misier NL, Moore JP, Nguyen HH, Lloyd MS, Dubin AM, Mah DY, Czosek RJ, Khairy P, Chang PM, Nielsen JC, Aydin A, Pilcher TA, O'Leary ET, Shivkumar K, de Groot NMS. Long-Term Outcomes of Cardiac Resynchronization Therapy in Patients With Repaired Tetralogy of Fallot: A Multicenter Study. Circ Arrhythm Electrophysiol 2024; 17:e012363. [PMID: 38344811 DOI: 10.1161/circep.123.012363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 01/17/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND A growing number of patients with tetralogy of Fallot develop left ventricular systolic dysfunction and heart failure, in addition to right ventricular dysfunction. Although cardiac resynchronization therapy (CRT) is an established treatment option, the effect of CRT in this population is still not well defined. This study aimed to investigate the early and late efficacy, survival, and safety of CRT in patients with tetralogy of Fallot. METHODS Data were analyzed from an observational, retrospective, multicenter cohort, initiated jointly by the Pediatric and Congenital Electrophysiology Society and the International Society of Adult Congenital Heart Disease. Twelve centers contributed baseline and longitudinal data, including vital status, left ventricular ejection fraction (LVEF), QRS duration, and NYHA functional class. Outcomes were analyzed at early (3 months), intermediate (1 year), and late follow-up (≥2 years) after CRT implantation. RESULTS A total of 44 patients (40.3±19.2 years) with tetralogy of Fallot and CRT were enrolled. Twenty-nine (65.9%) patients had right ventricular pacing before CRT upgrade. The left ventricular ejection fraction improved from 32% [24%-44%] at baseline to 42% [32%-50%] at early follow-up (P<0.001) and remained improved from baseline thereafter (P≤0.002). The QRS duration decreased from 180 [160-205] ms at baseline to 152 [133-182] ms at early follow-up (P<0.001) and remained decreased at intermediate and late follow-up (P≤0.001). Patients with upgraded CRT had consistent improvement in left ventricular ejection fraction and QRS duration at each time point (P≤0.004). Patients had a significantly improved New York Heart Association functional class after CRT implantation at each time point compared with baseline (P≤0.002). The transplant-free survival rates at 3, 5, and 8 years after CRT implantation were 85%, 79%, and 73%. CONCLUSIONS In patients with tetralogy of Fallot treated with CRT consistent improvement in QRS duration, left ventricular ejection fraction, New York Heart Association functional class, and reasonable long-term survival were observed. The findings from this multicenter study support the consideration of CRT in this unique population.
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Affiliation(s)
- Nawin L Ramdat Misier
- Department of Cardiology, Erasmus Medical Center, Rotterdam , The Netherlands (N.L.R.M., N.M.S.d.G.)
| | - Jeremy P Moore
- Ahmanson/University of California Los Angeles Adult Congenital Heart Disease Center, Los Angeles, CA (J.P.M., K.S.)
| | - Hoang H Nguyen
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX (H.H.N.)
| | - Michael S Lloyd
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (M.S.L.)
| | - Anne M Dubin
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto CA (A.M.D.)
| | - Douglas Y Mah
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston MA (D.Y.M., E.T.O.)
| | - Richard J Czosek
- Division of Pediatric Cardiology, Department of Pediatrics, The Heart Institute at Cincinnati Children's Hospital Medical Center, Cincinnati OH (R.J.C.)
| | - Paul Khairy
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal Quebec, Canada (P.K.)
| | - Philip M Chang
- Congenital Heart Center, University of Florida Health, Gainesville, FL (P.M.C.)
| | - Jens C Nielsen
- Department of Clinical Medicine, Aarhus University, Aarhus Denmark (J.C.N.)
- Department of Cardiology, Aarhus University Hospital, Aarhus Denmark (J.C.N.)
| | - Alper Aydin
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario Canada (A.A.)
| | - Thomas A Pilcher
- Division of Pediatric Cardiology, Department of Internal Medicine, University of Utah, Salt Lake City UT (T.A.P.)
| | - Edward T O'Leary
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston MA (D.Y.M., E.T.O.)
| | - Kalyanam Shivkumar
- Ahmanson/University of California Los Angeles Adult Congenital Heart Disease Center, Los Angeles, CA (J.P.M., K.S.)
| | - Natasja M S de Groot
- Department of Cardiology, Erasmus Medical Center, Rotterdam , The Netherlands (N.L.R.M., N.M.S.d.G.)
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5
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Cicenia M, Silvetti MS, Cantarutti N, Battipaglia I, Adorisio R, Saputo FA, Tamburri I, Campisi M, Baban A, Drago F. ICD outcome in pediatric arrhythmogenic cardiomyopathy. Int J Cardiol 2024; 394:131381. [PMID: 37739045 DOI: 10.1016/j.ijcard.2023.131381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/10/2023] [Accepted: 09/18/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Arrhythmogenic cardiomyopathy (ACM) is a very rare condition among pediatric patients. Sudden cardiac death (SCD) is the main complication and often requires ICD implantation. Aim of the study is the evaluation of the outcomes of ICD implanted ACM pediatric patients in terms of safety, efficacy and complications. METHODS All pediatric patients (<18 y.o.) diagnosed with ACM and who were implanted with ICD since 2009 in Our Institution were collected. Implantation was decided according to current recommendations/ guidelines, and outcome was recorded during follow-up. RESULTS Nineteen consecutive ACM patients were implanted with ICD. Subcutaneous ICDs (S-ICD) were implanted in 15 patients (79%) while transvenous ICDs (TV-ICD) in 4 patients (21%). Mean age at implantation was 14.3 ± 2.1 y.o. ICDs were implanted for secondary prevention in 4 (21%) patients, and for primary prevention in 15 (79%). During the follow-up (5.59 ± 3.4 years), appropriate ICD interventions were delivered in 4 (21%) patients for sustained VTs, [2 implanted in primary prevention (13%) and 2 in secondary prevention (50%)]. No defibrillation failures occurred. Inappropriate shocks occurred in 2 cases (10.5%). Device-related complications requiring device revision occurred in 3 (16%): lead dislodgement, surgical skin erosion and sensing defect. CONCLUSIONS In a pediatric ACM cohort, appropriate ICD therapies occurred in a minority of primary prevention patients and frequently in secondary prevention patients. The rate of inappropriate shocks and device-related complications were even more rare and mostly wound related. Therefore, ICD therapy in pediatric ACM is effective and safe.
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Affiliation(s)
- Marianna Cicenia
- Pediatric Cardiology and Arrhythmia/Syncope Complex Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Massimo Stefano Silvetti
- Pediatric Cardiology and Arrhythmia/Syncope Complex Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Nicoletta Cantarutti
- Pediatric Cardiology and Arrhythmia/Syncope Complex Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Irma Battipaglia
- Pediatric Cardiology and Arrhythmia/Syncope Complex Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rachele Adorisio
- Heart Failure and Transplant, Mechanical Circulatory Support Complex Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Fabio Anselmo Saputo
- Pediatric Cardiology and Arrhythmia/Syncope Complex Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Ilaria Tamburri
- Pediatric Cardiology and Arrhythmia/Syncope Complex Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marta Campisi
- Pediatric Cardiology and Arrhythmia/Syncope Complex Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Anwar Baban
- Pediatric Cardiology and Arrhythmia/Syncope Complex Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Fabrizio Drago
- Pediatric Cardiology and Arrhythmia/Syncope Complex Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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6
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Tan RB, Stephenson EA, Bulic A. Epicardial Devices in Pediatrics and Congenital Heart Disease. Card Electrophysiol Clin 2023; 15:467-480. [PMID: 37865520 DOI: 10.1016/j.ccep.2023.07.006] [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
Epicardial cardiac implantable electronic device implant remains a common option in pediatric patients and certain patients with congenital heart disease due to patient size, complex anatomy, residual intracardiac shunts, and prior surgery precluding transvenous implant. Advantages include the lack of thromboembolic and vascular risks and ability to implant during concomitant surgery. Significant disadvantages include the occurrence of lead dysfunction that can result in bradycardia events in pacemaker patients, inappropriate shocks in implantable cardiac defibrillator patients, and overall a more invasive procedure.
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Affiliation(s)
- Reina Bianca Tan
- Division of Cardiology, Department of Pediatrics, NYU Langone Health and Hassenfeld Children's Hospital, 403 East 34th Street, Level 4, New York, NY 10017, USA.
| | - Elizabeth A Stephenson
- University of Toronto, The Hospital for Sick Children, Labatt Family Heart Centre, 555 University Avenue, Room 1725, Toronto, Ontario M5G1X8, Canada
| | - Anica Bulic
- University of Toronto, The Hospital for Sick Children, Labatt Family Heart Centre, 555 University Avenue, Room 1725, Toronto, Ontario M5G1X8, Canada
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7
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Giacone HM, Dubin AM. Current Device Needs for Patients with Pediatric and Congenital Heart Disease. Card Electrophysiol Clin 2023; 15:527-534. [PMID: 37865525 DOI: 10.1016/j.ccep.2023.06.005] [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
Pediatric electrophysiologists believe that there is a paucity of pediatric-specific cardiac implantable electronic devices (CIEDs) available for their patients. Specific patient characteristics such as vascular size, intracardiac anatomy, and expected somatic growth limit the types of CIED implants possible for pediatric and congenital heart disease (CHD) patients. These patients demonstrate higher CIED-related complication rates compared with adults. As the number of pediatric and CHD patients who require CIEDs increases, so does the need for advocacy. Fortunately, collaboration among the Food and Drug Administration, industry, and pediatric societies has led to the improvement of regulations and support for clinical trials.
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Affiliation(s)
- Heather M Giacone
- Department of Pediatric Cardiology, Lucile Packard Children's Hospital at Stanford University, 750 Welch Road, Palo Alto, CA 94304, USA.
| | - Anne M Dubin
- Department of Pediatric Cardiology, Lucile Packard Children's Hospital at Stanford University, 750 Welch Road, Palo Alto, CA 94304, USA
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8
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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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9
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Kutarski A, Miszczak-Knecht M, Brzezinska M, Birbach M, Lipiński W, Jacheć W, Ziaja B, Polewczyk A, Tułecki Ł, Czajkowski M, Nowosielecka D, Bieganowska K. Lead Extraction in Children and Young Adults: When is the Best Time for Lead/System Replacement? Pediatr Cardiol 2023:10.1007/s00246-023-03320-9. [PMID: 37898588 DOI: 10.1007/s00246-023-03320-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/03/2023] [Indexed: 10/30/2023]
Abstract
The best strategy for lead management in children is a matter of debate, and our experiences are limited. This is a retrospective single-center study comparing difficulties and outcomes of transvenous lead extraction (TLE) implanted ich childhood and at age < 19 years (childhood-implanted-childhood-extracted, CICE) and at age < 19 (childhood-implanted-adulthood-extracted, CIAE). CICE patients-71 children (mean age 15.1 years) as compared to CIAE patients (114 adults (mean age 28.61 years) were more likely to have VVI than DDD pacemakers. Differences in implant duration (7.96 vs 14.08 years) appeared to be most important, but procedure complexity and outcomes also differed between the groups. Young adults with cardiac implantable electronic device implanted in childhood had more risk factors for major complications and underwent more complex procedures compared to children. Implant duration was significantly longer in CIAE patients than in children, being the most important factor that had an impact on patient safety and procedure complexity. CIAE patients were more likely to have prolonged operative duration and more complex procedures due to technical problems, and they were 2-3 times more likely to require second-line or advanced tools compared to children, but the rates of clinical and procedural success were comparable in both groups. The difference between the incidence of major complications between CICE and CIAE patients is very clear (MC 2.9 vs 7.0%, hemopericardium 1.4 vs 5.3% etc.), although statistically insignificant. Delay of lead extraction to adulthood seems to be a riskier option than planned TLE in children before growing up.
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Affiliation(s)
- Andrzej Kutarski
- Department of Cardiology, Medical University of Lublin, Lublin, Poland
| | | | - Monika Brzezinska
- Department of Cardiology, Children's Memorial Health Institute, Warsaw, Poland
| | - Mariusz Birbach
- Department of Cardiac Surgery, Children's Memorial Health Institute, Warsaw, Poland
| | - Wojciech Lipiński
- Department of Cardiac Surgery, Children's Memorial Health Institute, Warsaw, Poland
| | - Wojciech Jacheć
- 2nd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Bettina Ziaja
- Department of Cardiology, Specialist Hospital in Zabrze, Zabrze, Poland
| | - Anna Polewczyk
- Department of Medicine and Health Sciences, The Jan Kochanowski University, Kielce, Poland
| | - Łukasz Tułecki
- Department of Cardiac Surgery, Pope John Paul II Province Hospital, Zamość, Poland
| | - Marek Czajkowski
- Department of Cardiac Surgery, Medical University of Lublin, Lublin, Poland
| | - Dorota Nowosielecka
- Department of Cardiac Surgery, Pope John Paul II Province Hospital, Zamość, Poland.
- Department of Cardiology, Pope John Paul II Province Hospital, Aleje Jana Pawła II 10, 22-400, Zamość, Poland.
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10
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Heck R, Peters B, Lanmüller P, Photiadis J, Berger F, Falk V, Starck C, Kramer P. Transvenous lead extraction in children with bidirectional rotational dissection sheaths. Front Cardiovasc Med 2023; 10:1256752. [PMID: 37745106 PMCID: PMC10515391 DOI: 10.3389/fcvm.2023.1256752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Objectives Due to the limited longevity of endovascular leads, children require thoughtful lifetime lead management strategies including conservation of access vessel patency. Consequently, there is an increasing interest in transvenous lead extraction (TLE) in children, however, data on TLE and the use of powered mechanical dissection sheaths is limited. Methods We performed a retrospective cohort study analyzing all children <18 years that underwent TLE in our institution from 2015 to 2022. Procedural complexity, results and complications were defined as recommended by recent consensus statements. Results Twenty-eight children [median age 12.8 (interquartile range 11.3-14.6) years] were included. Forty-one leads were extracted [median dwell time 85 (interquartile range 52-102) months]. Extractions of 31 leads (76%) in 22 patients (79%) were complex, requiring advanced extraction tools including powered bidirectional rotational dissection sheaths in 14 children. There were no major complications. Complete procedural success was achieved in 18 (64%) and clinical success in 27 patients (96%), respectively. Procedural success and complexity varied between lead types. The Medtronic SelectSecure™ lead was associated with increased odds of extraction by simple traction (p = 0.006) and complete procedural success (p < 0.001) while the Boston Scientific Fineline™ II lead family had increased odds of partial procedural failure (p = 0.017). Conclusions TLE with the use of mechanical powered rotational dissection sheaths is feasible and safe in pediatric patients. In light of rare complications and excellent overall clinical success, TLE should be considered an important cornerstone in lifetime lead management in children. Particular lead types might be more challenging and less successful to extract.
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Affiliation(s)
- Roland Heck
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Björn Peters
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Congenital Heart Disease—Pediatric Cardiology, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
| | - Pia Lanmüller
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Joachim Photiadis
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Congenital and Pediatric Heart Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
| | - Felix Berger
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Congenital Heart Disease—Pediatric Cardiology, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Partner Site Berlin, DZHK (German Center for Cardiovascular Research), Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Partner Site Berlin, DZHK (German Center for Cardiovascular Research), Berlin, Germany
- Translational Cardiovascular Technologies, Institute of Translational Medicine, Department of Health Sciences and Technology, Swiss Federal Institute of Technology (ETH) Zurich, Switzerland
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Steinbeis Hochschule, Steinbeis-Transfer-Institut Kardiotechnik, Berlin, Germany
| | - Peter Kramer
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Congenital Heart Disease—Pediatric Cardiology, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
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11
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Einbinder T, Machtei A, Birk E, Schamroth Pravda N, Frenkel G, Amir G, Fogelman R. Low Risk of Inappropriate Shock Among Pediatric Patients With an Implantable Cardioverter Defibrillator: A Single Center Experience. Pediatr Cardiol 2023:10.1007/s00246-023-03280-0. [PMID: 37668692 DOI: 10.1007/s00246-023-03280-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 08/17/2023] [Indexed: 09/06/2023]
Abstract
Implantable cardioverter-defibrillators (ICD) are increasingly being used among the pediatric population for indications of both primary and secondary prevention. There is limited long-term data on the outcomes of pediatric patients following ICD implantation. The aim of this study was to investigate the characteristics of this population, burden of appropriate and inappropriate shock and complication rate in a large tertiary pediatric medical center. Included were children under the age of 18 years who underwent ICD implantation and had clinical follow up at our center. Data were retrospectively collected between study period 2005-2020. Primary outcome was the incidence of ICD shock appropriate and inappropriate. Secondary outcome was defining our patient population characteristics. Our cohort included 51 patients who underwent ICD implantation. Mean age at implantation was 10.9 ± 4.7 years and average follow-up time was 67 months. Diagnoses of implanted patients were: 28 (55%) patients with syndromes with risk for sudden death, cardiomyopathy in 14 patients (27%) and congenital heart disease (CHD) in 9 patients (18%). Forty-two (82%) patients had an ICD implanted for secondary prevention after experiencing a life-threatening arrhythmia and 9 (18%) for primary prevention. An endocardial system was implanted in 39 (76%) patients and an epicardial systems in 12 (24%) patients. A total of 20 (39%) patients received appropriate shocks for ventricular fibrillation(VF). 5 patients received inappropriate shocks, 4 due to sinus tachycardia and 1 due to rapidly conducted atrial fibrillation. Those who received an inappropriate shock had a significantly shorter ICD-programmed VF detection cycle length compared to those who did not receive an inappropriate shock (320 ms versus 270 ms, p = 0.062). This single center study demonstrates a high rate of appropriate ICD shocks (39%) and a low rate of inappropriate ICD shocks. Accurate programming of ICD devices in the pediatric population is paramount to avoid inappropriate ICD shocks.
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Affiliation(s)
- Tom Einbinder
- Department of Pediatric Cardiology, Schneider's Children Medical Center, Petach-Tikva, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ayelet Machtei
- Department of Pediatric Cardiology, Schneider's Children Medical Center, Petach-Tikva, Israel
| | - Einat Birk
- Department of Pediatric Cardiology, Schneider's Children Medical Center, Petach-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - George Frenkel
- Department of Pediatric Cardiology, Schneider's Children Medical Center, Petach-Tikva, Israel
| | - Gabriel Amir
- Department of Pediatric Cardiology, Schneider's Children Medical Center, Petach-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rami Fogelman
- Department of Pediatric Cardiology, Schneider's Children Medical Center, Petach-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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12
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Gómez-Mesa JE, Márquez-Murillo M, Figueiredo M, Berni A, Jerez AM, Núñez-Ayala E, Pow-Chon F, Sáenz-Morales LC, Pava-Molano LF, Montes MC, Garillo R, Galindo-Coral S, Reyes-Caorsi W, Speranza M, Romero A. Inter-American Society of Cardiology (CIFACAH-ELECTROSIAC) and Latin-American Heart Rhythm Society (LAHRS): multidisciplinary review on the appropriate use of implantable cardiodefibrillator in heart failure with reduced ejection fraction. J Interv Card Electrophysiol 2023; 66:1211-1229. [PMID: 36469237 PMCID: PMC10333140 DOI: 10.1007/s10840-022-01425-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/10/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND Our main objective was to present a multidisciplinary review on the epidemiology of sudden cardiac death (SCD) and the tools that could be used to identify malignant ventricular arrhythmias (VAs) and to perform risk stratification. In addition, indications and contraindications for the use of implantable cardioverter defibrillator (ICD) in general and in special populations including the elderly and patients with chronic kidney disease (CKD) are also given. METHODS An expert group from the Inter American Society of Cardiology (IASC), through their HF Council (CIFACAH) and Electrocardiology Council (ElectroSIAC), together with the Latin American Heart Rhythm Society (LAHRS), reviewed and discussed the literature regarding the appropriate use of an ICD in people with heart failure (HF) with reduced ejection fraction (HFpEF). Indications and contraindications for the use of ICD are presented in this multidisciplinary review. RESULTS Numerous clinical studies have demonstrated the usefulness of ICD in both primary and secondary prevention of SCD in HFpEF. There are currently precise indications and contraindications for the use of these devices. CONCLUSIONS In some Latin American countries, a low rate of implantation is correlated with low incomes, but this is not the case for all Latin America. Determinants of the low rates of ICD implantation in many Latin American countries are still a matter of research. VA remains one of the most common causes of cardiovascular death associated with HFrEF and different tools are available for stratifying the risk of SCD in this population.
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Affiliation(s)
- Juan Esteban Gómez-Mesa
- Cardiology Department, Fundación Valle del Lili, Cali, Colombia.
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia.
- Inter-American Council of Heart Failure and Pulmonary Hypertension/CIFACAH, Mexico City, Mexico.
- Inter-American Society of Cardiology/IASC, Mexico City, Mexico.
| | - Manlio Márquez-Murillo
- Inter-American Society of Cardiology/IASC, Mexico City, Mexico
- Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
- Inter-American Council of Electrocardiography and Arrhythmias/ELECTROSIAC, Mexico City, Mexico
| | - Marcio Figueiredo
- University of Campinas (UNICAMP) Hospital, Campinas, Brazil
- Latin American Heart Rhythm Society/LAHRS, Montevideo, Uruguay
| | - Ana Berni
- Inter-American Society of Cardiology/IASC, Mexico City, Mexico
- Inter-American Council of Electrocardiography and Arrhythmias/ELECTROSIAC, Mexico City, Mexico
- Hospital Angeles Pedregal, Mexico City, Mexico
| | - Ana Margarita Jerez
- Inter-American Council of Heart Failure and Pulmonary Hypertension/CIFACAH, Mexico City, Mexico
- Inter-American Society of Cardiology/IASC, Mexico City, Mexico
- Instituto de Cardiología Y Cirugía Cardiovascular, La Habana, Cuba
| | - Elaine Núñez-Ayala
- Inter-American Council of Heart Failure and Pulmonary Hypertension/CIFACAH, Mexico City, Mexico
- Inter-American Society of Cardiology/IASC, Mexico City, Mexico
- Electrophysiology, Arrhythmias and Pacemaker Unit, CEDIMAT, Centro Cardiovascular, Santo Domingo, Dominican Republic
| | - Freddy Pow-Chon
- Inter-American Council of Heart Failure and Pulmonary Hypertension/CIFACAH, Mexico City, Mexico
- Inter-American Society of Cardiology/IASC, Mexico City, Mexico
- Hospital Luis Vernaza, Guayaquil, Ecuador
| | - Luis Carlos Sáenz-Morales
- Latin American Heart Rhythm Society/LAHRS, Montevideo, Uruguay
- Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
| | - Luis Fernando Pava-Molano
- Cardiology Department, Fundación Valle del Lili, Cali, Colombia
- Latin American Heart Rhythm Society/LAHRS, Montevideo, Uruguay
| | - María Claudia Montes
- Cardiology Department, Fundación Valle del Lili, Cali, Colombia
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| | - Raúl Garillo
- Inter-American Society of Cardiology/IASC, Mexico City, Mexico
- Inter-American Council of Electrocardiography and Arrhythmias/ELECTROSIAC, Mexico City, Mexico
- Facultad de Ciencias Médicas, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina
| | - Stephania Galindo-Coral
- Cardiology Department, Fundación Valle del Lili, Cali, Colombia
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| | - Walter Reyes-Caorsi
- Inter-American Council of Electrocardiography and Arrhythmias/ELECTROSIAC, Mexico City, Mexico
- Latin American Heart Rhythm Society/LAHRS, Montevideo, Uruguay
- Comisión Honoraria Para La Salud Cardiovascular, Montevideo, Uruguay
| | - Mario Speranza
- Inter-American Council of Heart Failure and Pulmonary Hypertension/CIFACAH, Mexico City, Mexico
- Inter-American Society of Cardiology/IASC, Mexico City, Mexico
- Hospital Clínica Bíblica, Ciudad de Costa Rica, Costa Rica
| | - Alexander Romero
- Inter-American Council of Heart Failure and Pulmonary Hypertension/CIFACAH, Mexico City, Mexico
- Inter-American Society of Cardiology/IASC, Mexico City, Mexico
- Hospital Santo Tomas, Ciudad de Panama, Panama
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13
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Schweiger M, Amodeo A, Vierecke J, Hussein H, Berger F, de By TMMH, Zimpfer D, Sliwka J, Davies B, Miera O, Meyns B. Use of implantable cardioverter-defibrillator in children supported with ventricular assist device: An analysis of data from the EUROMACS registry. Artif Organs 2023; 47:1319-1325. [PMID: 36855905 DOI: 10.1111/aor.14515] [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] [Received: 12/08/2022] [Revised: 02/14/2023] [Accepted: 02/24/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Data on the use and outcome of children on ventricular assist device (VAD) support provided with an implantable cardioverter-defibrillator (ICD) remains poor. METHODS A retrospective analysis of the EUROMACS database on children supported with VAD < 19 years of age from January 1, 2009 to April 1, 2020. Patients with missing data on status of ICD, missing baseline and/or follow up information were excluded. The primary independent variable of interest was the concomitant presence or absence of an ICD at the time of VAD placement. Kaplan-Meier survival analysis was performed to evaluate survival differences between children on VAD with and without an ICD. RESULTS Out of 303 patients provided with a VAD, 7% (7♀, 15♂) had an ICD implanted and formed the study group. Median age was 14 years, median weight was 43.5 kg, and median BSA was 1.39. Median Intermacs stage was 2 (range: 1-7). Seventeen patients (77%) were transplanted, 4 (18%) died while on support, and 1 (5%) was weaned from device after myocardial recovery. Median time on support was 68 days compared to 361 days in the control group (p: 0.01). Three patients underwent device exchange due to thrombus formation in the pump. There was no difference in survival between groups (p = 0.342). CONCLUSION The presence of ICD in pediatric patients supported with a VAD is low (7%). Children on VAD support provided with an ICD do not have a survival benefit compared to children without an ICD.
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Affiliation(s)
- Martin Schweiger
- Department of Congenital Cardiovascular Surgery, Pediatric Heart Center, University Children's Hospital Zurich, Zürich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zürich, Switzerland
| | - Antonio Amodeo
- Children's Research Center, University Children's Hospital Zurich, Zürich, Switzerland
- Clinic of Cardiac Surgery, University Heart Center, University Hospital Zurich, Zürich, Switzerland
| | - Juliane Vierecke
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Hina Hussein
- Quality and Outcomes Research Unit, University Hospital Birmingham, Birmingham, UK
| | - Florian Berger
- Children's Research Center, University Children's Hospital Zurich, Zürich, Switzerland
- Division Pediatric Cardiology, Pediatric Heart Center, University Children's Hospital Zurich, Zürich, Switzerland
| | | | - Daniel Zimpfer
- Department for Heart Surgery, Medical University Graz, Graz, Austria
| | - Joanna Sliwka
- Department of Cardiac Surgery, Transplantology and Vascular Surgery, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Ben Davies
- Royal Children's Hospital, Melbourne, Victoria, Australia
| | | | - Bart Meyns
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium., Leuven, Belgium
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14
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Griffeth EM, Krishnan P, Dearani JA, Pahwa S, Ackerman MJ, Wackel PL, Todd A, Cannon BC. Pediatric Epicardial Devices: Early and Midterm Outcomes. World J Pediatr Congenit Heart Surg 2023; 14:451-458. [PMID: 36851830 PMCID: PMC10330933 DOI: 10.1177/21501351231157374] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Lead performance is suboptimal in young patients and a main cause of device system failure. Our objective was to assess early and midterm outcomes after epicardial device implantation in a contemporary pediatric cohort. METHODS A total of 116 consecutive pediatric patients underwent 137 epicardial device implantations from 2010 to 2019. Forty pacemakers and 97 implantable cardioverter defibrillators (ICDs) were implanted. Lead failure was defined as leads repaired, replaced, or abandoned due to fracture, dislodgement, or dysfunction. Freedom from device system failure was determined using Kaplan-Meier analysis. RESULTS Mean age at implantation was 10 ± 5 years, 46 (34%) were younger than 8 years old, 41 (30%) had prior cardiac surgery, and 38 (28%) had prior devices. Main indications were acquired heart block (17/40 [43%]), sinus node dysfunction (14/40 [35%]), and congenital heart block (7/40 [18%]) for pacemakers, and hypertrophic cardiomyopathy (46/97 [47%]), long QT syndrome (31/97 [32%]), and ventricular arrhythmia (17/97 [18%]) for ICDs. There were no early deaths. Three-year freedom from device system failure was 80% (95% CI 73%, 88%) for all patients and 88% (95% CI 79%, 99%) for patients <8 years old. Device system failure causes included lead fracture (20/34 [59%]), lead dysfunction (5/34 [15%]), lead dislodgement (5/34 [15%]), infection (3/34 [9%]), and pericarditis (1/34 [3%]). Reintervention was required in 26/34 (76%) device system failures. CONCLUSIONS Epicardial device implantation is safe, shows acceptable midterm outcomes in children, and is an effective option in patients younger than 8 years old. Close device surveillance continues to be essential to detect lead failure early and ensure timely reintervention.
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Affiliation(s)
- Elaine M Griffeth
- Department of Cardiovascular Surgery, Mayo Clinic,
Rochester, MN, USA
| | - Prasad Krishnan
- Department of Cardiovascular Surgery, Mayo Clinic,
Rochester, MN, USA
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic,
Rochester, MN, USA
| | - Siddharth Pahwa
- Department of Cardiovascular Surgery, Mayo Clinic,
Rochester, MN, USA
| | | | - Philip L Wackel
- Division of Pediatric Cardiology, Mayo Clinic, Rochester,
MN, USA
| | - Austin Todd
- Department of Quantitative Health Sciences, Mayo Clinic,
Rochester, MN, USA
| | - Bryan C Cannon
- Division of Pediatric Cardiology, Mayo Clinic, Rochester,
MN, USA
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15
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Kaski JP, Kammeraad JAE, Blom NA, Happonen JM, Janousek J, Klaassen S, Limongelli G, Östman-Smith I, Sarquella Brugada G, Ziolkowska L. Indications and management of implantable cardioverter-defibrillator therapy in childhood hypertrophic cardiomyopathy. Cardiol Young 2023; 33:681-698. [PMID: 37102324 DOI: 10.1017/s1047951123000872] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Sudden cardiac death is the most common mode of death during childhood and adolescence in hypertrophic cardiomyopathy, and identifying those individuals at highest risk is a major aspect of clinical care. The mainstay of preventative therapy is the implantable cardioverter-defibrillator, which has been shown to be effective at terminating malignant ventricular arrhythmias in children with hypertrophic cardiomyopathy but can be associated with substantial morbidity. Accurate identification of those children at highest risk who would benefit most from implantable cardioverter-defibrillator implantation while minimising the risk of complications is, therefore, essential. This position statement, on behalf of the Association for European Paediatric and Congenital Cardiology (AEPC), reviews the currently available data on established and proposed risk factors for sudden cardiac death in childhood-onset hypertrophic cardiomyopathy and current approaches for risk stratification in this population. It also provides guidance on identification of individuals at risk of sudden cardiac death and optimal management of implantable cardioverter-defibrillators in children and adolescents with hypertrophic cardiomyopathy.
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Affiliation(s)
- Juan Pablo Kaski
- Centre for Paediatric Inherited and Rare Cardiovascular Disease, University College London Institute of Cardiovascular Science, London, UK
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, UK
| | - Janneke A E Kammeraad
- Erasmus MC - Sophia Children's Hospital, Department of Paediatric Cardiology, Rotterdam, the Netherlands
| | - Nico A Blom
- Department of Pediatric Cardiology, University of Leiden, Leiden, the Netherlands
- Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - Juha-Matti Happonen
- Department of Paediatric Cardiology, Helsinki University Children's Hospital, Helsinki, Finland
| | - Jan Janousek
- Children's Heart Center, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Sabine Klaassen
- Department of Pediatric Cardiology, Charite-Universitatsmedizin Berlin, Berlin, Germany
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Disease Unit, AO dei Colli Monaldi Hospital, Universita della Campania "Luigi Vanvitelli", Naples, Italy
| | - Ingegerd Östman-Smith
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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16
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Koike T, Shoda M, Ejima K, Yagishita D, Suzuki A, Hasegawa S, Kataoka S, Yazaki K, Higuchi S, Kanai M, Yamaguchi J. Impact of
fracture‐prone
implantable cardioverter defibrillator leads on
long‐term
patient mortality. J Arrhythm 2023. [DOI: 10.1002/joa3.12843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
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17
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Le Bos PA, Pontailler M, Maltret A, Kraiche D, Gaudin R, Barbanti C, Marijon E, Raisky O, Bonnet D, Waldmann V. Epicardial vs. transvenous implantable cardioverter defibrillators in children. Europace 2023; 25:961-968. [PMID: 36735263 PMCID: PMC10062323 DOI: 10.1093/europace/euad015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/23/2022] [Indexed: 02/04/2023] Open
Abstract
AIMS The implantable cardioverter defibrillator (ICD) has been increasingly used in children. Both epicardial and transvenous approaches are used, with controversy regarding the best option with no specific recommendations. We aimed to compare outcomes associated with epicardial vs. transvenous ICDs in children. METHODS AND RESULTS Data were analysed from a retrospective study including all patients <18-year-old implanted with an ICD in a tertiary centre from 2003 to 2021. Outcomes were compared between epicardial and transvenous ICDs. A total of 122 children with an ICD (mean age 11.5 ± 3.8 years, 57.4% males) were enrolled, with 84 (64.1%) epicardial ICDs and 38 (29.0%) transvenous ICDs. Early (<30 days) ICD-related complications were reported in 17 (20.2%) patients with an epicardial ICD vs. 0 (0.0%) with a transvenous ICD (P = 0.002). Over a mean follow-up of 4.8 ± 4.0 years, 25 (29.8%) patients with an epicardial ICD and 9 (23.7%) patients with a transvenous ICD experienced at least one late ICD-related complication [hazard ratio (HR) 1.8, 95% confidence interval (CI) 0.8-4.0]. Implantable cardioverter defibrillator lead dysfunction occurred in 19 (22.6%) patients with an epicardial ICD vs. 3 (7.9%) with a transvenous ICD (HR 5.7, 95% CI 1.3-24.5) and was associated with a higher incidence of ICD-related reintervention (HR 3.0, 95% CI 1.3-7.0). After considering potential confounders, especially age and weight at implantation, this association was no longer significant (P = 0.112). The freedom from ICD lead dysfunction was greater in patients with pleural coils than in those with epicardial coils (HR 0.38, 95% CI 0.15-0.96). CONCLUSION In children, after a consideration of patient characteristics at implantation, the burden of complications and ICD lead dysfunction appears to be similar in patients with epicardial and transvenous devices. Pleural coils seem to be associated with better outcomes than epicardial coils in this population. CLINICAL TRIAL REGISTRATION NCT05349162.
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Affiliation(s)
- Pierre Antoine Le Bos
- M3C-Necker, Hôpital Universitaire Necker-Enfants Malades, 149 rue de Sèvres, 75015 Paris, France
| | - Margaux Pontailler
- Department of Pediatric Cardiac Surgery, Necker Hospital, 149 rue de Sèvres, 75015 Paris, France
| | - Alice Maltret
- M3C-Necker, Hôpital Universitaire Necker-Enfants Malades, 149 rue de Sèvres, 75015 Paris, France
| | - Diala Kraiche
- M3C-Necker, Hôpital Universitaire Necker-Enfants Malades, 149 rue de Sèvres, 75015 Paris, France
| | - Regis Gaudin
- Department of Pediatric Cardiac Surgery, Necker Hospital, 149 rue de Sèvres, 75015 Paris, France
| | - Claudio Barbanti
- Pediatric Cardiac Anesthesia and Cardiopulmonary Unit, Necker Hospital, 149 rue de Sèvres, 75015 Paris, France
| | - Eloi Marijon
- Université de Paris Cité, INSERM, Paris Cardiovascular Research Centre, 56 rue Leblanc, 75015 Paris, France.,Electrophysiology Unit, European Georges Pompidou Hospital, 20 rue Leblanc, 75015 Paris, France
| | - Olivier Raisky
- Department of Pediatric Cardiac Surgery, Necker Hospital, 149 rue de Sèvres, 75015 Paris, France.,Université de Paris Cité, INSERM, Paris Cardiovascular Research Centre, 56 rue Leblanc, 75015 Paris, France
| | - Damien Bonnet
- M3C-Necker, Hôpital Universitaire Necker-Enfants Malades, 149 rue de Sèvres, 75015 Paris, France.,Université de Paris Cité, INSERM, Paris Cardiovascular Research Centre, 56 rue Leblanc, 75015 Paris, France.,Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, 20 rue Leblanc, 75015 Paris, France
| | - Victor Waldmann
- M3C-Necker, Hôpital Universitaire Necker-Enfants Malades, 149 rue de Sèvres, 75015 Paris, France.,Université de Paris Cité, INSERM, Paris Cardiovascular Research Centre, 56 rue Leblanc, 75015 Paris, France.,Electrophysiology Unit, European Georges Pompidou Hospital, 20 rue Leblanc, 75015 Paris, France.,Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, 20 rue Leblanc, 75015 Paris, France
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18
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Teixeira RA, Fagundes AA, Baggio Junior JM, Oliveira JCD, Medeiros PDTJ, Valdigem BP, Teno LAC, Silva RT, Melo CSD, Elias Neto J, Moraes Júnior AV, Pedrosa AAA, Porto FM, Brito Júnior HLD, Souza TGSE, Mateos JCP, Moraes LGBD, Forno ARJD, D'Avila ALB, Cavaco DADM, Kuniyoshi RR, Pimentel M, Camanho LEM, Saad EB, Zimerman LI, Oliveira EB, Scanavacca MI, Martinelli Filho M, Lima CEBD, Peixoto GDL, Darrieux FCDC, Duarte JDOP, Galvão Filho SDS, Costa ERB, Mateo EIP, Melo SLD, Rodrigues TDR, Rocha EA, Hachul DT, Lorga Filho AM, Nishioka SAD, Gadelha EB, Costa R, Andrade VSD, Torres GG, Oliveira Neto NRD, Lucchese FA, Murad H, Wanderley Neto J, Brofman PRS, Almeida RMS, Leal JCF. Brazilian Guidelines for Cardiac Implantable Electronic Devices - 2023. Arq Bras Cardiol 2023; 120:e20220892. [PMID: 36700596 PMCID: PMC10389103 DOI: 10.36660/abc.20220892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | - Rodrigo Tavares Silva
- Universidade de Franca (UNIFRAN), Franca, SP - Brasil
- Centro Universitário Municipal de Franca (Uni-FACEF), Franca, SP - Brasil
| | | | - Jorge Elias Neto
- Universidade Federal do Espírito Santo (UFES), Vitória, ES - Brasil
| | - Antonio Vitor Moraes Júnior
- Santa Casa de Ribeirão Preto, Ribeirão Preto, SP - Brasil
- Unimed de Ribeirão Preto, Ribeirão Preto, SP - Brasil
| | - Anisio Alexandre Andrade Pedrosa
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Luis Gustavo Belo de Moraes
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | | | | | - Mauricio Pimentel
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | | | - Eduardo Benchimol Saad
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil
- Hospital Samaritano, Rio de Janeiro, RJ - Brasil
| | | | | | - Mauricio Ibrahim Scanavacca
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Martino Martinelli Filho
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Carlos Eduardo Batista de Lima
- Hospital Universitário da Universidade Federal do Piauí (UFPI), Teresina, PI - Brasil
- Empresa Brasileira de Serviços Hospitalares (EBSERH), Brasília, DF - Brasil
| | | | - Francisco Carlos da Costa Darrieux
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Sissy Lara De Melo
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Eduardo Arrais Rocha
- Hospital Universitário Walter Cantídio, Universidade Federal do Ceará (UFC), Fortaleza, CE - Brasil
| | - Denise Tessariol Hachul
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Silvana Angelina D'Orio Nishioka
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Roberto Costa
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Gustavo Gomes Torres
- Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN - Brasil
| | | | | | - Henrique Murad
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | - Rui M S Almeida
- Centro Universitário Fundação Assis Gurgacz, Cascavel, PR - Brasil
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Efficacy of SubcutAneous implantable cardioVErter-defibrillators in ≤18 year-old CHILDREN: SAVE-CHILDREN registry. Int J Cardiol 2023; 371:204-210. [PMID: 36087632 DOI: 10.1016/j.ijcard.2022.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/30/2022] [Accepted: 09/05/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND In adult patients, subcutaneous implantable cardioverter defibrillators (S-ICDs) have been reported to be non-inferior to transvenous ICDs with respect to the incidence of device-related complications and inappropriate shocks. Only a few reports have investigated the efficacy of S-ICDs in the pediatric field. This study aimed to investigate the utility and safety of S-ICDs in patients ≤18 years old. METHODS This study was a multicenter, observational, retrospective study on S-ICD implantations. Patients <18 years old who underwent S-ICD implantations were enrolled. The detailed data on the device implantations and eligibility tests, incidence of appropriate- and inappropriate shocks, and follow-up data were assessed. RESULTS A total of 62 patients were enrolled from 30 centers. The patients ranged in age from 3 to 18 (median 14 years old [IQR 11.0-16.0 years]). During a median follow up of 27 months (13.3-35.8), a total of 16 patients (26.2%) received appropriate shocks and 13 (21.3%) received inappropriate shocks. The common causes of the inappropriate shocks were sinus tachycardia (n = 4, 30.8%) and T-wave oversensing (n = 4, 30.8%). In spite of the physical growth, the number of suitable sensing vectors did not change during the follow up. No one had any lead fractures or device infections in the chronic phase. CONCLUSIONS Our study suggested that S-ICDs can prevent sudden cardiac death in the pediatric population with a low incidence of lead complications or device infections. The number of suitable sensing vectors did not change during the patients' growth.
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20
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Silvetti MS, Bruyndonckx L, Maltret A, Gebauer R, Kwiatkowska J, Környei L, Albanese S, Raimondo C, Paech C, Kempa M, Fésüs G, Knops RE, Blom NA, Drago F. The SIDECAR project: S-IcD registry in European paediatriC and young Adult patients with congenital heaRt defects. Europace 2022; 25:460-468. [PMID: 36107451 PMCID: PMC9935000 DOI: 10.1093/europace/euac162] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS Subcutaneous-implantable cardiac defibrillators (S-ICDs) are used increasingly to prevent sudden cardiac death in young patients. This study was set up to gain insight in the indications for S-ICD, possible complications, and their predictors and follow-up results. METHODS AND RESULTS A multicentre, observational, retrospective, non-randomized, standard-of-care registry on S-ICD outcome in young patients with congenital heart diseases (CHDs), inherited arrhythmias (IAs), idiopathic ventricular fibrillation (IVF), and cardiomyopathies (CMPs). Anthropometry was registered as well as implantation technique, mid-term device-related complications, and incidence of appropriate/inappropriate shocks (IASs). Data are reported as median (interquartile range) or mean ± standard deviation. Eighty-one patients (47% CMPs, 20% CHD, 21% IVF, and 12% IA), aged 15 (14-17) years, with body mass index (BMI) 21.8 ± 3.8 kg/m2, underwent S-ICD implantation (primary prevention in 59%). This was performed with two-incision technique in 81% and with a subcutaneous pocket in 59%. Shock and conditional zones were programmed at 250 (200-250) and 210 (180-240) b.p.m., respectively. No intraoperative complications occurred. Follow up was 19 (6-35) months: no defibrillation failure occurred, 17% of patients received appropriate shocks, 13% of patients received IAS (supraventricular tachycardias 40%, T-wave oversensing 40%, and non-cardiac oversensing 20%). Reprogramming, proper drug therapy, and surgical revision avoided further IAS. Complications requiring surgical revision occurred in 9% of patients, with higher risks in patients with three-incision procedures [hazard ratio (HR) 4.3, 95% confidence interval (95% CI) 0.5-34, P = 0.038] and BMI < 20 (HR 5.1, 95% CI 1-24, P = 0.031). CONCLUSION This multicentre European paediatric registry showed good S-ICD efficacy and safety in young patients. Newer implantation techniques and BMI > 20 showed better outcome.
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Affiliation(s)
| | - Luc Bruyndonckx
- Department of Paediatric Cardiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands,Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium
| | - Alice Maltret
- Department of Paediatric Cardiology Hopital Necker-Enfants Malades, Paris, France,Hopital Marie Lannelongue-M3C, GHPSJ, Université Paris Descartes, Paris, France
| | - Roman Gebauer
- Department of Paediatric Cardiology, Heart Centre Leipzig, University of Leipzig, Leipzig, Germany
| | - Joanna Kwiatkowska
- Department of Paediatric Cardiology and Congenital Heart Defects, Medical University of Gdansk, Gdansk, Poland
| | - László Környei
- Gottsegen National Cardiovascular Center, Budapest, Hungary
| | - Sonia Albanese
- Heart Surgery Team, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Cristina Raimondo
- Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy,Department of Paediatric Cardiology Hopital Necker-Enfants Malades, Paris, France
| | - Christian Paech
- Department of Paediatric Cardiology, Heart Centre Leipzig, University of Leipzig, Leipzig, Germany
| | - Maciej Kempa
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Gábor Fésüs
- Gottsegen National Cardiovascular Center, Budapest, Hungary
| | - Reinoud E Knops
- Department of Paediatric Cardiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands,Department of Paediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Nico Andreas Blom
- Department of Paediatric Cardiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands,Department of Paediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Fabrizio Drago
- Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
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21
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Balaji S, Atkins DL, Berger S, Etheridge SP, Shah MJ. The Case for Home AED in Children, Adolescents, and Young Adults Not Meeting Criteria for ICD. JACC Clin Electrophysiol 2022; 8:1165-1172. [PMID: 36137726 DOI: 10.1016/j.jacep.2022.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 12/01/2022]
Abstract
Children, adolescents, and young adults with conditions such as cardiomyopathies and channelopathies are at higher risk of sudden cardiac death caused by lethal arrhythmias, especially ventricular fibrillation. Timely defibrillation saves lives. Patients thought to be at significantly high risk of sudden death typically undergo placement of an implantable cardioverter-defibrillator. Patients thought to be at lower risk are typically followed medically but do not undergo implantable cardioverter-defibrillator placement. However, low risk does not equal no risk. Compared with the general population, many of these patients are at significantly higher risk for lethal arrhythmias. We make the case that such individuals and families will benefit from having an at-home automatic external defibrillator. Used in conjunction with conventional measures such as training on cardiopulmonary resuscitation, an at-home automatic external defibrillator could lead to significantly shortened time to defibrillation with better overall and neurological survival. We recommend that the cost of such home automatic external defibrillators should be covered by medical insurance.
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Affiliation(s)
- Seshadri Balaji
- Department of Pediatrics, Oregon Health and Science University, Portland Oregon, USA.
| | - Dianne L Atkins
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | | | | | - Maully J Shah
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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22
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Waldmann V, Bouzeman A, Duthoit G, Koutbi L, Bessière F, Labombarda F, Marquié C, Gourraud JB, Mondoly P, Sellal JM, Bordachar P, Hermida A, Al Arnaout A, Anselme F, Audinet C, Bernard Y, Boveda S, Bun SS, Chassignolle M, Clerici G, Da Costa A, de Guillebon M, Defaye P, Elbaz N, Eschalier R, Garcia R, Guenancia C, Guy-Moyat B, Halimi F, Irles D, Iserin L, Jourda F, Ladouceur M, Lagrange P, Laredo M, Mansourati J, Massoulié G, Mathiron A, Maury P, Messali A, Narayanan K, Nguyen C, Ninni S, Perier MC, Pierre B, Pujadas P, Sacher F, Sagnol P, Sharifzadehgan A, Walton C, Winum P, Zakine C, Fauchier L, Martins R, Pasquié JL, Thambo JB, Jouven X, Combes N, Marijon E. Sex Differences in Outcomes of Tetralogy of Fallot Patients With Implantable Cardioverter-Defibrillators. JACC Clin Electrophysiol 2022; 8:1304-1314. [DOI: 10.1016/j.jacep.2022.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/24/2022] [Accepted: 06/09/2022] [Indexed: 11/30/2022]
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23
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Freedenberg VA, Berul CI. Potential for shock leads to potential for stress. Heart Rhythm 2022; 19:1530-1531. [PMID: 35817253 DOI: 10.1016/j.hrthm.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Vicki A Freedenberg
- Children's National Hospital, Washington, District of Columbia; George Washington University School of Medicine, Washington, District of Columbia
| | - Charles I Berul
- Children's National Hospital, Washington, District of Columbia; George Washington University School of Medicine, Washington, District of Columbia.
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24
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Kawada S, Chakraborty P, Nanthakumar J, Albertini L, Oechslin EN, Roche SL, Silversides C, Wald RM, Downar E, Harris L, Swan L, Alonso-Gonzalez R, Thorne S, Nanthakumar K, Mondésert B, Khairy P, Nair K. The validity of current implantable cardioverter-defibrillator guidelines in a real-world population of adults with congenital heart disease: A single-center experience. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022. [DOI: 10.1016/j.ijcchd.2022.100355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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25
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Gulletta S, Gasperetti A, Schiavone M, Vogler J, Fastenrath F, Breitenstein A, Laredo M, Palmisano P, Mitacchione G, Compagnucci P, Kaiser L, Hakmi S, Angeletti A, De Bonis S, Picarelli F, Arosio R, Casella M, Steffel J, Fierro N, Guarracini F, Santini L, Pignalberi C, Piro A, Lavalle C, Pisanò E, Viecca M, Curnis A, Badenco N, Ricciardi D, Russo AD, Tondo C, Kuschyk J, Bella PD, Biffi M, Forleo GB, Tilz R. Age-related differences and associated mid-term outcomes of subcutaneous implantable cardioverter defibrillators: a propensity-matched analysis from a multicenter European registry. Heart Rhythm 2022; 19:1109-1115. [DOI: 10.1016/j.hrthm.2022.02.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 12/24/2022]
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26
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Zahedivash A, Hanisch D, Dubin AM, Trela A, Chubb H, Motonaga KS, Goodyer WR, Maeda K, Reinhartz O, Ma M, Martin E, Ceresnak SR. Implantable Cardioverter Defibrillators in Infants and Toddlers: Indications, Placement, Programming, and Outcomes. Circ Arrhythm Electrophysiol 2022; 15:e010557. [PMID: 35089800 DOI: 10.1161/circep.121.010557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Limited data exist regarding implantable cardioverter defibrillator (ICD) usage in infants and toddlers. This study evaluates ICD placement indications, procedural techniques, programming strategies, and outcomes of ICDs in infants and toddlers. METHODS This is a single-center retrospective review of all patients ≤3 years old who received an ICD from 2009 to 2021. RESULTS Fifteen patients received an ICD at an age of 1.2 years (interquartile range [IQR], 0.1-2.4; 12 [80%] women; weight, 8.2 kg [IQR, 4.2-12.6]) and were followed for a median of 4.28 years (IQR, 1.40-5.53) or 64.2 patient-years. ICDs were placed for secondary prevention in 12 patients (80%). Diagnoses included 8 long-QT syndromes (53%), 4 idiopathic ventricular tachycardias/ventricular fibrillations (VFs; 27%), 1 recurrent ventricular tachycardia with cardiomyopathy (7%), 1 VF with left ventricular noncompaction (7%), and 1 catecholaminergic polymorphic ventricular tachycardia (7%). All implants were epicardial, with a coil in the pericardial space. Intraoperative defibrillation safety testing was attempted in 11 patients (73%), with VF induced in 8 (53%). Successful restoration of sinus rhythm was achieved in all tested patients with a median of 9 (IQR, 7.3-11.3) J or 0.90 (IQR, 0.68-1.04) J/kg. Complications consisted of 1 postoperative chylothorax and 3 episodes of feeding intolerance. VF detection was programmed to 250 (IQR, 240-250) ms with first shock delivering 10 (IQR, 5-15) J or 1.1 (IQR, 0.8-1.4) J/kg. Three patients (20%) received appropriate shocks for ventricular tachycardia/VF. No patient received an inappropriate shock. There were 2 (13%) ventricular lead fractures (at 2.6 and 4.2 years post-implant), 1 (7%) pocket-site infection, and 2 (13%) generator exchanges. All patients were alive, and 1 patient (7%) received a heart transplant. CONCLUSIONS ICDs can be safely and effectively placed for sudden death prevention in infants and toddlers with good midterm outcomes.
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Affiliation(s)
- Aydin Zahedivash
- Department of Pediatrics, Pediatric Cardiology (A.Z., A.M.D., H.C., K.S.M., W.R.G., S.R.C., D.H., A.T.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA
| | - Debra Hanisch
- Department of Pediatrics, Pediatric Cardiology (A.Z., A.M.D., H.C., K.S.M., W.R.G., S.R.C., D.H., A.T.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA
| | - Anne M Dubin
- Department of Pediatrics, Pediatric Cardiology (A.Z., A.M.D., H.C., K.S.M., W.R.G., S.R.C., D.H., A.T.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA
| | - Anthony Trela
- Department of Pediatrics, Pediatric Cardiology (A.Z., A.M.D., H.C., K.S.M., W.R.G., S.R.C., D.H., A.T.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA
| | - Henry Chubb
- Department of Pediatrics, Pediatric Cardiology (A.Z., A.M.D., H.C., K.S.M., W.R.G., S.R.C., D.H., A.T.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA
| | - Kara S Motonaga
- Department of Pediatrics, Pediatric Cardiology (A.Z., A.M.D., H.C., K.S.M., W.R.G., S.R.C., D.H., A.T.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA.,Department of Cardiothoracic Surgery, Children's Hospital of Philadelphia, University of Pennsylvania (K.S.M.)
| | - William Rowland Goodyer
- Department of Pediatrics, Pediatric Cardiology (A.Z., A.M.D., H.C., K.S.M., W.R.G., S.R.C., D.H., A.T.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA
| | | | - Olaf Reinhartz
- Department of Cardiothoracic Surgery (O.R., M.M., E.M.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA
| | - Michael Ma
- Department of Cardiothoracic Surgery (O.R., M.M., E.M.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA
| | - Elisabeth Martin
- Department of Cardiothoracic Surgery (O.R., M.M., E.M.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA
| | - Scott R Ceresnak
- Department of Pediatrics, Pediatric Cardiology (A.Z., A.M.D., H.C., K.S.M., W.R.G., S.R.C., D.H., A.T.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA
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27
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Silvetti MS, Tamburri I, Campisi M, Saputo FA, Cazzoli I, Cantarutti N, Cicenia M, Adorisio R, Baban A, Ravà L, Drago F. ICD Outcome in Pediatric Cardiomyopathies. J Cardiovasc Dev Dis 2022; 9:jcdd9020033. [PMID: 35200687 PMCID: PMC8875861 DOI: 10.3390/jcdd9020033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/10/2022] [Accepted: 01/17/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Pediatric patients with cardiomyopathies are at risk of malignant arrhythmias and sudden cardiac death (SCD). An ICD may prevent SCD. The aim of this study was to evaluate ICD implantation outcomes, and to compare transvenous and subcutaneous ICDs (S-ICDs) implanted in pediatric patients with cardiomyopathies. Methods: The study is single center and retrospective, and includes pediatric patients with cardiomyopathies who required ICD implantation (2010–2021). Outcomes were recorded for appropriate/inappropriate ICD therapy and surgical complications. Transvenous ICD and S-ICD were compared. Data are presented as median values (25th–75th centiles). Results: Forty-four patients with cardiomyopathies (hypertrophic 39%, arrhythmogenic 32%, dilated 27%, and restrictive 2%) underwent transvenous (52%) and S-ICD (48%) implantation at 14 (12–17) years of age, mostly for primary prevention (73%). The follow-up period was 29 (14–60) months. Appropriate ICD therapies were delivered in 25% of patients, without defibrillation failures. Lower age at implantation and secondary prevention were significant risk factors for malignant ventricular arrhythmias that required appropriate ICD therapies. ICD-related complications were surgical complications (18%) and inappropriate shocks (7%). No significant differences in outcomes were recorded, either when comparing transvenous and S-ICD or comparing the different cardiomyopathies. Conclusions: In pediatric patients with cardiomyopathy, ICD therapy is effective, with a low rate of inappropriate shocks. Neither ICD type (transvenous and S-ICDs) nor the cardiomyopathies subgroup revealed divergent outcomes.
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Affiliation(s)
- Massimo Stefano Silvetti
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (I.T.); (M.C.); (F.A.S.); (I.C.); (N.C.); (M.C.); (R.A.); (A.B.); (F.D.)
- Correspondence: ; Tel.: +39-06-6859-1
| | - Ilaria Tamburri
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (I.T.); (M.C.); (F.A.S.); (I.C.); (N.C.); (M.C.); (R.A.); (A.B.); (F.D.)
| | - Marta Campisi
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (I.T.); (M.C.); (F.A.S.); (I.C.); (N.C.); (M.C.); (R.A.); (A.B.); (F.D.)
| | - Fabio Anselmo Saputo
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (I.T.); (M.C.); (F.A.S.); (I.C.); (N.C.); (M.C.); (R.A.); (A.B.); (F.D.)
| | - Ilaria Cazzoli
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (I.T.); (M.C.); (F.A.S.); (I.C.); (N.C.); (M.C.); (R.A.); (A.B.); (F.D.)
| | - Nicoletta Cantarutti
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (I.T.); (M.C.); (F.A.S.); (I.C.); (N.C.); (M.C.); (R.A.); (A.B.); (F.D.)
| | - Marianna Cicenia
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (I.T.); (M.C.); (F.A.S.); (I.C.); (N.C.); (M.C.); (R.A.); (A.B.); (F.D.)
| | - Rachele Adorisio
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (I.T.); (M.C.); (F.A.S.); (I.C.); (N.C.); (M.C.); (R.A.); (A.B.); (F.D.)
| | - Anwar Baban
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (I.T.); (M.C.); (F.A.S.); (I.C.); (N.C.); (M.C.); (R.A.); (A.B.); (F.D.)
| | - Lucilla Ravà
- Epidemiology Institute, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy;
| | - Fabrizio Drago
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (I.T.); (M.C.); (F.A.S.); (I.C.); (N.C.); (M.C.); (R.A.); (A.B.); (F.D.)
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Shah MJ, Silka MJ, Avari Silva JN, Balaji S, Beach CM, Benjamin MN, Berul CI, Cannon B, Cecchin F, Cohen MI, Dalal AS, Dechert BE, Foster A, Gebauer R, Gonzalez Corcia MC, Kannankeril PJ, Karpawich PP, Kim JJ, Krishna MR, Kubuš P, LaPage MJ, Mah DY, Malloy-Walton L, Miyazaki A, Motonaga KS, Niu MC, Olen M, Paul T, Rosenthal E, Saarel EV, Silvetti MS, Stephenson EA, Tan RB, Triedman J, Von Bergen NH, Wackel PL. 2021 PACES expert consensus statement on the indications and management of cardiovascular implantable electronic devices in pediatric patients. Indian Pacing Electrophysiol J 2021; 21:367-393. [PMID: 34333141 PMCID: PMC8577100 DOI: 10.1016/j.ipej.2021.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
In view of the increasing complexity of both cardiovascular implantable electronic devices (CIEDs) and patients in the current era, practice guidelines, by necessity, have become increasingly specific. This document is an expert consensus statement that has been developed to update and further delineate indications and management of CIEDs in pediatric patients, defined as ≤21 years of age, and is intended to focus primarily on the indications for CIEDs in the setting of specific disease categories. The document also highlights variations between previously published adult and pediatric CIED recommendations and provides rationale for underlying important differences. The document addresses some of the deterrents to CIED access in low- and middle-income countries and strategies to circumvent them. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by class of recommendation and level of evidence. Several questions addressed in this document either do not lend themselves to clinical trials or are rare disease entities, and in these instances recommendations are based on consensus expert opinion. Furthermore, specific recommendations, even when supported by substantial data, do not replace the need for clinical judgment and patient-specific decision-making. The recommendations were opened for public comment to Pediatric and Congenital Electrophysiology Society (PACES) members and underwent external review by the scientific and clinical document committee of the Heart Rhythm Society (HRS), the science advisory and coordinating committee of the American Heart Association (AHA), the American College of Cardiology (ACC), and the Association for European Paediatric and Congenital Cardiology (AEPC). The document received endorsement by all the collaborators and the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). This document is expected to provide support for clinicians and patients to allow for appropriate CIED use, appropriate CIED management, and appropriate CIED follow-up in pediatric patients.
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Affiliation(s)
- Maully J Shah
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Michael J Silka
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
| | | | | | | | - Monica N Benjamin
- Hospital de Pediatría Juan P. Garrahan, Hospital El Cruce, Hospital Británico de Buenos Aires, Instituto Cardiovascular ICBA, Buenos Aires, Argentina
| | | | | | - Frank Cecchin
- New York University Grossman School of Medicine, New York, NY, USA
| | | | - Aarti S Dalal
- Washington University in St. Louis, St. Louis, Missouri, USA
| | | | - Anne Foster
- Advocate Children's Heart Institute, Chicago, IL, USA
| | - Roman Gebauer
- Heart Centre Leipzig, University of Leipzig, Leipzig, Germany
| | | | | | - Peter P Karpawich
- University Pediatricians, Children's Hospital of Michigan, Detroit, MI, USA
| | | | | | - Peter Kubuš
- Children's Heart Center, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | | | | | | | - Aya Miyazaki
- Shizuoka General Hospital and Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | | | - Mary C Niu
- University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | | | - Thomas Paul
- Georg-August-University Medical Center, Göttingen, Germany
| | - Eric Rosenthal
- Evelina London Children's Hospital and St Thomas' Hospital, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | | | | | - Reina B Tan
- New York University Langone Health, New York, NY, USA
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29
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Shah MJ, Silka MJ, Silva JNA, Balaji S, Beach CM, Benjamin MN, Berul CI, Cannon B, Cecchin F, Cohen MI, Dalal AS, Dechert BE, Foster A, Gebauer R, Gonzalez Corcia MC, Kannankeril PJ, Karpawich PP, Kim JJ, Krishna MR, Kubuš P, LaPage MJ, Mah DY, Malloy-Walton L, Miyazaki A, Motonaga KS, Niu MC, Olen M, Paul T, Rosenthal E, Saarel EV, Silvetti MS, Stephenson EA, Tan RB, Triedman J, Bergen NHV, Wackel PL. 2021 PACES Expert Consensus Statement on the Indications and Management of Cardiovascular Implantable Electronic Devices in Pediatric Patients: Developed in collaboration with and endorsed by the Heart Rhythm Society (HRS), the American College of Cardiology (ACC), the American Heart Association (AHA), and the Association for European Paediatric and Congenital Cardiology (AEPC) Endorsed by the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). JACC Clin Electrophysiol 2021; 7:1437-1472. [PMID: 34794667 DOI: 10.1016/j.jacep.2021.07.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
In view of the increasing complexity of both cardiovascular implantable electronic devices (CIEDs) and patients in the current era, practice guidelines, by necessity, have become increasingly specific. This document is an expert consensus statement that has been developed to update and further delineate indications and management of CIEDs in pediatric patients, defined as ≤21 years of age, and is intended to focus primarily on the indications for CIEDs in the setting of specific disease categories. The document also highlights variations between previously published adult and pediatric CIED recommendations and provides rationale for underlying important differences. The document addresses some of the deterrents to CIED access in low- and middle-income countries and strategies to circumvent them. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by class of recommendation and level of evidence. Several questions addressed in this document either do not lend themselves to clinical trials or are rare disease entities, and in these instances recommendations are based on consensus expert opinion. Furthermore, specific recommendations, even when supported by substantial data, do not replace the need for clinical judgment and patient-specific decision-making. The recommendations were opened for public comment to Pediatric and Congenital Electrophysiology Society (PACES) members and underwent external review by the scientific and clinical document committee of the Heart Rhythm Society (HRS), the science advisory and coordinating committee of the American Heart Association (AHA), the American College of Cardiology (ACC), and the Association for European Paediatric and Congenital Cardiology (AEPC). The document received endorsement by all the collaborators and the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). This document is expected to provide support for clinicians and patients to allow for appropriate CIED use, appropriate CIED management, and appropriate CIED follow-up in pediatric patients.
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Affiliation(s)
- Maully J Shah
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
| | - Michael J Silka
- University of Southern California Keck School of Medicine, Los Angeles, California, USA.
| | | | | | | | - Monica N Benjamin
- Hospital de Pediatría Juan P. Garrahan, Hospital El Cruce, Hospital Británico de Buenos Aires, Instituto Cardiovascular ICBA, Buenos Aires, Argentina
| | | | | | - Frank Cecchin
- New York University Grossman School of Medicine, New York, New York, USA
| | | | - Aarti S Dalal
- Washington University in St. Louis, St. Louis, Missouri, USA
| | | | - Anne Foster
- Advocate Children's Heart Institute, Chicago, Illinois, USA
| | - Roman Gebauer
- Heart Centre Leipzig, University of Leipzig, Leipzig, Germany
| | | | | | - Peter P Karpawich
- University Pediatricians, Children's Hospital of Michigan, Detroit, Michigan, USA
| | | | | | - Peter Kubuš
- Children's Heart Center, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | | | | | | | - Aya Miyazaki
- Shizuoka General Hospital and Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | | | - Mary C Niu
- University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Melissa Olen
- Nicklaus Children's Hospital, Miami, Florida, USA
| | - Thomas Paul
- Georg-August-University Medical Center, Göttingen, Germany
| | - Eric Rosenthal
- Evelina London Children's Hospital and St Thomas' Hospital, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | | | | | - Reina B Tan
- New York University Langone Health, New York, New York, USA
| | | | - Nicholas H Von Bergen
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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30
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2021 PACES expert consensus statement on the indications and management of cardiovascular implantable electronic devices in pediatric patients. Cardiol Young 2021; 31:1738-1769. [PMID: 34338183 DOI: 10.1017/s1047951121003413] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
In view of the increasing complexity of both cardiovascular implantable electronic devices (CIEDs) and patients in the current era, practice guidelines, by necessity, have become increasingly specific. This document is an expert consensus statement that has been developed to update and further delineate indications and management of CIEDs in pediatric patients, defined as ≤21 years of age, and is intended to focus primarily on the indications for CIEDs in the setting of specific disease categories. The document also highlights variations between previously published adult and pediatric CIED recommendations and provides rationale for underlying important differences. The document addresses some of the deterrents to CIED access in low- and middle-income countries and strategies to circumvent them. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by class of recommendation and level of evidence. Several questions addressed in this document either do not lend themselves to clinical trials or are rare disease entities, and in these instances recommendations are based on consensus expert opinion. Furthermore, specific recommendations, even when supported by substantial data, do not replace the need for clinical judgment and patient-specific decision-making. The recommendations were opened for public comment to Pediatric and Congenital Electrophysiology Society (PACES) members and underwent external review by the scientific and clinical document committee of the Heart Rhythm Society (HRS), the science advisory and coordinating committee of the American Heart Association (AHA), the American College of Cardiology (ACC), and the Association for European Paediatric and Congenital Cardiology (AEPC). The document received endorsement by all the collaborators and the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). This document is expected to provide support for clinicians and patients to allow for appropriate CIED use, appropriate CIED management, and appropriate CIED follow-up in pediatric patients.
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31
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Maltret A, Benaich FA, Rendu J, Fressart V, Roux-Buisson N, Bonnet D, Denjoy I. Challenging indication of cardioverter defibrillator implantation after sudden cardiac arrest in the very young: a case series of catecholaminergic polymorphic ventricular tachycardia secondary to de novo calmodulin p.Asn98Ser. Eur Heart J Case Rep 2021; 5:ytab393. [PMID: 34729453 PMCID: PMC8557678 DOI: 10.1093/ehjcr/ytab393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/07/2021] [Accepted: 09/20/2021] [Indexed: 11/14/2022]
Abstract
Background Calmodulinopathy is an emerging group of primary electrical disease with various, severe, and early onset phenotype. Sudden cardiac arrest (SCA)/death can be the first symptom and current medical management seems insufficient to prevent recurrences. Implantable cardioverter-defibrillator (ICD) in the young is challenging and can be harmful. Case summary We report the management of two very young boys (aged 3.5 and 5.5 years old) who survived an SCA due to calmodulin mutation responsible of a catecholaminergic polymorphic ventricular tachycardia phenotype. In both case, SCA had an adrenergic trigger. Despite SCA, ICD implantation was denied by the parents. After thorough discussion with the family, the patients were managed with solely betablocker treatment and loop recorder implantation. At last follow-up of 30 and 23 months, respectively, there were no recurrence of any cardiac event. Discussion The benefits of ICD implantation at a very young age must be weighed against the risk complication. In the youngest, whom recreative activities are under constant supervision, the decision, jointly made with the parents, could be to postpone ICD.
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Affiliation(s)
- Alice Maltret
- Hôpital Marie Lannelongue-M3C, GHPSJ, Université Paris Saclay, service de cardiologie congénitale, Le Plessis-Robinson, France
- Corresponding author. Tel: +33 140 942 303,
| | | | - John Rendu
- Centre Hospitalier Universitaire Grenoble Alpes, Laboratoire de Biochimie et Génétique Moléculaire, Univ. Grenoble Alpes, Inserm U1216, Grenoble Institut Neurosciences, Grenoble, France
| | - Véronique Fressart
- Groupe Hospitalier Pitié-Salpêtrière, Service de Biochimie Métabolique, Unité de Cardiogénétique et Myogénétique, APHP, Paris, France
| | - Nathalie Roux-Buisson
- Centre Hospitalier Universitaire Grenoble Alpes, Laboratoire de Biochimie et Génétique Moléculaire, Univ. Grenoble Alpes, Inserm U1216, Grenoble Institut Neurosciences, Grenoble, France
| | - Damien Bonnet
- M3C-Necker, Hôpital Universitaire Necker-Enfants Malades, APHP, Paris, France
| | - Isabelle Denjoy
- CNMR, Maladies Cardiaques Héréditaires Rares, Service de cardiologie, Hôpital Bichat, APHP, Paris, France
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Shah MJ, Silka MJ, Silva JA, Balaji S, Beach C, Benjamin M, Berul C, Cannon B, Cecchin F, Cohen M, Dalal A, Dechert B, Foster A, Gebauer R, Gonzalez Corcia MC, Kannankeril P, Karpawich P, Kim J, Krishna MR, Kubuš P, Malloy-Walton L, LaPage M, Mah D, Miyazaki A, Motonaga K, Niu M, Olen M, Paul T, Rosenthal E, Saarel E, Silvetti MS, Stephenson E, Tan R, Triedman J, Von Bergen N, Wackel P. 2021 PACES Expert Consensus Statement on the Indications and Management of Cardiovascular Implantable Electronic Devices in Pediatric Patients. Heart Rhythm 2021; 18:1888-1924. [PMID: 34363988 DOI: 10.1016/j.hrthm.2021.07.038] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 07/15/2021] [Indexed: 01/10/2023]
Abstract
In view of the increasing complexity of both cardiovascular implantable electronic devices (CIEDs) and patients in the current era, practice guidelines, by necessity, have become increasingly specific. This document is an expert consensus statement that has been developed to update and further delineate indications and management of CIEDs in pediatric patients, defined as ≤21 years of age, and is intended to focus primarily on the indications for CIEDs in the setting of specific disease categories. The document also highlights variations between previously published adult and pediatric CIED recommendations and provides rationale for underlying important differences. The document addresses some of the deterrents to CIED access in low- and middle-income countries and strategies to circumvent them. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by class of recommendation and level of evidence. Several questions addressed in this document either do not lend themselves to clinical trials or are rare disease entities, and in these instances recommendations are based on consenus expert opinion. Furthermore, specific recommendations, even when supported by substantial data, do not replace the need for clinical judgment and patient-specific decision-making. The recommendations were opened for public comment to Pediatric and Congenital Electrophysiology Society (PACES) members and underwent external review by the scientific and clinical document committee of the Heart Rhythm Society (HRS), the science advisory and coordinating committee of the American Heart Association (AHA), the American College of Cardiology, (ACC) and the Association for European Paediatric and Congenital Cardiology (AEPC). The document received endorsement by all the collaborators and the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). This document is expected to provide support for clinicians and patients to allow for appropriate CIED use, appropriate CIED management, and appropriate follow-up in pediatric patients.
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Affiliation(s)
- Maully J Shah
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
| | - Michael J Silka
- University of Southern California Keck School of Medicine, Los Angeles, California.
| | | | | | - Cheyenne Beach
- Yale University School of Medicine, New Haven, Connecticut
| | - Monica Benjamin
- Hospital de Pediatría Juan P. Garrahan, Hospital El Cruce, Hospital Británico de Buenos Aires, Instituto Cardiovascular ICBA, Buenos Aires, Argentina
| | | | | | - Frank Cecchin
- New York Univeristy Grossman School of Medicine, New York, New York
| | | | - Aarti Dalal
- Washington University in St. Louis, St. Louis, Missouri
| | | | - Anne Foster
- Advocate Children's Heart Institute, Chicago, Illinois
| | - Roman Gebauer
- Heart Centre Leipzig, University of Leipzig, Leipzig, Germany
| | | | | | - Peter Karpawich
- University Pediatricians, Children's Hospital of Michigan, Detroit, Michigan
| | | | | | - Peter Kubuš
- Children's Heart Center, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | | | | | - Doug Mah
- Harvard Medical School, Boston, Massachussetts
| | - Aya Miyazaki
- Shizuoka General Hospital and Mt. Fuji Shizuoka Children's Hospital, Shizuoka, Japan
| | | | - Mary Niu
- University of Utah Health Sciences Center, Salt Lake City, Utah
| | | | - Thomas Paul
- Georg-August-University Medical Center, Göttingen, Germany
| | - Eric Rosenthal
- Evelina London Children's Hospital and St Thomas' Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | | | | | | | - Reina Tan
- New York University Langone Health, New York, New York
| | - John Triedman
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Nicholas Von Bergen
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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33
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Blomström-Lundqvist C, Traykov V, Erba PA, Burri H, Nielsen JC, Bongiorni MG, Poole J, Boriani G, Costa R, Deharo JC, Epstein LM, Saghy L, Snygg-Martin U, Starck C, Tascini C, Strathmore N. European Heart Rhythm Association (EHRA) international consensus document on how to prevent, diagnose, and treat cardiac implantable electronic device infections-endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), the Latin American Heart Rhythm Society (LAHRS), International Society for Cardiovascular Infectious Diseases (ISCVID) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Europace 2021; 22:515-549. [PMID: 31702000 PMCID: PMC7132545 DOI: 10.1093/europace/euz246] [Citation(s) in RCA: 203] [Impact Index Per Article: 67.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 08/19/2019] [Indexed: 01/28/2023] Open
Abstract
Pacemakers, implantable cardiac defibrillators, and cardiac resynchronization therapy devices are potentially life-saving treatments for a number of cardiac conditions, but are not without risk. Most concerning is the risk of a cardiac implantable electronic device (CIED) infection, which is associated with significant morbidity, increased hospitalizations, reduced survival, and increased healthcare costs. Recommended preventive strategies such as administration of intravenous antibiotics before implantation are well recognized. Uncertainties have remained about the role of various preventive, diagnostic, and treatment measures such as skin antiseptics, pocket antibiotic solutions, anti-bacterial envelopes, prolonged antibiotics post-implantation, and others. Guidance on whether to use novel device alternatives expected to be less prone to infections and novel oral anticoagulants is also limited, as are definitions on minimum quality requirements for centres and operators and volumes. Moreover, an international consensus document on management of CIED infections is lacking. The recognition of these issues, the dissemination of results from important randomized trials focusing on prevention of CIED infections, and observed divergences in managing device-related infections as found in an European Heart Rhythm Association worldwide survey, provided a strong incentive for a 2019 International State-of-the-art Consensus document on risk assessment, prevention, diagnosis, and treatment of CIED infections.
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Affiliation(s)
| | - Vassil Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Paola Anna Erba
- Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, Pisa, Italy, and University of Groningen, University Medical Center Groningen, Medical Imaging Center, Groningen, The Netherlands
| | - Haran Burri
- Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland
| | | | - Maria Grazia Bongiorni
- Division of Cardiology and Arrhythmology, CardioThoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Jeanne Poole
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Giuseppe Boriani
- Division of Cardiology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Roberto Costa
- Department of Cardiovascular Surgery, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil
| | - Jean-Claude Deharo
- Department of Cardiology, Aix Marseille Université, CHU la Timone, Marseille, France
| | - Laurence M Epstein
- Electrophysiology, Northwell Health, Hofstra/Northwell School of Medicine, Manhasset, NY, USA
| | - Laszlo Saghy
- Division of Electrophysiology, 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - Ulrika Snygg-Martin
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, Azienda ospedaliera dei Colli, Naples, Italy
| | - Neil Strathmore
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
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34
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Blomström-Lundqvist C, Traykov V, Erba PA, Burri H, Nielsen JC, Bongiorni MG, Poole J, Boriani G, Costa R, Deharo JC, Epstein LM, Saghy L, Snygg-Martin U, Starck C, Tascini C, Strathmore N. European Heart Rhythm Association (EHRA) international consensus document on how to prevent, diagnose, and treat cardiac implantable electronic device infections-endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), the Latin American Heart Rhythm Society (LAHRS), International Society for Cardiovascular Infectious Diseases (ISCVID) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg 2021; 57:e1-e31. [PMID: 31724720 DOI: 10.1093/ejcts/ezz296] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 08/19/2019] [Indexed: 12/26/2022] Open
Abstract
Pacemakers, implantable cardiac defibrillators, and cardiac resynchronization therapy devices are potentially life-saving treatments for a number of cardiac conditions, but are not without risk. Most concerning is the risk of a cardiac implantable electronic device (CIED) infection, which is associated with significant morbidity, increased hospitalizations, reduced survival, and increased healthcare costs. Recommended preventive strategies such as administration of intravenous antibiotics before implantation are well recognized. Uncertainties have remained about the role of various preventive, diagnostic, and treatment measures such as skin antiseptics, pocket antibiotic solutions, anti-bacterial envelopes, prolonged antibiotics post-implantation, and others. Guidance on whether to use novel device alternatives expected to be less prone to infections and novel oral anticoagulants is also limited, as are definitions on minimum quality requirements for centres and operators and volumes. Moreover, an international consensus document on management of CIED infections is lacking. The recognition of these issues, the dissemination of results from important randomized trials focusing on prevention of CIED infections, and observed divergences in managing device-related infections as found in an European Heart Rhythm Association worldwide survey, provided a strong incentive for a 2019 International State-of-the-art Consensus document on risk assessment, prevention, diagnosis, and treatment of CIED infections.
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Affiliation(s)
| | - Vassil Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Paola Anna Erba
- Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, Pisa, Italy, and University of Groningen, University Medical Center Groningen, Medical Imaging Center, Groningen, Netherlands
| | - Haran Burri
- Department of Cardiology, University Hospital of Geneva, Geneva, Switzerland
| | | | - Maria Grazia Bongiorni
- Division of Cardiology and Arrhythmology, CardioThoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Jeanne Poole
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Giuseppe Boriani
- Division of Cardiology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Roberto Costa
- Department of Cardiovascular Surgery, Heart Institute (InCor) of the University of São Paulo, São Paulo, Brazil
| | - Jean-Claude Deharo
- Department of Cardiology, Aix Marseille Université, CHU la Timone, Marseille, France
| | - Laurence M Epstein
- Electrophysiology, Northwell Health, Hofstra/Northwell School of Medicine, Manhasset, NY, USA
| | - Laszlo Saghy
- Division of Electrophysiology, 2nd Department of Medicine and Cardiology Centre, University of Szeged, Szeged, Hungary
| | - Ulrika Snygg-Martin
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, Azienda ospedaliera dei Colli, Naples, Italy
| | - Neil Strathmore
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
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35
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Blomström-Lundqvist C, Traykov V, Erba PA, Burri H, Nielsen JC, Bongiorni MG, Poole J, Boriani G, Costa R, Deharo JC, Epstein LM, Sághy L, Snygg-Martin U, Starck C, Tascini C, Strathmore N. European Heart Rhythm Association (EHRA) international consensus document on how to prevent, diagnose, and treat cardiac implantable electronic device infections-endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), the Latin American Heart Rhythm Society (LAHRS), International Society for Cardiovascular Infectious Diseases (ISCVID), and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2021; 41:2012-2032. [PMID: 32101604 DOI: 10.1093/eurheartj/ehaa010] [Citation(s) in RCA: 107] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/07/2019] [Accepted: 01/10/2020] [Indexed: 01/07/2023] Open
Abstract
Pacemakers, implantable cardiac defibrillators, and cardiac resynchronization therapy devices are potentially lifesaving treatments for a number of cardiac conditions but are not without risk. Most concerning is the risk of a cardiac implantable electronic device (CIED) infection, which is associated with significant morbidity, increased hospitalizations, reduced survival, and increased health care costs. Recommended preventive strategies such as administration of intravenous antibiotics before implantation are well-recognized. Uncertainties have remained about the role of various preventive, diagnostic, and treatment measures such as skin antiseptics, pocket antibiotic solutions, antibacterial envelopes, prolonged antibiotics post-implantation, and others. When compared with previous guidelines or consensus statements, the present consensus document gives guidance on the use of novel device alternatives, novel oral anticoagulants, antibacterial envelopes, prolonged antibiotics post-implantation, as well as definitions on minimum quality requirements for centres and operators and volumes. The recognition that an international consensus document focused on management of CIED infections is lacking, the dissemination of results from new important randomized trials focusing on prevention of CIED infections, and observed divergences in managing device-related infections as found in an European Heart Rhythm Association worldwide survey, provided a strong incentive for a Novel 2019 International State-of-the-art Consensus document on risk assessment, prevention, diagnosis, and treatment of CIED infections.
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Affiliation(s)
| | - Vassil Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Acibadem City Clinic Tokuda Hospital, Nikola Vaptsarov blvd 51 B, 1 407 Sofia, Bulgaria
| | - Paola Anna Erba
- Department of Translational Research and New Technology in Medicine, University of Pisa-AOUP, Lungarno Antonio Pacinotti, 43, 56126 Pisa PI, Italy.,Department of Nuclear Medicine & Molecular Imaging University Medical Center Groningen, University of Groningen, 9712 CP Groningen, Netherlands
| | - Haran Burri
- Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus, Denmark
| | - Maria Grazia Bongiorni
- CardioThoracic and Vascular Department, University Hospital of Pisa, Via Paradisa 2, 56125 Pisa PI, Italy
| | - Jeanne Poole
- Department of Cardiology, University of Washington, Roosevelt Way NE, Seattle, WA 98115, USA
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Largo del Pozzo, 71, 41125 Modena, Italy
| | - Roberto Costa
- Department of Cardiovascular Surgery, Heart Institute (InCor) of the University of São Paulo, Butanta, São Paulo - State of São Paulo, Brazil
| | - Jean-Claude Deharo
- Department of Cardiology, Aix Marseille Université, CHU la Timone, 278 Rue Saint-Pierre, 13005 Marseille, France
| | - Laurence M Epstein
- Electrophysiology, Northwell Health, Hofstra/Northwell School of Medicine, 300 Community Drive, Manhasset, NY 11030, USA
| | - László Sághy
- Electrophysiology Division, 2nd Department of Medicine and Cardiology Centre, University of Szeged, Aradi vértanúk tere 1, 6720 Szeged, Hungary
| | - Ulrika Snygg-Martin
- Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Pl. 1, 13353 Berlin, Germany
| | - Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, Azienda ospedaliera dei Colli, Via Gaetano Quagliariello, 54, 80131 Napoli NA, Italy
| | - Neil Strathmore
- Department of Cardiology, Royal Melbourne Hospital, 300 Grattan St, Parkville VIC 3050, Melbourne, Australia
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36
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Song MK, Uhm JS, Baek JS, Yoon JK, Na JY, Yu HT, Yang JH, Oh S, Park SW, Song J, Huh J, Bae EJ. Clinical Outcomes of Implantable Cardioverter-Defibrillator in Pediatric Patients - A Korean Multicenter Study. Circ J 2021; 85:1356-1364. [PMID: 33980762 DOI: 10.1253/circj.cj-20-0468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Implantable cardioverter-defibrillator (ICD) therapy is important for the prevention of sudden cardiac death, but data on clinical outcomes of ICD therapy in Asian pediatric patients are scarce. The aim of this Korean multicenter study was to evaluate the current state and elucidate the clinical outcomes of ICD therapy in children.Methods and Results:Data from 5 pediatric cardiology centers were retrospectively collected from 2007 to 2019. Altogether, 99 patients were enrolled (mean age 13.9±4.1 years). The most common underlying disease was a primary electrical disease (56%). An ICD was implanted for primary prevention in 19%. Appropriate shock occurred in 44% of patients at a median of 1.6 years after implantation. There was no significant difference in the appropriate shock rate between patients with primary and secondary prevention indications (32% vs. 48%, respectively). A total of 33 patients (33%) experienced inappropriate shock, which was associated with primary electrical disease and follow-up duration on multivariate analysis. 17% of patients had ICD-related complications. CONCLUSIONS The utilization rate of ICD for primary prevention was still low in the pediatric population in Korea, but there was a substantial rate of appropriate shock in these patients. Efforts to increase ICD usage to save the lives of high-risk patients and reduce the incidence of inappropriate shock are required.
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Affiliation(s)
- Mi Kyoung Song
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine
| | - Jae-Sun Uhm
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine
| | - Jae Suk Baek
- Department of Pediatrics, University of Ulsan College of Medicine
| | | | - Jae Yoon Na
- Departments of Pediatrics, Hanyang University College of Medicine
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine
| | - Ji-Hyuk Yang
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine
| | | | - Jinyoung Song
- Department of Pediatrics, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - June Huh
- Department of Pediatrics, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Eun-Jung Bae
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine
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Wong GR, Ang M, Jayarajan J, Walker F, Lambiase PD. Pregnancy in patients with implantable cardiac defibrillators. Herzschrittmacherther Elektrophysiol 2021; 32:214-220. [PMID: 33970332 DOI: 10.1007/s00399-021-00750-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/15/2021] [Indexed: 02/05/2023]
Abstract
The number of patients of reproductive age with inherited and congenital heart disease receiving implantable cardiac defibrillators (ICD) is steadily increasing. Safely and effectively coordinating pregnancy in this high-risk cohort is important to optimise maternal-foetal outcomes. As members of the multidisciplinary team caring for pregnant patients with indications for ICD, cardiologists and electrophysiologists should be aware of the considerations and nuances involved in managing these patients. This article reviews the pathophysiology of arrhythmias, ICD implantation considerations, novel minimal fluoroscopy techniques and subcutaneous ICD. In addition, antenatal and device management during pregnancy and delivery are discussed.
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Affiliation(s)
- Geoffrey R Wong
- Department of Electrophysiology, St Bartholomews Hospital NHS Trust & Institute of Cardiovascular Science UCL, London, UK
| | - Megan Ang
- Department of Obstetric Imaging, Mercy Hospital for Women, Melbourne, Australia
| | - Jasveer Jayarajan
- Department of Obstetric Imaging, Mercy Hospital for Women, Melbourne, Australia
| | - Fiona Walker
- Department of Grown-Up Congenital Heart Disease, St Bartholomews Hospital, London, UK
| | - Pier D Lambiase
- Department of Electrophysiology, St Bartholomews Hospital NHS Trust & Institute of Cardiovascular Science UCL, London, UK.
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Köbe J, Willy K, Eckardt L, Baumgartner H, Wasmer K. Narrative review of: risk stratification and implantable cardioverter-defibrillator therapy in adults with congenital heart disease. Cardiovasc Diagn Ther 2021; 11:538-549. [PMID: 33968632 DOI: 10.21037/cdt-20-633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Fortunately, the population of adults with congenital heart disease (ACHD) is growing due to improved operation techniques. Life expectancy is continuously rising, nevertheless, sudden cardiac death is one of the leading causes of mortality in ACHD late after initial diagnosis. Risk stratification in ACHD remains challenging as large study results are missing, congenital defects and operation methods differ considerably between individual patients and results from acquired heart diseases are often not conferrable. The purpose of this narrative review is to objectively summarize the current knowledge on arrhythmogenic risk of ACHD and to give an overview on implantable cardioverter-defibrillator (ICD) therapy in this collective. Remarkable progress has been made in electrophysiological understanding of critical areas of slow conduction especially in patients with Tetralogy of Fallot (ToF). In patients with transposition of the great arteries after atrial baffling (Mustard/Senning procedure) atrial arrhythmias play a crucial role in sudden cardiac death. ICD therapy in ACHD may pose special technical challenges due to limited access for intracardiac leads. The introduction of the totally subcutaneous ICD improved therapeutic options for ACHD especially when contraindications for transvenous leads are present. Risk stratification in ACHD has to be seen as a team approach, requires thorough understanding of congenital heart defects and the operation techniques and needs unconventional technical approaches in some cases.
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Affiliation(s)
- Julia Köbe
- Department of Cardiology II - Electrophysiology, University Hospital Muenster, Muenster, Germany
| | - Kevin Willy
- Department of Cardiology II - Electrophysiology, University Hospital Muenster, Muenster, Germany
| | - Lars Eckardt
- Department of Cardiology II - Electrophysiology, University Hospital Muenster, Muenster, Germany
| | - Helmut Baumgartner
- Department of Cardiology III, Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany
| | - Kristina Wasmer
- Department of Cardiology II - Electrophysiology, University Hospital Muenster, Muenster, Germany
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Whitehill RD, Chandler SF, DeWitt E, Abrams DJ, Walsh EP, Kelleman M, Mah DY. Lead age as a predictor for failure in pediatrics and congenital heart disease. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:586-594. [PMID: 33432629 DOI: 10.1111/pace.14166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/30/2020] [Accepted: 12/13/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pediatric and congenital heart disease (CHD) patients have a high rate of transvenous (TV) lead failure. OBJECTIVE To determine whether TV lead age can aid risk assessment for lead failure to guide the decision of whether a lead should be replaced or reused at the time of a generator change. METHODS Retrospective cohort study of patients <21 years old undergoing TV device implant from 2000 to 2014 at our institution. Patient, device, and lead variables were collected. Leads were compared in groups based on how many generator changes were completed. RESULTS A total of 393 leads in 257 patients met inclusion criteria, 60 leads failed (15%). Failed leads were more likely to have not yet undergone generator change (p = .048). CHD (p = .045), Tendril lead type (p = .02) and silicone insulation (p = .02) were associated with failure. In multivariate analysis, younger leads (p = .022), number of generator changes (p = .003), CHD (p = .005) and silicone insulation (p = .004) remained significant while Tendril lead type did not (p = .052). Survival curves show an early decline around 4 years. CONCLUSIONS Lead failure rate in pediatric and CHD patients is high. Leads that have not yet undergone a generator change were more likely to fail in this cohort. The strategy of serial replacement based on lead age needs further research to justify in this population.
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Affiliation(s)
- Robert D Whitehill
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Cardiology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Stephanie F Chandler
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Elizabeth DeWitt
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Dominic J Abrams
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Edward P Walsh
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael Kelleman
- Department of Cardiology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Douglas Y Mah
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Robinson JA, LaPage MJ, Atallah J, Webster G, Miyake CY, Ratnasamy C, Ollberding NJ, Mohan S, Von Bergen NH, Johnsrude CL, Garnreiter JM, Spar DS, Czosek RJ. Outcomes of Pediatric Patients With Defibrillators Following Initial Presentation With Sudden Cardiac Arrest. Circ Arrhythm Electrophysiol 2021; 14:e008517. [PMID: 33401923 DOI: 10.1161/circep.120.008517] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Implantable cardioverter defibrillators (ICD) are recommended for secondary prevention after sudden cardiac arrest (SCA). The outcomes of pediatric patients receiving an ICD after SCA remain unclear. The objective of this study is to evaluate outcomes, future risk for appropriate shocks, and identify characteristics associated with appropriate ICD therapy during follow-up. METHODS Multicenter retrospective analysis of patients (age ≤21 years) without prior cardiac disease who received an ICD following SCA. Patient/device characteristics, cardiac function, and underlying diagnoses were collected, along with SCA event characteristics. Patient outcomes including complications and device therapies were analyzed. RESULTS In total, 106 patients were included, median age 14.7 years. Twenty (19%) received appropriate shocks and 16 (15%) received inappropriate shocks (median follow-up 3 years). First-degree relative with SCA was associated with appropriate shocks (P<0.05). In total, 40% patients were considered idiopathic. Channelopathy was the most frequent late diagnosis not made at time of presentation. Neither underlying diagnosis nor idiopathic status was associated with increased incidence of appropriate shock. Monomorphic ventricular tachycardia (hazard ratio, 4.6 [1.2-17.3]) and family history of sudden death (hazard ratio, 6.5 [1.4-29.8]) were associated with freedom from appropriate shock in a multivariable model (area under the receiver operating characteristic curve, 0.8). Time from diagnoses to evaluation demonstrated a nonlinear association with freedom from appropriate shock (P=0.015). In patients >2 years from implantation, younger age (P=0.02) and positive exercise test (P=0.04) were associated with appropriate shock. CONCLUSIONS The risk of future device therapy is high in pediatric patients receiving an ICD after SCA, irrelevant of underlying disease. Lack of a definitive diagnosis after SCA was not associated with lower risk of subsequent events and does not obviate the need for secondary prophylaxis.
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MESH Headings
- Adolescent
- Child
- Child, Preschool
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/prevention & control
- Defibrillators, Implantable
- Electric Countershock/instrumentation
- Female
- Humans
- Incidence
- Infant
- Infant, Newborn
- Male
- Primary Prevention/methods
- Retrospective Studies
- Risk Assessment/methods
- Risk Factors
- Secondary Prevention/methods
- Survival Rate/trends
- Tachycardia, Ventricular/mortality
- Tachycardia, Ventricular/physiopathology
- Tachycardia, Ventricular/therapy
- Treatment Outcome
- United States/epidemiology
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Affiliation(s)
- Jeffrey A Robinson
- The Heart Institute (J.A.R., D.S.S., R.J.C.), Cincinnati Children's Hospital Medical Center, OH
- Dr. C.C. & Mabel L. Criss Heart Center, Children's Hospital & Medical Center, University of Nebraska Medical Center, Omaha (J.A.R.)
| | - Martin J LaPage
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor (M.J.L.)
| | - Joseph Atallah
- Department of Pediatrics, University of Alberta, Edmonton, Canada (J.A.)
| | - Gregory Webster
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, IL (G.W.)
| | | | - Christopher Ratnasamy
- Congenital Heart Center, Spectrum Health, Helen DeVos Children's Hospital, Grand Rapids, MI (C.R.)
| | | | - Shaun Mohan
- University of Kentucky HealthCare, Lexington (S.M.)
| | - Nicholas H Von Bergen
- American Family Children's Hospital, University of Wisconsin School of Medicine & Public Health, Madison (N.H.V.B.)
| | | | | | - David S Spar
- The Heart Institute (J.A.R., D.S.S., R.J.C.), Cincinnati Children's Hospital Medical Center, OH
- Division of Biostatistics & Epidemiology (D.S.S., R.J.C.), Cincinnati Children's Hospital Medical Center, OH
| | - Richard J Czosek
- The Heart Institute (J.A.R., D.S.S., R.J.C.), Cincinnati Children's Hospital Medical Center, OH
- Division of Biostatistics & Epidemiology (D.S.S., R.J.C.), Cincinnati Children's Hospital Medical Center, OH
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von Alvensleben JC, Dechert B, Bradley DJ, Fish FA, Moore JP, Pilcher TA, Escudero C, Ceresnak SR, Kwok SY, Balaji S, Aziz PF, Papagiannis J, Cortez D, Garnreiter J, Kean A, Schäfer M, Collins KK. Subcutaneous Implantable Cardioverter-Defibrillators in Pediatrics and Congenital Heart Disease. JACC Clin Electrophysiol 2020; 6:1752-1761. [DOI: 10.1016/j.jacep.2020.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/06/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
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Abstract
PURPOSE OF REVIEW Cardiomyopathies are rare in the pediatric population, but significantly impact on morbidity and mortality. The present review aims to provide an overview of cardiomyopathies in children and some practical guidelines for their prognostic stratification and management. RECENT FINDINGS Pediatric cardiomyopathies may present as isolated cardiac muscle disease or in the context of complex clinical syndromes. The etiologic characterization represents an important step in the diagnosis and treatment of cardiomyopathies because of its impact on prognosis and on therapeutic measures. Indeed, replacement therapy is nowadays widely available and changes the natural history of the disease. More complex is the management of isolated cardiomyopathies, which lack specific therapies, mainly aimed at symptomatic relief. In this context, heart transplantation shows excellent outcomes in children, but wait-list mortality is still very high. Device therapy for sudden cardiac death prevention and the use of mechanical assist devices are becoming more common in the clinical practice and may help to reduce mortality. SUMMARY Providing insight into pediatric cardiomyopathies classification helps in the prognostication and management of such diseases. Recent years witnessed a significant improvement in mortality, but future research is still needed to improve quality of life and life expectations in the pediatric population.
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Implantation of cardiac defibrillator in an infant with hypertrophic cardiomyopathy and newly identified MYBP3 mutation. Turk Arch Pediatr 2020; 55:304-308. [PMID: 33061760 PMCID: PMC7536448 DOI: 10.14744/turkpediatriars.2018.35556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/17/2018] [Indexed: 12/04/2022]
Abstract
Hypertrophic cardiomyopathy has the highest incidence rate among genetically inherited cardiac diseases. It develops as a result of mutations in genes in related to the sarcomere protein in cardiac muscle. Generally, this results in asymmetrical hypertrophy. Patients who are symptomatic and have a significantly narrow left ventricular undergo should receive surgical treatment, whereas patients with a sudden cardiac death risk should receive treatment with an implantable cardiac defibrillator. This paper presents an infant with hypertrophic cardiomyopathy who was recently identified as having a mutation that resulted in a deletion-insertion type framework shift in the gene MYBPC3, who had family history of sudden death at a young age, and received myectomy and treatment with an implantable cardiac defibrillator in the same session due to a severely narrowed left ventricular outflow tract.
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Abstract
PURPOSE OF REVIEW The goal of this paper is to provide an overview of contemporary knowledge specific to the causes, management, and outcome of heart failure in children. RECENT FINDINGS While recently there have been subtle improvements in heart failure outcomes in children, these improvements lag significantly behind that of adults. There is a growing body of literature suggesting that pediatric heart failure is a unique disease process with age- and disease-specific myocardial adaptations. In addition, the heterogenous etiologies of heart failure in children contribute to differential response to therapies and challenge the ability to obtain meaningful results from prospective clinical trials. Consideration of novel clinical trial designs with achievable but clinically relevant endpoints and focused study of the mechanisms underlying pediatric heart failure secondary to cardiomyopathies and structural heart disease are essential if we hope to advance care and identify targeted and effective therapies.
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Affiliation(s)
| | - Anastacia M Garcia
- Division of Cardiology, Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA
| | - Roni M Jacobsen
- Division of Cardiology, Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA
| | - Shelley D Miyamoto
- Division of Cardiology, Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA.
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45
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Miron A, Lafreniere-Roula M, Steve Fan CP, Armstrong KR, Dragulescu A, Papaz T, Manlhiot C, Kaufman B, Butts RJ, Gardin L, Stephenson EA, Howard TS, Aziz PF, Balaji S, Ladouceur VB, Benson LN, Colan SD, Godown J, Henderson HT, Ingles J, Jeewa A, Jefferies JL, Lal AK, Mathew J, Jean-St-Michel E, Michels M, Nakano SJ, Olivotto I, Parent JJ, Pereira AC, Semsarian C, Whitehill RD, Wittekind SG, Russell MW, Conway J, Richmond ME, Villa C, Weintraub RG, Rossano JW, Kantor PF, Ho CY, Mital S. A Validated Model for Sudden Cardiac Death Risk Prediction in Pediatric Hypertrophic Cardiomyopathy. Circulation 2020; 142:217-229. [PMID: 32418493 PMCID: PMC7365676 DOI: 10.1161/circulationaha.120.047235] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/29/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hypertrophic cardiomyopathy is the leading cause of sudden cardiac death (SCD) in children and young adults. Our objective was to develop and validate a SCD risk prediction model in pediatric hypertrophic cardiomyopathy to guide SCD prevention strategies. METHODS In an international multicenter observational cohort study, phenotype-positive patients with isolated hypertrophic cardiomyopathy <18 years of age at diagnosis were eligible. The primary outcome variable was the time from diagnosis to a composite of SCD events at 5-year follow-up: SCD, resuscitated sudden cardiac arrest, and aborted SCD, that is, appropriate shock following primary prevention implantable cardioverter defibrillators. Competing risk models with cause-specific hazard regression were used to identify and quantify clinical and genetic factors associated with SCD. The cause-specific regression model was implemented using boosting, and tuned with 10 repeated 4-fold cross-validations. The final model was fitted using all data with the tuned hyperparameter value that maximizes the c-statistic, and its performance was characterized by using the c-statistic for competing risk models. The final model was validated in an independent external cohort (SHaRe [Sarcomeric Human Cardiomyopathy Registry], n=285). RESULTS Overall, 572 patients met eligibility criteria with 2855 patient-years of follow-up. The 5-year cumulative proportion of SCD events was 9.1% (14 SCD, 25 resuscitated sudden cardiac arrests, and 14 aborted SCD). Risk predictors included age at diagnosis, documented nonsustained ventricular tachycardia, unexplained syncope, septal diameter z-score, left ventricular posterior wall diameter z score, left atrial diameter z score, peak left ventricular outflow tract gradient, and presence of a pathogenic variant. Unlike in adults, left ventricular outflow tract gradient had an inverse association, and family history of SCD had no association with SCD. Clinical and clinical/genetic models were developed to predict 5-year freedom from SCD. Both models adequately discriminated between patients with and without SCD events with a c-statistic of 0.75 and 0.76, respectively, and demonstrated good agreement between predicted and observed events in the primary and validation cohorts (validation c-statistic 0.71 and 0.72, respectively). CONCLUSION Our study provides a validated SCD risk prediction model with >70% prediction accuracy and incorporates risk factors that are unique to pediatric hypertrophic cardiomyopathy. An individualized risk prediction model has the potential to improve the application of clinical practice guidelines and shared decision making for implantable cardioverter defibrillator insertion. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT0403679.
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Affiliation(s)
- Anastasia Miron
- Division of Cardiology (A.M., T.P., S.M.), Hospital for Sick Children, Toronto, Ontario, Canada
| | - Myriam Lafreniere-Roula
- Ted Rogers Computational Program, Ted Rogers Center for Heart Research, The Hospital for Sick Children, University Health Network, Toronto, Ontario, Canada (M.L.-R., C.-P, S.F.)
| | - Chun-Po Steve Fan
- Ted Rogers Computational Program, Ted Rogers Center for Heart Research, The Hospital for Sick Children, University Health Network, Toronto, Ontario, Canada (M.L.-R., C.-P, S.F.)
| | - Katey R. Armstrong
- Division of Pediatric Cardiology, Department of Pediatrics, British Columbia Children’s Hospital, Vancouver, Canada (K.R.A.)
| | - Andreea Dragulescu
- Department of Cardiology (A.D., V.B.L., L.N.B., A.J., E.J.-St-M.), Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tanya Papaz
- Division of Cardiology (A.M., T.P., S.M.), Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cedric Manlhiot
- Department of Pediatrics, Johns Hopkins Medical Center, Baltimore, MD (C.M.)
| | - Beth Kaufman
- Department of Pediatrics, Lucile Packard Children’s Hospital Stanford, Palo Alto, CA (B.K.)
| | - Ryan J. Butts
- Division of Pediatric Cardiology, Department of Pediatrics, Children’s Medical Center of Dallas, TX (R.J.B.)
| | - Letizia Gardin
- Department of Cardiology, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada (L.G.)
| | - Elizabeth A. Stephenson
- Department of Cardiology, Labatt Family Heart Center, Hospital for Sick Children, University of Toronto, Ontario, Canada (E.A.S., S.M.)
| | - Taylor S. Howard
- Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine, Texas Children’s Hospital (T.S.H.)
| | - Pete F. Aziz
- Center for Pediatric and Congenital Heart Disease, Pediatric Electrophysiology and Pacing, Cleveland Clinic Children’s Hospital, OH (P.F.A.)
| | - Seshadri Balaji
- Department of Pediatrics, Division of Cardiology, Oregon Health & Science University, OHSU Doernbecher Children’s Hospital, Portland (S.B.)
| | - Virginie Beauséjour Ladouceur
- Department of Cardiology (A.D., V.B.L., L.N.B., A.J., E.J.-St-M.), Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lee N. Benson
- Department of Cardiology (A.D., V.B.L., L.N.B., A.J., E.J.-St-M.), Hospital for Sick Children, Toronto, Ontario, Canada
| | - Steven D. Colan
- Department of Cardiology, Boston Children’s Hospital, MA (S.D.C.)
| | - Justin Godown
- Department of Pediatrics, Division of Pediatric Cardiology, Monroe Carrell Jr Children’s Hospital at Vanderbilt, Nashville, TN (J.G.)
| | | | - Jodie Ingles
- Agnes Ginges Center for Molecular Cardiology at Centenary Institute, The University of Sydney, New South Wales, Australia (J.I., C.S.)
| | - Aamir Jeewa
- Department of Cardiology (A.D., V.B.L., L.N.B., A.J., E.J.-St-M.), Hospital for Sick Children, Toronto, Ontario, Canada
| | - John L. Jefferies
- Division of Adult Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis (J.L.J.)
| | - Ashwin K. Lal
- Division of Pediatric Cardiology, University of Utah Primary Children’s Hospital, Salt Lake City (A.K.L.)
| | - Jacob Mathew
- Department of Cardiology, The Royal Children’s Hospital, Melbourne, Victoria, Australia (J.M., R.G.W.)
| | - Emilie Jean-St-Michel
- Department of Cardiology (A.D., V.B.L., L.N.B., A.J., E.J.-St-M.), Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michelle Michels
- Department of Cardiology, Thoraxcenter, Erasmus MC Rotterdam, South Holland, Netherlands (M.M.)
| | - Stephanie J. Nakano
- Department of Pediatrics, Division of Cardiology, Children’s Hospital Colorado, Aurora (S.J.N.)
| | - Iacopo Olivotto
- Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy (I.O.)
| | - John J. Parent
- Department of Pediatrics, Riley Children’s Hospital, Indianapolis, IN (J.J.P.)
| | - Alexandre C. Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Brazil (A.C.P.)
| | - Christopher Semsarian
- Agnes Ginges Center for Molecular Cardiology at Centenary Institute, The University of Sydney, New South Wales, Australia (J.I., C.S.)
| | | | | | - Mark W. Russell
- Pediatrics, C.S. Mott Children’s Hospital, Ann Arbor, MI (M.W.R.)
| | - Jennifer Conway
- Division of Pediatric Cardiology, Department of Pediatrics, Stollery Children’s Hospital, Edmonton, AB, Canada (J.C.)
| | - Marc E. Richmond
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University College of Physicians and Surgeons/Morgan Stanley Children’s Hospital, New York, NY (M.E.R.)
| | - Chet Villa
- The Heart Institute, Cincinnati Children’s Hospital, OH (S.G.W., C.V.)
| | - Robert G. Weintraub
- Department of Cardiology, The Royal Children’s Hospital, Melbourne, Victoria, Australia (J.M., R.G.W.)
- Murdoch Children’s Research Institute, University of Melbourne, Victoria, Australia (R.G.W.)
| | - Joseph W. Rossano
- Division of Cardiology, Children’s Hospital of Philadelphia, PA (J.W.R.)
| | - Paul F. Kantor
- Division of Cardiology, Children’s Hospital of Los Angeles, CA (P.F.K.)
| | - Carolyn Y. Ho
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (C.Y.H.)
| | - Seema Mital
- Division of Cardiology (A.M., T.P., S.M.), Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Cardiology, Labatt Family Heart Center, Hospital for Sick Children, University of Toronto, Ontario, Canada (E.A.S., S.M.)
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L.Goldenthal I, Rosenbaum MS, Lewis M, Sciacca RR, Garan H, Biviano AB. Inappropriate implantable cardioverter-defibrillator shocks in repaired tetralogy of fallot patients: Prevalence and electrophysiological mechanisms. IJC HEART & VASCULATURE 2020; 28:100543. [PMID: 32490149 PMCID: PMC7256636 DOI: 10.1016/j.ijcha.2020.100543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/18/2020] [Indexed: 11/26/2022]
Abstract
Background Patients with Tetralogy of Fallot (TOF) are at increased risk for sudden cardiac death, often undergo implantable cardioverter defibrillator (ICD) implantation at younger ages, and are at greater risk of experiencing inappropriate shocks. We investigated occurrences of ICD shocks in TOF patients to identify prevalence, characteristics associated with inappropriate shocks, and therapeutic interventions after inappropriate shocks. Methods Records of patients with repaired TOF and ICD implantation who were followed at Columbia University Irving Medical Center between 1/1/2000 and 5/1/2019 were analyzed. Results 44 patients with repaired TOF and ICD implantation were reviewed. Mean age at implantation was 39 ± 13 years. Eight (18%) patients received both appropriate and inappropriate shocks, 6 (14%) received only appropriate shocks, and 3 (7%) received only inappropriate shocks. Three patients received inappropriate shocks for sinus tachycardia, 7 for atrial arrhythmias, and 1 for noise artifact. Inappropriately shocked patients had lower beat per minute (bpm) cutoff values for ICD therapy (mean = 162 ± 24 bpm vs. 182 ± 16 bpm, p = 0.007). After inappropriate shocks, 1 patient underwent lead replacement, 1 had the VT cutoff increased, and 6 were treated with medications. Conclusions One quarter of TOF patients with ICDs experienced inappropriate shock therapy, the timing of which was most often clustered within the first two years after implant or years later. Lower shock therapy zones were associated with increased risk for inappropriate shocks, and the majority of inappropriate shocks resulted from atrial arrhythmias with rapid ventricular response. Treatments for inappropriate shocks included increasing VT therapy bpm and rhythm and/or rate control medications.
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Affiliation(s)
| | | | | | | | | | - Angelo B. Biviano
- Corresponding author at: Associate Professor of Medicine, Cardiology at Columbia University, Columbia University Medical Center, 161 Fort Washington Ave #546, New York, NY 10032, USA.
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47
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Nomura Y, Kato T, Nishihara E, Morishima I, Kuraishi K. Two-incision technique for the subcutaneous implantable cardioverter defibrillator. Pediatr Int 2020; 62:736-738. [PMID: 32424905 DOI: 10.1111/ped.14252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 05/24/2019] [Accepted: 11/07/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Yoji Nomura
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Taichi Kato
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eiki Nishihara
- Department of Pediatric Cardiology and Neonatology, Ogaki Municipal Hospital, Gifu, Japan
| | | | - Kenji Kuraishi
- Department of Pediatric Cardiology and Neonatology, Ogaki Municipal Hospital, Gifu, Japan
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48
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McCulloch MA, Lal AK, Knecht K, Butts RJ, Villa CR, Johnson JN, Conway J, Bock MJ, Schumacher KR, Law SP, Friedland-Little JM, Deshpande SR, West SC, Lytrivi ID, Gambetta KE, Wittlieb-Weber CA. Implantable Cardioverter Defibrillator Use in Males with Duchenne Muscular Dystrophy and Severe Left Ventricular Dysfunction. Pediatr Cardiol 2020; 41:925-931. [PMID: 32157397 DOI: 10.1007/s00246-020-02336-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/28/2020] [Indexed: 01/16/2023]
Abstract
Duchenne muscular dystrophy (DMD) is characterized by myocardial fibrosis and left ventricular (LV) dysfunction. Implantable cardioverter defibrillator (ICD) use has not been characterized in this population but is considered for symptomatic patients with severe LV dysfunction (SLVD) receiving guideline-directed medical therapy (GDMT). We evaluated ICD utilization and efficacy in patients with DMD. Retrospective cohort study of DMD patients from 17 centers across North America between January 2, 2005 and December 31, 2015. ICD use and its effect on survival were evaluated in patients with SLVD defined as ejection fraction (EF) < 35% and/ or shortening fraction (SF) < 16% on final echocardiogram. SLVD was present in 57/436 (13.1%) patients, of which 12 (21.1%) died during the study period. Of these 12, (mean EF 20.9 ± 6.2% and SF 13.7 ± 7.2%), 8 received GDMT, 5 received steroids, and none received an ICD. ICDs were placed in 9/57 (15.8%) patients with SLVD (mean EF 31.2 ± 8.5% and SF 10.3 ± 4.9%) at a mean age of 20.4 ± 6.3 years; 8/9 received GDMT, 7 received steroids, and all were alive at study end; mean ICD duration was 36.1 ± 26.2 months. Nine ICDs were implanted at six different institutions, associated with two appropriate shocks for ventricular tachycardia in two patients, no inappropriate shocks, and one lead fracture. ICD use may be associated with improved survival and minimal complications in DMD cardiomyopathy with SLVD. However, inconsistent GDMT utilization may be a significant confounder. Future studies should define optimal indications for ICD implantation in patients with DMD cardiomyopathy.
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Affiliation(s)
- Michael A McCulloch
- Division of Pediatric Cardiology, University of Virginia Children's Hospital, PO Box 800386, Charlottesville, VA, 22903, USA.
| | - Ashwin K Lal
- Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA
| | - Kenneth Knecht
- Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ryan J Butts
- Children's Medical Center of Dallas, UT Southwestern Medical Center, Dallas, TX, USA
| | - Chet R Villa
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Jennifer Conway
- Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - Matthew J Bock
- Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Kurt R Schumacher
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Sabrina P Law
- Morgan Stanley Children's Hospital of New York Presbyterian, New York, NY, USA
| | | | | | - Shawn C West
- Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | | | - Katheryn E Gambetta
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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49
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Kurath-Koller S, Sallmon H, Scherr D, Bisping E, Burmas A, Knez I, Koestenberger M. Wearable cardioverter-defibrillator as bridging to ICD in pediatric hypertrophic cardiomyopathy with myocardial bridging - a case report. BMC Pediatr 2020; 20:207. [PMID: 32393291 PMCID: PMC7212673 DOI: 10.1186/s12887-020-02113-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 04/29/2020] [Indexed: 11/10/2022] Open
Abstract
Background There is only limited experience with wearable cardioverter-defibrillators (WCD) in pediatric patients. We report on the successful application of a WCD in an adolescent patient with hypertrophic cardiomyopathy and myocardial bridging. Case presentation A 15-year-old girl presented with a history of recurrent syncope, dyspnea, and vertigo with exercise. Diagnostic work-up revealed non-obstructive hypertrophic cardiomyopathy and signs of myocardial ischemia with exercise. Given this high-risk constellation, the patient was scheduled for prophylactic implantation of an implantable cardioverter-defibrillator (ICD). One month after initial presentation and days prior to the planned ICD implantation, the patient collapsed during an episode of sustained ventricular tachycardia (VT) while running. VT was terminated by WCD shock delivery. Following this event, computerized tomography scan revealed myocardial bridging of the left anterior descending coronary artery causing a 90% stenosis in systole. After coronary surgery, life threatening arrhythmias have not recurred, but due to progressive heart failure, the patient underwent successful heart transplantation after 2 years. Conclusions The reported case highlights the importance and applicability of WCDs and the potentially malign nature of myocardial bridging in pediatric high-risk patients.
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Affiliation(s)
- Stefan Kurath-Koller
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Hannes Sallmon
- Department of Pediatric Cardiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Daniel Scherr
- Division of Cardiology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Egbert Bisping
- Division of Cardiology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Ante Burmas
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
| | - Igor Knez
- Division of Cardiac Surgery, Department of Surgery, Medical University Graz, Graz, Austria
| | - Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
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50
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Abstract
Pediatric heart failure (PHF) is an important cause of mortality and morbidity. Whereas ischemic heart disease is the most important cause of heart failure in adults, congenital heart diseases (CHD) and cardiomyopathies are important etiologies of PHF. Management of PHF also differs from that of adults. Here authors have reviewed the literature on PHF with respect to etiology, symptoms, investigations and treatment strategies.
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Affiliation(s)
- Manojkumar Rohit
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Sudhansu Budakoty
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
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