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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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Prutkin JM, Wang Y, Escudero CA, Stephenson EA, Minges KE, Curtis JP, Hsu JC. Defibrillation Safety Margin Testing in Patients With Congenital Heart Disease: Results From the NCDR. JACC Clin Electrophysiol 2021; 7:1145-1154. [PMID: 33933411 DOI: 10.1016/j.jacep.2021.02.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/10/2021] [Accepted: 02/17/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This study analyzed the predictors of defibrillation safety margin (DSM) testing at the time of implantable cardioverter-defibrillator (ICD) insertion and factors associated with inadequate DSM in patients with congenital heart disease (CHD). BACKGROUND There are few data about the prevalence and safety of DSM testing in those with CHD. METHODS A retrospective analysis was performed of all patients with atrial or ventricular septal defect, tetralogy of Fallot, transposition of the great vessels, Ebstein anomaly, or common ventricle undergoing a transvenous ICD procedure in the National Cardiovascular Data Registry (NCDR) ICD Registry from April 2010 to March 2016, and DSM testing was assessed. Inadequate DSM was defined as a lowest successful energy tested <10 J than the maximum output of the ICD generator. RESULTS Of all ICD recipients (N = 7,024), DSM testing was performed in 52.0% (n = 3,654). The mean lowest successful energy tested was 20.7 ± 7.3 J. Of those with DSM adequacy data available (n = 3,623), an inadequate DSM occurred in 13.8% (n = 501). After multivariable adjustment, DSM testing was not associated with in-hospital complications or death (odds ratio [OR]: 1.00; 95% confidence interval [CI]: 0.79 to 1.28) but was associated with lower odds of prolonged hospital stay (>3 days) (OR: 0.71; 95% CI: 0.60 to 0.84; p < 0.0001). An inadequate DSM was not associated with in-hospital death or complications (OR: 1.27; 95% CI: 0.79 to 2.04) or prolonged hospital stay (OR: 1.34; 95% CI: 0.995 to 1.81). CONCLUSIONS DSM testing is being performed less frequently over time and seems safe in those with CHD. An inadequate DSM was not associated with worse in-hospital outcomes.
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Affiliation(s)
- Jordan M Prutkin
- Division of Cardiology, Section of Electrophysiology, University of Washington, Seattle, Washington, USA.
| | - Yongfei Wang
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA; Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Carolina A Escudero
- Division of Pediatric Cardiology, Section of Electrophysiology, University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada
| | | | - Karl E Minges
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Jeptha P Curtis
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA; Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Jonathan C Hsu
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California-San Diego, La Jolla, California, USA
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Backhoff D, Müller MJ, Dakna M, Leha A, Schneider H, Krause U, Paul T. Value of defibrillation threshold testing in children with nontransvenous implantable cardioverter defibrillators: Are routine DFT tests indicated? Pacing Clin Electrophysiol 2020; 43:805-813. [DOI: 10.1111/pace.14003] [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: 05/10/2020] [Revised: 06/22/2020] [Accepted: 06/28/2020] [Indexed: 11/30/2022]
Affiliation(s)
- David Backhoff
- Department of Pediatric Cardiology and Intensive Care Medicine Georg August University Medical Center Göttingen Germany
| | - Matthias J. Müller
- Department of Pediatric Cardiology and Intensive Care Medicine Georg August University Medical Center Göttingen Germany
| | - Mohammed Dakna
- Department of Medical Statistics University Medical Center Göttingen Göttingen Germany
| | - Andreas Leha
- Department of Medical Statistics University Medical Center Göttingen Göttingen Germany
| | - Heike Schneider
- Department of Pediatric Cardiology and Intensive Care Medicine Georg August University Medical Center Göttingen Germany
| | - Ulrich Krause
- Department of Pediatric Cardiology and Intensive Care Medicine Georg August University Medical Center Göttingen Germany
| | - Thomas Paul
- Department of Pediatric Cardiology and Intensive Care Medicine Georg August University Medical Center Göttingen Germany
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Prevalence, predictors and complications with defibrillation threshold testing in pediatric patients: Results from the NCDR. Int J Cardiol 2020; 305:44-49. [DOI: 10.1016/j.ijcard.2020.01.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/30/2019] [Accepted: 01/13/2020] [Indexed: 11/17/2022]
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Baskar S, Bao H, Minges KE, Spar DS, Czosek RJ. Characteristics and Outcomes of Pediatric Patients Who Undergo Placement of Implantable Cardioverter Defibrillators: Insights From the National Cardiovascular Data Registry. Circ Arrhythm Electrophysiol 2019; 11:e006542. [PMID: 30354291 DOI: 10.1161/circep.118.006542] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Implantable cardioverter defibrillators (ICDs) are an important part of therapy for many patients, yet there is little data on population characteristics, complications, or system survival in pediatric patients. Methods A retrospective review of ICD recipients in the National Cardiovascular Data Registry ICD Registry was performed from 2010 to 2016. Patient characteristics and complications between pediatric (≤21 years) and adult populations (>21 years) were compared. Variables associated with complications and early device interventions within the pediatric cohort were evaluated using multivariate modeling. Results There were 562 209 total ICD implants, of which 3461 occurred in the pediatric cohort. Among the pediatric patients, 60% of implants were for primary prevention, and nonischemic cardiomyopathy was the most common underlying disease (60%). Over time, there was an increasing trend of both primary and secondary prevention ICD implantations ( P<0.05). Compared with adults, pediatric patients were more likely to have structural heart disease, hypertrophic cardiomyopathy, and channelopathy, and to receive a single-chamber device (all P<0.001). There was no difference in inhospital complications between the adult and pediatric cohorts (2.4% versus 2.6%, P=0.3). However, among the pediatric patients, lower weight, Ebstein anomaly, worse New York Heart Association class, dual chamber, and cardiac resynchronization therapy-defibrillator were associated with greater risk of complications. Although reintervention for generator replacement or upgrade was more common in adults, the time to reintervention was shorter in the pediatric cohort. Conclusions We observed an increasing trend in ICD device implantation among pediatric patients. The pediatric cohort had similar inhospital complication rates compared with adults but had a shorter time to reintervention.
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Affiliation(s)
- Shankar Baskar
- The Heart Institute, Cincinnati Children's Hospital Medical Center, OH (S.B., D.S.S., R.J.C.)
| | - Haikun Bao
- Center for Outcomes Research and Evaluation, Yale-New Haven Health Services Corporation, CT (H.B., K.E.M.)
| | - Karl E Minges
- Center for Outcomes Research and Evaluation, Yale-New Haven Health Services Corporation, CT (H.B., K.E.M.).,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (K.E.M.)
| | - David S Spar
- The Heart Institute, Cincinnati Children's Hospital Medical Center, OH (S.B., D.S.S., R.J.C.)
| | - Richard J Czosek
- The Heart Institute, Cincinnati Children's Hospital Medical Center, OH (S.B., D.S.S., R.J.C.)
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Kannabhiran M, Mustafa U, Acharya M, Telles N, Alexandria B, Reddy P, Dominic P. Routine DFT testing in patients undergoing ICD implantation does not improve mortality: A systematic review and meta-analysis. J Arrhythm 2018; 34:598-606. [PMID: 30555603 PMCID: PMC6288554 DOI: 10.1002/joa3.12109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 07/24/2018] [Indexed: 01/30/2023] Open
Abstract
Defibrillation threshold (DFT) testing has been an integral part of implantable cardioverter-defibrillator (ICD) implantation to confirm appropriate sensing of ventricular fibrillation and to establish an adequate safety margin for defibrillation. However, there is a lack of evidence regarding benefits of routine DFT testing. Therefore, we performed a meta-analysis to assess its mortality benefit. We searched MEDLINE for studies comparing mortality outcomes in ICD recipients who underwent DFT testing to those who did not. For the second analysis, studies comparing outcomes in patients with high- vs low-energy DFT were included. Odds ratio and standard errors were calculated, and inverse variance method in a random-effect model was used to combine effect sizes. Fifteen studies with 10,975 subjects comparing outcomes in patients who underwent routine DFT testing during ICD implantation and those who did not were included. There was no difference in the group that did not undergo DFT testing with regards to all-cause mortality (OR 0.935; CI 0.725-1.207; P = 0.606), cardiac mortality (OR 0.709; CI 0.385-1.307; P = 0.271), noncardiac mortality (OR 0.921; CI 0.701-1.210; P = 0.554), and arrhythmic mortality (OR 1.152; CI 0.831-1.596; P = 0.396). Percentage of successful appropriate first shocks among the two groups showed no difference. Five studies with 2278 subjects were included in the second analysis comparing patients with low DFT vs high DFT. Patients with high DFT had no significant increase in all-cause mortality compared to patients with low DFT (OR 0.527; CI 0.034-8.107; P = 0.646). Patients requiring higher DFT had no increased all-cause mortality compared to patients with lower DFT. Routine DFT testing during ICD implantation does not confer any significant benefit.
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Affiliation(s)
- Munish Kannabhiran
- The Department of Medicine/Division of Cardiology and Center for Cardiovascular Diseases & SciencesLouisiana State University Health Sciences Center‐ Shreveport (LSUHSC‐S)ShreveportLouisiana
| | - Usman Mustafa
- The Department of Medicine/Division of Cardiology and Center for Cardiovascular Diseases & SciencesLouisiana State University Health Sciences Center‐ Shreveport (LSUHSC‐S)ShreveportLouisiana
| | - Madan Acharya
- The Department of Medicine/Division of Cardiology and Center for Cardiovascular Diseases & SciencesLouisiana State University Health Sciences Center‐ Shreveport (LSUHSC‐S)ShreveportLouisiana
| | - Nelson Telles
- The Department of Medicine/Division of Cardiology and Center for Cardiovascular Diseases & SciencesLouisiana State University Health Sciences Center‐ Shreveport (LSUHSC‐S)ShreveportLouisiana
| | - Brackett Alexandria
- The Department of Medicine/Division of Cardiology and Center for Cardiovascular Diseases & SciencesLouisiana State University Health Sciences Center‐ Shreveport (LSUHSC‐S)ShreveportLouisiana
| | - Pratap Reddy
- The Department of Medicine/Division of Cardiology and Center for Cardiovascular Diseases & SciencesLouisiana State University Health Sciences Center‐ Shreveport (LSUHSC‐S)ShreveportLouisiana
| | - Paari Dominic
- The Department of Medicine/Division of Cardiology and Center for Cardiovascular Diseases & SciencesLouisiana State University Health Sciences Center‐ Shreveport (LSUHSC‐S)ShreveportLouisiana
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Müller MJ, Dieks JK, Backhoff D, Schneider HE, Ruschewski W, Tirilomis T, Paul T, Krause U. Efficacy and safety of non-transvenous cardioverter defibrillators in infants and young children. J Interv Card Electrophysiol 2018; 54:151-159. [PMID: 30255451 DOI: 10.1007/s10840-018-0451-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 09/07/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Implantable cardioverter defibrillators (ICD) protect from sudden cardiac death (SCD). In infants and young children, ICD implantation and programming is challenging due to small body size, elevated heart rates, and high physical activity. PURPOSE We report our experience applying a non-transvenous ICD (NT-ICD) system to infants and children < 12 years of age and < 45-kg body weight. METHODS Between 07/2004 and 07/2016, NT-ICD had been implanted in 36 patients. Nine out of 36 patients (25%) had NT-ICD implantation for primary and 27/36 (75%) for secondary prevention. Underlying diseases included inherited primary electrical arrhythmogenic diseases (n = 26; 72%), cardiomyopathies (n = 8; 22%), and congenital heart defects (n = 2; 6%). The median (interquartile range) age at implantation was 6 (1.9-8.4) years, and the median body weight was 21.7 (11.2-26.8) kg. Three different NT-ICD implantation techniques had been applied over time: (1) abdominal device/subcutaneous shock coil, (2) abdominal device/pleural shock coil, and (3) subcardiac device/pleural shock coil. RESULTS During median follow-up of 5.2 (2.7-7.2) years, appropriate ICD discharges were documented in 12 (33.3%) and inappropriate shocks in 4 patients (11.1%). In 12/36 individuals (33.3%), a total of 25 surgical revisions were required due to NT-ICD malfunction. Eighteen out of 25 (72%) surgical revisions were necessary in patients with subcutaneous shock coil/abdominal device position. Surgical revisions (3/25, 12%) were significantly reduced (p < 0.001) after modifying the implantation technique to subcardiac device/pleural shock coil. CONCLUSIONS NT-ICD was safe and effective in infants and young children. Appropriate ICD discharges occurred in a considerable number of patients. After modifying the implantation technique, the need for surgical revision could significantly be decreased.
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Affiliation(s)
- Matthias J Müller
- Department of Pediatric Cardiology and Intensive Care, University Medical Center, Georg August University Goettingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
| | - Jana K Dieks
- Department of Pediatric Cardiology and Intensive Care, University Medical Center, Georg August University Goettingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - David Backhoff
- Department of Pediatric Cardiology and Intensive Care, University Medical Center, Georg August University Goettingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Heike E Schneider
- Department of Pediatric Cardiology and Intensive Care, University Medical Center, Georg August University Goettingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Wolfgang Ruschewski
- Department of Thoracic, Heart, and Cardiovascular Surgery, University Medical Center, Georg August University Goettingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Theodor Tirilomis
- Department of Thoracic, Heart, and Cardiovascular Surgery, University Medical Center, Georg August University Goettingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Thomas Paul
- Department of Pediatric Cardiology and Intensive Care, University Medical Center, Georg August University Goettingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Ulrich Krause
- Department of Pediatric Cardiology and Intensive Care, University Medical Center, Georg August University Goettingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
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Kriebel T, Müller MJ, Ruschewski W, Krause U, Paul T, Schneider H. Value of Regular Defibrillation Threshold Testing After Extracardiac Implantable Cardioverter Defibrillator Placement in Small Children During Mid-Term Follow-Up. JACC Clin Electrophysiol 2018; 4:936-943. [PMID: 30025695 DOI: 10.1016/j.jacep.2018.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 03/05/2018] [Accepted: 03/15/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The purpose of this study was to analyze course of defibrillation threshold (DFT) with growth. BACKGROUND Data on regular DFT testing after extracardiac implantable cardioverter-defibrillator (ICD) placement in infants and small children is still limited. METHODS An extracardiac ICD was placed in 23 pediatric patients (median age 6.1 years; median body weight 21 kg, median length 120 cm). The defibrillator lead was tunneled pleurally, and the device was placed as "active can" in the right upper abdomen or in a horizontal position between the diaphragm and the pericardium, respectively. DFT was verified intraoperatively, 3 months later, and every 12 months thereafter. The aim was to achieve DFT <15 J allowing ICD programming with a double safety margin above DFT. RESULTS In all 23 patients, an intraoperative DFT <15 J could be accomplished. Serial DFT testing showed an increase from a median DFT of 10 J intraoperatively to 15 J after 1 year. During mean follow-up of 2.0 years, a significant correlation between DFT and body length, but not body weight, was observed. In 4 of 23 (17%) patients, surgical revision was required because of a DFT increase >20 J during regular DFT testing. No complications regarding DFT testing were noted. CONCLUSIONS After extracardiac ICD placement in infants and small children, DFT increase related to body length was evident during mid-term follow-up. Routine serial DFT testing was a safe procedure and identified a significant DFT increase in 4 of 23 patients. Serial DFT testing during follow-up in these patients is recommended.
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Affiliation(s)
- Thomas Kriebel
- Department of Pediatric Cardiology and Intensive Care Medicine, George August University Medical Center, Göttingen, Germany.
| | - Matthias J Müller
- Department of Pediatric Cardiology and Intensive Care Medicine, George August University Medical Center, Göttingen, Germany
| | - Wolfgang Ruschewski
- Department of Thoracic and Cardiovascular Surgery, Georg August University Medical Center, Göttingen, Germany
| | - Ulrich Krause
- Department of Pediatric Cardiology and Intensive Care Medicine, George August University Medical Center, Göttingen, Germany
| | - Thomas Paul
- Department of Pediatric Cardiology and Intensive Care Medicine, George August University Medical Center, Göttingen, Germany
| | - Heike Schneider
- Department of Pediatric Cardiology and Intensive Care Medicine, George August University Medical Center, Göttingen, Germany
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Chubb H, Rosenthal E. Implantable cardioverter-defibrillators in congenital heart disease. Herzschrittmacherther Elektrophysiol 2016; 27:95-103. [PMID: 27250725 PMCID: PMC4894938 DOI: 10.1007/s00399-016-0437-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 05/06/2016] [Indexed: 01/28/2023]
Abstract
Implantable cardioverter-defibrillators (ICD) have an important role in reducing sudden cardiac death in patients with congenital heart disease (CHD); however, the benefit of ICDs needs to be weighed up against both short-term and long-term adverse effects, which are difficult to evaluate in the heterogeneous CHD population. A tailored approach, taking into account risk stratification and patient-specific factors, is needed to select the most appropriate strategy. This review discusses primary and secondary ICD indications, implantation approaches and long-term follow-up. Recent publications have shed light on the concerns of system longevity, lead extractions, inappropriate shocks and impact on the quality of life. All of these factors require consideration prior to commitment to this long-term treatment strategy.
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Affiliation(s)
- H Chubb
- Department of Paediatric Cardiology, Evelina London Children's Hospital, Westminster Bridge Road, SE1 7EH, London, UK
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - E Rosenthal
- Department of Paediatric Cardiology, Evelina London Children's Hospital, Westminster Bridge Road, SE1 7EH, London, UK.
- Adult Congenital Heart Disease Group, Departments of Cardiology at Guy's and St Thomas' NHS Foundation Trust & Evelina London Children's Hospital, London, UK.
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Defibrillation Threshold Testing: Who Doesn't Get It? Card Electrophysiol Clin 2016; 4:135-41. [PMID: 26939810 DOI: 10.1016/j.ccep.2012.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Defibrillation testing has been routinely performed as part of the implantable cardioverter-defibrillator (ICD) implantation procedure, and is currently supported by practice guidelines; however, more recently, this practice has been called into question. Such testing is safe, and serious complications are rare. With modern ICD systems, physicians will rarely encounter a patient in whom defibrillation will fail. This article reviews the literature regarding the utility, necessity, complications, and cost of routine operative and follow-up defibrillation testing, and, it is hoped, clarifies the issue of "Who doesn't get it?"
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Khairy P, Van Hare GF, Balaji S, Berul CI, Cecchin F, Cohen MI, Daniels CJ, Deal BJ, Dearani JA, Groot ND, Dubin AM, Harris L, Janousek J, Kanter RJ, Karpawich PP, Perry JC, Seslar SP, Shah MJ, Silka MJ, Triedman JK, Walsh EP, Warnes CA. PACES/HRS expert consensus statement on the recognition and management of arrhythmias in adult congenital heart disease: developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American College of Cardiology (ACC), the American Heart Association (AHA), the European Heart Rhythm Association (EHRA), the Canadian Heart Rhythm Society (CHRS), and the International Society for Adult Congenital Heart Disease (ISACHD). Can J Cardiol 2014; 30:e1-e63. [PMID: 25262867 DOI: 10.1016/j.cjca.2014.09.002] [Citation(s) in RCA: 151] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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12
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Khairy P, Van Hare GF, Balaji S, Berul CI, Cecchin F, Cohen MI, Daniels CJ, Deal BJ, Dearani JA, Groot ND, Dubin AM, Harris L, Janousek J, Kanter RJ, Karpawich PP, Perry JC, Seslar SP, Shah MJ, Silka MJ, Triedman JK, Walsh EP, Warnes CA. PACES/HRS Expert Consensus Statement on the Recognition and Management of Arrhythmias in Adult Congenital Heart Disease: developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American College of Cardiology (ACC), the American Heart Association (AHA), the European Heart Rhythm Association (EHRA), the Canadian Heart Rhythm Society (CHRS), and the International Society for Adult Congenital Heart Disease (ISACHD). Heart Rhythm 2014; 11:e102-65. [PMID: 24814377 DOI: 10.1016/j.hrthm.2014.05.009] [Citation(s) in RCA: 380] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Indexed: 02/07/2023]
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Radbill AE, Triedman JK, Berul CI, Walsh EP, Alexander ME, Webster G, Cecchin F. Prospective evaluation of defibrillation threshold and postshock rhythm in young ICD recipients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:1487-93. [PMID: 22978847 DOI: 10.1111/j.1540-8159.2012.03519.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Adaptation of implantable cardioverter defibrillator (ICD) systems to the needs of pediatric and congenital heart patients is problematic due to constraints of vascular and thoracic anatomy. An improved understanding of the defibrillation energy and postshock pacing requirements in such patients may help direct more tailored ICD therapy. We describe the first prospective evaluation of defibrillation threshold (DFT) and postshock rhythm in this population. METHODS We prospectively studied patients ≤ 60 kg at time of ICD intervention. DFTs were obtained using a binary search protocol with three VF inductions. Postshock pacing was programmed using a stepwise protocol, lowering the rate prior to each VF induction. RESULTS Twenty patients were enrolled: 11 had channelopathy, five congenital heart disease, and four cardiomyopathy. The median age was 16 years, median weight 48 kg. Twelve patients had a transvenous high-voltage coil; eight had pericardial +/- subcutaneous coil(s). Median DFT was 7 J (range 3-31 J); 19/20 patients had DFT ≤ 15 J and all patients <25 kg had DFT ≤ 9 J (n = 6). There was no difference in DFT between patients with transvenous versus pericardial +/- subcutaneous coils (median 7 J vs 6 J, P = 0.59). No patient with normal atrioventricular conduction prior to defibrillation required postshock pacing (n = 16). There were no adverse events. CONCLUSIONS These data suggest that many pediatric ICD patients have low DFTs and adequate postshock escape rhythm. This may help determine appropriate parameters for future design of pediatric-specific ICDs.
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Affiliation(s)
- Andrew E Radbill
- Department of Pediatrics, Vanderbilt University School of Medicine, and the Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee 37232-9119, USA.
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Update on the Use and Outcomes of Implantable Cardioverter Defibrillators in Pediatric Patients. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2012; 14:435-42. [DOI: 10.1007/s11936-012-0202-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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SHAH MAULLYJ. Implantable Cardioverter Defibrillator-Related Complications in the Pediatric Population. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32 Suppl 2:S71-4. [DOI: 10.1111/j.1540-8159.2009.02389.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tomaske M, Pretre R, Rahn M, Bauersfeld U. Epicardial and pleural lead ICD systems in children and adolescents maintain functionality over 5 years. Europace 2008; 10:1152-6. [DOI: 10.1093/europace/eun214] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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TOMASKE MAREN, BAUERSFELD URS. Experience with Implantable Cardioverter-Defibrillator Therapy in Grown-Ups with Congenital Heart Disease. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31 Suppl 1:S35-7. [DOI: 10.1111/j.1540-8159.2008.00953.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Kantoch MJ, Rebeyka IM, Houlden LA, Dyck JD. Direct intracardiac placement of an automatic implantable cardioverter defibrillator coil lead in a small child. ACTA ACUST UNITED AC 2007; 9:669-71. [PMID: 17468297 DOI: 10.1093/europace/eum036] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A 3.5-year-old child with hypertrophic obstructive cardiomyopathy and recurrent syncope underwent surgical left-ventricular outflow tract myectomy and implantation of a single-chamber automatic cardioverter defibrillator. A single-coil active fixation lead was introduced via a purse-string suture in the right atrial appendage and the lead tip positioned and fixed in the right-ventricular apex under direct visualization via a small right atriotomy incision. Described configuration may be considered in small children undergoing intracardiac surgery at the time of defibrillator implantation.
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Affiliation(s)
- Michal J Kantoch
- 4C3 WMC Health Sciences Centre, Division of Pediatric Cardiology, Department of Pediatrics and Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada T6G 2B7.
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Bar-Cohen Y, Silka MJ. Congenital long QT syndrome: Diagnosis and management in pediatric patients. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2006; 8:387-95. [PMID: 16939677 DOI: 10.1007/s11936-006-0043-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The long QT syndrome (LQTS) is characterized by electrocardiographic abnormalities and a high incidence of syncope and sudden cardiac death (SCD). The diagnosis is suggested when ventricular repolarization abnormalities result in prolongation of the corrected QT interval. When LQTS is suspected, genetic screening may identify a specific long QT subtype and provide guidance for appropriate therapy. Treatment depends on the relative risk of SCD, which is increased with longer QT durations, prior cardiac events, and a family history of SCD. beta Blockers are considered the initial treatment of choice, with implantable cardioverter-defibrillator (ICD) therapy warranted in high-risk patients. In patients with frequent ICD shocks or in those at high risk for SCD where ICD placement cannot be performed, cardiac pacing and/or left cardiac sympathetic denervation may be indicated.
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Affiliation(s)
- Yaniv Bar-Cohen
- Department of Pediatrics, Division of Cardiology, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #34, Los Angeles, CA 90027, USA.
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Stephenson EA, Kaltman JR. Current state of the art for use of pacemakers and defibrillators in patients with congenital cardiac malformations. Cardiol Young 2006; 16 Suppl 3:151-6. [PMID: 17378055 DOI: 10.1017/s1047951106001090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
As patients with congenital cardiac malformations increasingly survive therapeutic interventions, and our understanding of primary electrical diseases increases, the landscape of paediatric and congenital electrophysiology is expanding. Electrophysiologic abnormalities, both tachycardic and bradycardic, are commonly seen in post-operative patients with congenital cardiac disease, as well as being part of the natural history of congenital malformations and cardiomyopathies. Disturbances of rhythm represent an increasing morbidity in this population, and therapies using devices in the form of pacemakers and implantable cardioverter-defibrillators have taken on a correspondingly important role. In this review, we discuss some of the key features and recent advances in pacing for bradycardia, resynchronization pacing, anti-tachycardia pacing, and use of implantable cardioverter-defibrillators.
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Kugler JD, Erickson CC. Nontransvenous implantable cardioverter defibrillator systems: not just for small pediatric patients. J Cardiovasc Electrophysiol 2006; 17:47-8. [PMID: 16426399 DOI: 10.1111/j.1540-8167.2005.00309.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Stephenson EA, Batra AS, Knilans TK, Gow RM, Gradaus R, Balaji S, Dubin AM, Rhee EK, Ro PS, Thøgersen AM, Cecchin F, Triedman JK, Walsh EP, Berul CI. A Multicenter Experience with Novel Implantable Cardioverter Defibrillator Configurations in the Pediatric and Congenital Heart Disease Population. J Cardiovasc Electrophysiol 2006; 17:41-6. [PMID: 16426398 DOI: 10.1111/j.1540-8167.2005.00271.x] [Citation(s) in RCA: 195] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In pediatric and congenital heart disease patients, transvenous ICD implantation may be limited secondary to patient size, venous, or cardiac anatomy. Epicardial patches require a thoracotomy, and may lead to a restrictive pericardial process. Because of these issues, we have explored novel ICD configurations. METHODS Retrospective review at 10 centers implanting ICDs without a transvenous shocking coil or epicardial patches. RESULTS Twenty-two patients underwent implant at a mean age of 8.9 years (range: 0.3-43.5), with a mean weight of 25.5 kg (range: 5.2-70). Diagnoses included complex CHD, intracardiac tumors, cardiomyopathy, idiopathic VT, LV noncompaction, and long QT syndrome. Three configurations were used: subcutaneous array, a transvenous design ICD lead placed on the epicardium, or a transvenous design ICD lead placed subcutaneously. Difficulties were found at implant in 8 patients: 4 had difficulty inducing VT/VF, and 4 had high DFTs. Over a mean follow-up of 2.2 years (range: 0.2-10.5), 7 patients had appropriate shocks. Inappropriate shocks occurred in 4 patients. System revisions were required in 7 patients: 2 generator changes (in 1 patient), 3 pace-sense lead replacement, 1 additional subcutaneous coil placement due to increased DFT, 1 upgrade to a transvenous system, and 1 revision to epicardial patch system. CONCLUSIONS ICD implantation can be performed without epicardial patches or transvenous high-energy leads in this population, using individualized techniques. This will allow ICD use in patients who have intracardiac shunting or are deemed too small for transvenous ICD leads. The long-term outcome and possible complications are as yet unknown in this population, and they should be monitored closely with follow-up DFTs.
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STEPHENSON ELIZABETHA, BATRA ANJANS, KNILANS TIMOTHYK, GOW ROBERTM, GRADAUS RAINER, BALAJI SESHADRI, DUBIN ANNEM, RHEE EDWARDK, RO PAMELAS, THØGERSEN ANNAM, CECCHIN FRANK, TRIEDMAN JK, WALSH EDWARDP, BERUL CHARLESI. A Multicenter Experience with Novel Implantable Cardioverter Defibrillator Configurations in the Pediatric and Congenital Heart Disease Population. J Cardiovasc Electrophysiol 2005. [DOI: 10.1046/j.1540-8167.2003.02949.x-i1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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STEPHENSON ELIZABETHA, BATRA ANJANS, KNILANS TIMOTHYK, GOW ROBERTM, GRADAUS RAINER, BALAJI SESHADRI, DUBIN ANNEM, RHEE EDWARDK, RO PAMELAS, THOGERSEN ANNAM, CECCHIN FRANK, TRIEDMAN JK, WALSH EDWARDP, BERUL CHARLESI. A Multicenter Experience with Novel Implantable Cardioverter Defibrillator Configurations in the Pediatric and Congenital Heart Disease Population. J Cardiovasc Electrophysiol 2005. [DOI: 10.1111/j.1540-8167.2005.50209.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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