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Kohli U, von Alvensleben J, Srinivasan C. Subcutaneous Implantable Cardioverter Defibrillators in Pediatrics and Congenital Heart Disease. Card Electrophysiol Clin 2023; 15:e1-e16. [PMID: 38030336 DOI: 10.1016/j.ccep.2023.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Subcutaneous implantable cardioverter defibrillators (S-ICDs) are being used with increased frequency in children and patients with congenital heart disease. Vascular access complexities, intracardiac shunts, and specific anatomies make these devices particularly appealing for some of these patients. Alternative screening, implantation, and programming techniques should be considered based on patient size, body habitus, anatomy, procedural history, and preference. Appropriate and inappropriate shock rates are generally comparable to those seen with transvenous devices. Complications such as infection can occur, although their severity is likely to be less than that seen with transvenous devices. Technical advances are likely to further broaden S-ICD applicability.
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Affiliation(s)
- Utkarsh Kohli
- Division of Pediatric Cardiology, Department of Pediatrics, West Virginia University School of Medicine and West Virginia University Children's Heart Center, 64 Medical Center Drive, Robert C. Byrd Health Science Center, PO Box 9214, Morgantown, WV 26506-9214, USA.
| | - Johannes von Alvensleben
- Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, Aurora, CO 80045 720-777-1234, USA
| | - Chandra Srinivasan
- The Children's Hospital of Philadelphia; University of Perelman School of Medicine, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
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2
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Sarubbi B, Ciriello GD, Papaccioli G, Correra A, Romeo E, Grimaldi N, Colonna D, Palma M. Combined subcutaneous implantable cardioverter defibrillator and pacemaker devices in complex congenital heart disease: a single-center experienced based study. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01670-1. [PMID: 37878161 DOI: 10.1007/s10840-023-01670-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 10/11/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Subcutaneous implantable cardioverter defibrillators (S-ICD) are widely accepted therapy in congenital heart disease (CHD) patients at risk of life-threatening ventricular arrhythmias or sudden cardiac death (SCD) when pacing is not required. Occasionally, pacemaker (PM)-dependent CHD patients will subsequently develop an indication for a cardioverter defibrillator. The use of S-ICD in complex CHD patients who have had already PM devices implanted implies some specific considerations, as the safety for these patients in unknown and recommendations among physicians may vary widely. METHODS We review the data and studied the indications for S-ICD in complex CHD with previous PM and discuss its usefulness in clinical practice. RESULTS From a large cohort of 345 patients enrolled in the S-ICD Monaldi care registry, which encompass all the patients implanted in the Monaldi Hospital of Naples, we considered 11 consecutive complex CHD patients (10M/1F aged 40.4 ±18.4 years) who underwent S-ICD implant after a previous PM implant, from February 2015 to October 2022. Mean follow-up was 25.5 ± 22 months. All the patients showed a good compliance to the device system with no complications (infections or skin erosions). CONCLUSIONS In complex CHD with already implanted PM devices, S-ICD implant appears to be a safe alternative to PM upgrading to transvenous ICD system, avoiding abandoned leads or life-threatening lead extraction. However, there are important issues with regard to testing and programming that need to be addressed at the time of implantation.
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Affiliation(s)
- Berardo Sarubbi
- Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, Italy.
| | | | | | - Anna Correra
- Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, Italy
| | - Emanuele Romeo
- Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, Italy
| | - Nicola Grimaldi
- Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, Italy
| | - Diego Colonna
- Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, Italy
| | - Michela Palma
- Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, Italy
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3
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Paul T, Krause U, Sanatani S, Etheridge SP. Advancing the science of management of arrhythmic disease in children and adult congenital heart disease patients within the last 25 years. Europace 2023; 25:euad155. [PMID: 37622573 PMCID: PMC10450816 DOI: 10.1093/europace/euad155] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 08/26/2023] Open
Abstract
This review article reflects how publications in EP Europace have contributed to advancing the science of management of arrhythmic disease in children and adult patients with congenital heart disease within the last 25 years. A special focus is directed to congenital atrioventricular (AV) block, the use of pacemakers, cardiac resynchronization therapy devices, and implantable cardioverter defibrillators in the young with and without congenital heart disease, Wolff-Parkinson-White syndrome, mapping and ablation technology, and understanding of cardiac genomics to untangle arrhythmic sudden death in the young.
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Affiliation(s)
- Thomas Paul
- Department of Pediatric Cardiology, Intensive Care Medicine and Neonatology, Pediatric Heart Center, Georg-August-University Medical Center, Robert-Koch-Str, 40, Göttingen D-37075, Germany
| | - Ulrich Krause
- Department of Pediatric Cardiology, Intensive Care Medicine and Neonatology, Pediatric Heart Center, Georg-August-University Medical Center, Robert-Koch-Str, 40, Göttingen D-37075, Germany
| | - Shubhayan Sanatani
- Children’s Heart Centre, British Columbia Children’s Hospital, Vancouver, BC, Canada
| | - Susan P Etheridge
- Pediatric Cardiology, University of Utah School of Medicine and Primary Children’s Medical Center, Salt Lake City, UT
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4
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Mondésert B, Moore JP, Khairy P. Cardiac Implantable Electronic Devices in the Fontan Patient. Can J Cardiol 2022; 38:1048-1058. [PMID: 35588949 DOI: 10.1016/j.cjca.2022.04.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 12/22/2022] Open
Abstract
As a result of remarkable progress in operative techniques and cardiology care during childhood, Fontan patients continue to age and require team-based multidisciplinary expertise to manage complications encountered in adulthood. They face particular challenges in terms of altered hemodynamic stressors, cardiac and hepatic failure, and arrhythmias. Arrhythmias in Fontan patients are highly prevalent and associated with underlying anatomy, surgical technique, and postoperative sequelae. Diagnostic tools, treatments, and device strategies for arrhythmias in Fontan patients should be adapted to the specific anatomy, type of surgical repair, and clinical status. Great strides in our understanding of arrhythmia mechanisms, options and techniques to obtain access to relevant cardiac structures, and application of both old and new technologies have contributed to improving cardiac implantable electronic device (CIED) therapies for this unique population. In this state-of-the-art review, we discuss the various arrhythmias encountered in Fontan patients, their diagnosis, and options for treatment and prevention, with a focus on CIEDs. Throughout, access challenges particular to the Fontan circulation are considered. Recently developed technologies, such as the sub-cutaneous implantable cardioverter defibrillator carry the potential to be transformative but require awareness of Fontan-specific issues. Moreover, new leadless pacing technology represents a promising strategy that may soon become applicable to Fontan patients with sinus node dysfunction. CIEDs are essential tools in managing Fontan patients but the complex clinical scenarios that arise in this patient population are among the most challenging for the congenital electrophysiologist.
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Affiliation(s)
- Blandine Mondésert
- Adult Congenital Heart Disease Center, Montreal Heart Institute, Medicine Department, Université de Montréal, Montreal, Canada.
| | - Jeremy P Moore
- Division of Cardiology, Department of Medicine, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, CA; UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, CA; Division of Cardiology, Department of Pediatrics, UCLA Health System, Los Angeles, CA
| | - Paul Khairy
- Adult Congenital Heart Disease Center, Montreal Heart Institute, Medicine Department, Université de Montréal, Montreal, Canada
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5
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Wiles BM, Roberts PR, Allavatam V, Acharyya A, Vemishetty N, ElRefai M, Wilson DG, Maharatna K, Chen H, Morgan JM. Personalized subcutaneous implantable cardioverter-defibrillator sensing vectors generated by mathematical rotation increase device eligibility whilst preserving device performance. Europace 2022; 24:1267-1275. [PMID: 35022725 DOI: 10.1093/europace/euab310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/30/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS Approximately 5.7% of potential subcutaneous implantable cardioverter-defibrillator (S-ICD) recipients are ineligible by virtue of their vector morphology, with higher rates of ineligibility observed in some at-risk groups. Mathematical vector rotation is a novel technique that can generate a personalized sensing vector, one with maximal R:T ratio, using electrocardiogram (ECG) signal recorded from the present S-ICD location. METHODS AND RESULTS A cohort of S-ICD ineligible patients were identified through ECG screening of ICD patients with no ventricular pacing requirement and their personalized vectors were generated using ECG signal from a Holter monitor. Subcutaneous ICD eligibility in this cohort was then recalculated. In a separate cohort, episodes of arrhythmia were recorded in patients undergoing arrhythmia induction, and arrhythmia detection in standard S-ICD vectors was compared to rotated vectors using an S-ICD simulator. Ninety-two participants (mean age 64.9 ± 2.7 years) underwent screening and 5.4% were found to be S-ICD ineligible. Personalized vector generation increased the R:T ratio in these vectors from 2.21 to 7.21 (4.54-9.88, P < 0.001) increasing the cohort eligibility from 94.6% to 100%. Rotated S-ICD vectors also showed high ventricular fibrillation (VF) detection sensitivity (97.8%), low time to VF detection (6.1 s), and excellent tachycardia discrimination (sensitivity 96%, specificity 88%), with no significant differences between rotated and standard vectors. CONCLUSION In S-ICD ineligible patients, mathematical vector rotation can generate a personalized vector that is associated with a significant increase in R:T ratio, resulting in universal device eligibility in our cohort. Ventricular fibrillation detection efficacy, time to VF detection, and tachycardia discrimination were not affected by vector rotation.
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Affiliation(s)
- Benedict M Wiles
- Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK.,Faculty of Medicine, University of Southampton, Southampton, UK
| | - Paul R Roberts
- Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK.,Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Amit Acharyya
- Department of Electrical Engineering, Indian Institute of Technology, Hyderabad, India
| | - Naresh Vemishetty
- Department of Electrical Engineering, Indian Institute of Technology, Hyderabad, India
| | - Mohamed ElRefai
- Cardiac Rhythm Management Research Department, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK.,Faculty of Medicine, University of Southampton, Southampton, UK
| | - David G Wilson
- Cardiology Department, Worcestershire Acute Hospitals NHS Foundation Trust, Worcester, UK
| | - Koushik Maharatna
- School of Electronics and Computer Science, University of Southampton, Southampton, UK
| | - Hanjie Chen
- School of Electronics and Computer Science, University of Southampton, Southampton, UK
| | | | - John M Morgan
- Faculty of Medicine, University of Southampton, Southampton, UK.,Cardiac Rhythm Management, Boston Scientific, Marlborough, MA, USA
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6
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Wang L, Javadekar N, Rajagopalan A, Rogovoy NM, Haq KT, Broberg CS, Tereshchenko LG. Eligibility for subcutaneous implantable cardioverter-defibrillator in congenital heart disease. Heart Rhythm 2021; 17:860-869. [PMID: 32354451 DOI: 10.1016/j.hrthm.2020.01.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/08/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Adult congenital heart disease (ACHD) patients can benefit from a subcutaneous implantable cardioverter-defibrillator (S-ICD). OBJECTIVE The purpose of this study was to assess left- and right-sided S-ICD eligibility in ACHD patients, use machine learning to predict S-ICD eligibility in ACHD patients, and transform 12-lead electrocardiogram (ECG) to S-ICD 3-lead ECG, and vice versa. METHODS ACHD outpatients (n = 101; age 42 ± 14 years; 52% female; 85% white; left ventricular ejection fraction [LVEF] 56% ± 9%) were enrolled in a prospective study. Supine and standing 12-lead ECG were recorded simultaneously with a right- and left-sided S-ICD 3-lead ECG. Peak-to-peak QRS and T amplitudes; RR, PR, QT, QTc, and QRS intervals; Tmax, and R/Tmax (31 predictor variables) were tested. Model selection, training, and testing were performed using supine ECG datasets. Validation was performed using standing ECG datasets and an out-of-sample non-ACHD population (n = 68; age 54 ± 16 years; 54% female; 94% white; LVEF 61% ± 8%). RESULTS Forty percent of participants were ineligible for S-ICD. Tetralogy of Fallot patients passed right-sided screening (57%) more often than left-sided screening (21%; McNemar χ2P = .025). Female participants had greater odds of eligibility (adjusted odds ratio [OR] 5.9; 95% confidence interval [CI] 1.6-21.7; P = .008). Validation of the ridge models was satisfactory for standing left-sided (receiver operating characteristic area under the curve [ROC AUC] 0.687; 95% CI 0.582-0.791) and right-sided (ROC AUC 0.655; 95% CI 0.549-0.762) S-ICD eligibility prediction. Validation of transformation matrices showed satisfactory agreement (<0.1 mV difference). CONCLUSION Nearly half of the contemporary ACHD population is ineligible for S-ICD. The odds of S-ICD eligibility are greater for female than for male ACHD patients. Machine learning prediction of S-ICD eligibility can be used for screening of S-ICD candidates.
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Affiliation(s)
- Linda Wang
- Oregon Health & Science University, Knight Cardiovascular Institute, Portland, Oregon
| | - Neeraj Javadekar
- Oregon Health & Science University, Knight Cardiovascular Institute, Portland, Oregon
| | - Ananya Rajagopalan
- Oregon Health & Science University, Knight Cardiovascular Institute, Portland, Oregon
| | - Nichole M Rogovoy
- Oregon Health & Science University, Knight Cardiovascular Institute, Portland, Oregon
| | - Kazi T Haq
- Oregon Health & Science University, Knight Cardiovascular Institute, Portland, Oregon
| | - Craig S Broberg
- Oregon Health & Science University, Knight Cardiovascular Institute, Portland, Oregon
| | - Larisa G Tereshchenko
- Oregon Health & Science University, Knight Cardiovascular Institute, Portland, Oregon.
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7
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Zormpas C, Silber-Peest AS, Eiringhaus J, Hillmann HAK, Hohmann S, Müller-Leisse J, Westhoff-Bleck M, Veltmann C, Duncker D. Author reply: S-ICD eligibilities in adults with congenital heart disease. ESC Heart Fail 2021; 8:3444-3446. [PMID: 34121341 PMCID: PMC8318500 DOI: 10.1002/ehf2.13467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 05/31/2021] [Indexed: 12/13/2022] Open
Affiliation(s)
- Christos Zormpas
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.,Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | | | - Jörg Eiringhaus
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.,Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Henrike A K Hillmann
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.,Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Stephan Hohmann
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.,Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Johanna Müller-Leisse
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.,Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | | | - Christian Veltmann
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.,Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.,Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
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8
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Sarubbi B, Correra A, Colonna D, Romeo E, Palma M, Merola A, D'Alto M, Scognamiglio G, Fusco F, Barracano R, Borrelli N, Grimaldi N, D'Onofrio A, Russo MG. Subcutaneous implantable cardioverter defibrillator in complex adult congenital heart disease. Results from the S-ICD “Monaldi Care” registry. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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9
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Zormpas C, Silber‐Peest AS, Eiringhaus J, Hillmann HA, Hohmann S, Müller‐Leisse J, Westhoff‐Bleck M, Veltmann C, Duncker D. Eligibility for subcutaneous implantable cardioverter-defibrillator in adults with congenital heart disease. ESC Heart Fail 2021; 8:1502-1508. [PMID: 33538124 PMCID: PMC8006645 DOI: 10.1002/ehf2.13243] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/30/2020] [Accepted: 01/19/2021] [Indexed: 01/06/2023] Open
Abstract
AIMS Patients with adult congenital heart disease (ACHD) carry an increased risk for sudden cardiac death. Implantable cardioverter-defibrillator (ICD) therapy may be challenging in these patients due to anatomical barriers, repeated cardiac surgery, or complicated transvenous access. Thus, the subcutaneous ICD (S-ICD) can be a promising alternative in this patient population. Patients with ACHD show significant electrocardiogram (ECG) abnormalities, which could affect S-ICD sensing because it depends on surface ECG. METHODS AND RESULTS One hundred patients with ACHD were screened for S-ICD eligibility. Standard ECG-based screening test and automated S-ICD screening test were performed in all patients. Sixty-six patients (66%) were male. Underlying congenital heart disease (CHD) was mainly CHD of great complexity (71%) and moderate complexity (29%), including repaired tetralogy of Fallot (20%), which was the most common entity. Thirty-seven patients (37%) already had a pacemaker (23%) or ICD (14%) implanted. Automated screening test identified 83 patients (83%) eligible for S-ICD implantation in either left parasternal position (78%) or right parasternal position (75%). Absence of sinus rhythm, QRS duration, and a paced QRS complex were associated with S-ICD screening failure in univariate analysis. Receiver operating characteristic curve and multivariate analysis revealed a QRS duration ≥148 ms as the only independent predictor for S-ICD screening failure. CONCLUSIONS Patients with ACHD show satisfactory eligibility rates (83%) for S-ICD implantation utilizing the automated screening test, including patients with CHD of high complexity. S-ICD therapy should be considered with caution in ACHD patients with a QRS duration ≥148 ms and/or need for ventricular pacing.
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MESH Headings
- Adult
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Defibrillators, Implantable
- Eligibility Determination
- Heart Defects, Congenital/complications
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/therapy
- Humans
- Male
- Patient Selection
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Affiliation(s)
- Christos Zormpas
- Hannover Heart Rhythm Center, Department of Cardiology and AngiologyHannover Medical SchoolCarl‐Neuberg‐Str. 1HannoverD‐30625Germany
- Department of Cardiology and AngiologyHannover Medical SchoolHannoverGermany
| | | | - Jörg Eiringhaus
- Hannover Heart Rhythm Center, Department of Cardiology and AngiologyHannover Medical SchoolCarl‐Neuberg‐Str. 1HannoverD‐30625Germany
- Department of Cardiology and AngiologyHannover Medical SchoolHannoverGermany
| | - Henrike A.K. Hillmann
- Hannover Heart Rhythm Center, Department of Cardiology and AngiologyHannover Medical SchoolCarl‐Neuberg‐Str. 1HannoverD‐30625Germany
- Department of Cardiology and AngiologyHannover Medical SchoolHannoverGermany
| | - Stephan Hohmann
- Hannover Heart Rhythm Center, Department of Cardiology and AngiologyHannover Medical SchoolCarl‐Neuberg‐Str. 1HannoverD‐30625Germany
- Department of Cardiology and AngiologyHannover Medical SchoolHannoverGermany
| | - Johanna Müller‐Leisse
- Hannover Heart Rhythm Center, Department of Cardiology and AngiologyHannover Medical SchoolCarl‐Neuberg‐Str. 1HannoverD‐30625Germany
- Department of Cardiology and AngiologyHannover Medical SchoolHannoverGermany
| | | | - Christian Veltmann
- Hannover Heart Rhythm Center, Department of Cardiology and AngiologyHannover Medical SchoolCarl‐Neuberg‐Str. 1HannoverD‐30625Germany
- Department of Cardiology and AngiologyHannover Medical SchoolHannoverGermany
| | - David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and AngiologyHannover Medical SchoolCarl‐Neuberg‐Str. 1HannoverD‐30625Germany
- Department of Cardiology and AngiologyHannover Medical SchoolHannoverGermany
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Probst V, Boveda S, Sadoul N, Marquié C, Chauvin M, Mondoly P, Gras D, Jacon P, Defaye P, Leclercq C, Anselme F. Subcutaneous implantable cardioverter defibrillator indication in prevention of sudden cardiac death in difficult clinical situations: A French expert position paper. Arch Cardiovasc Dis 2020; 113:359-366. [PMID: 32334981 DOI: 10.1016/j.acvd.2020.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/09/2020] [Indexed: 01/21/2023]
Abstract
The introduction of a new technology always raises questions about its place compared with the reference technology. The use of an implantable cardioverter defibrillator to prevent sudden cardiac death is now a widely proven technique, with a clear statement of its indication in the guidelines. More recently, a subcutaneous implantable cardioverter defibrillator has been introduced, and appears to be an attractive technique as it removes the need to implant a lead inside the right ventricle to treat the patient, which should dramatically decrease the risk of complications over time. Currently, only one model of subcutaneous implantable cardioverter defibrillator is available on the market; its indications are the same as for transvenous implantable cardioverter defibrillators, except for patients who need stimulation because of conduction disorders or ventricular tachycardias that can potentially be treated effectively by antitachycardia pacing. The different technical characteristics of transvenous versus subcutaneous implantable cardioverter defibrillators therefore raise the question of which to choose in different clinical settings. The experts who participated in the preparation of this manuscript had three meetings, organized by the company Boston Scientific. Each expert prepared the draft of a section corresponding to a clinical situation. The choice between transvenous versus subcutaneous implantable cardioverter defibrillator was then voted on by all the experts. The results of the votes are presented in this manuscript, as it seemed important to us to show the disparities of opinion that can exist in certain situations. The votes were cast independently and anonymously.
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Affiliation(s)
- Vincent Probst
- Service de cardiologie et des maladies vasculaires, CHU de Nantes, l'institut du thorax, 44007 Nantes, France.
| | | | - Nicolas Sadoul
- Service de cardiologie, CHU de Nancy, 54500 Vandœuvre-lès-Nancy, France
| | | | - Michel Chauvin
- Service de cardiologie, CHU de Strasbourg, 67000 Strasbourg, France
| | - Pierre Mondoly
- Service de cardiologie, CHU de Toulouse, 31300 Toulouse, France
| | - Daniel Gras
- Hôpital privé du confluent, 44200 Nantes, France
| | - Peggy Jacon
- Service de cardiologie, CHU de Grenoble, 38700 La Tronche, France
| | - Pascal Defaye
- Service de cardiologie, CHU de Grenoble, 38700 La Tronche, France
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Diagnostic and Therapeutic Approach to Arrhythmias in Adult Congenital Heart Disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:44. [PMID: 31342289 DOI: 10.1007/s11936-019-0749-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW Adult survivors of congenital heart disease (CHD) are at increased risk of arrhythmia. The goal of this review is to outline diagnostic and therapeutic approaches to arrhythmia in adult CHD patients. RECENT FINDINGS Macro-reentrant atrial tachyarrhythmia is the most common arrhythmia encountered in adults with CHD. Approximately 25% of hospitalizations associated with arrhythmia. The risk of ventricular arrhythmia is estimated as high as 25-100 times that for the general population and increased after two decades. Routine ambulatory monitoring is important for arrhythmia risk assessment in adults with CHD. There are limitations, potential adverse effects, and risk of recurrence with antiarrhythmic drugs, catheter ablation, and surgical approaches. Adults with CHD suffer various forms of arrhythmia, are at increased risk of sudden death, and require special consideration for medical and interventional therapy.
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12
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Right-Sided Subcutaneous Implantable Cardioverter Defibrillator System Implantation in a Patient with Complex Congenital Heart Disease and Dextrocardia: A Case Report and Literature Review. Case Rep Cardiol 2019; 2019:3907190. [PMID: 30867968 PMCID: PMC6379875 DOI: 10.1155/2019/3907190] [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: 10/13/2018] [Revised: 01/13/2019] [Accepted: 01/23/2019] [Indexed: 11/24/2022] Open
Abstract
Patients with complex congenital heart disease (CHD) and low left ventricular ejection fraction are at an increased risk of sudden cardiac death (SCD). Prevention of SCD by subcutaneous implantable cardioverter defibrillator (S-ICD) implantation may represent a valuable option in certain CHD patients. Patients with CHD and dextrocardia pose a challenge in S-ICD system implantation, and nonstandard device placement may be required. Furthermore, electrocardiogram (ECG) screening prior to S-ICD implantation in CHD patients has significant limitations. This case represents the placement of a S-ICD system on the right side of the chest in a 26-year-old male with severe biventricular failure and nonsustained ventricular tachycardia following multiple corrective surgeries of situs inversus totalis, double-outlet right ventricle with a ventricular septal defect, and pulmonary atresia. The use of S-ICDs in a CHD population and in particular CHD patients with dextrocardia and right-sided S-ICD implantation is briefly discussed.
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13
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Al-Ghamdi B. Subcutaneous Implantable Cardioverter Defibrillators: An Overview of Implantation Techniques and Clinical Outcomes. Curr Cardiol Rev 2019; 15:38-48. [PMID: 30014805 PMCID: PMC6367695 DOI: 10.2174/1573403x14666180716164740] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 07/09/2018] [Accepted: 07/10/2018] [Indexed: 11/22/2022] Open
Abstract
Sudden Cardiac Death (SCD) is a significant health problem worldwide. Multiple randomized controlled trials have shown that Implantable Cardioverter Defibrillators (ICDs) are effective life-saving management option for individuals at risk of SCD in both primary and secondary prevention. Although the conventional transvenous ICDs (TV-ICDs) are safe and effective, there are potential complications associated with its use, including localized pocket or wound infection or systematic infection, a vascular access related complication such as pneumothorax, and venous thrombosis, and lead related complications such as dislodgement, malfunction, and perforation. Furthermore, transvenous leads placement may not be feasible in certain patients like those with venous anomaly or occlusion, or with the presence of intracardiac shunts. Transvenous leads extraction, when needed, is associated with considerable morbidity & mortality and requires significant skills and costs. Totally subcutaneous ICD (S-ICD) is designed to afford the same life-saving benefit of the conventional TV-ICDs while avoiding the shortcomings of the TV-leads and to simplify the implant techniques and hence expand the use of ICDs in clinical practice. It becomes commercially available after receiving CE mark in 2009, and its use increased significantly after its FDA approval in 2012. This review aims to give an overview of the S-ICD system components, implantation procedure, clinical indications, safety, efficacy, and future directions.
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Affiliation(s)
- Bandar Al-Ghamdi
- Heart Center, College of Medicine, King Faisal Specialist Hospital & Research Centre, Zahrawi St, Al Maather, Riyadh 12713, Saudi Arabia.,Alfaisal University, College of Medicine, King Faisal Specialist Hospital & Research Centre, Zahrawi St, Al Maather, Riyadh 12713, Saudi Arabia
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14
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Garside H, Leyva F, Hudsmith L, Marshall H, de Bono J. Eligibility for subcutaneous implantable cardioverter defibrillators in the adult congenital heart disease population. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 42:65-70. [DOI: 10.1111/pace.13537] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/03/2018] [Accepted: 10/03/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Hannah Garside
- Department of Cardiology; Queen Elizabeth Hospital; Birmingham United Kingdom
| | - Francisco Leyva
- Department of Cardiology; Queen Elizabeth Hospital; Birmingham United Kingdom
- Aston Medical Research Institute, Aston Medical School; Aston University; Birmingham United Kingdom
| | - Lucy Hudsmith
- Department of Cardiology; Queen Elizabeth Hospital; Birmingham United Kingdom
| | - Howard Marshall
- Department of Cardiology; Queen Elizabeth Hospital; Birmingham United Kingdom
| | - Joseph de Bono
- Department of Cardiology; Queen Elizabeth Hospital; Birmingham United Kingdom
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15
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Sakhi R, Yap SC, Michels M, Schinkel AFL, Kauling RM, Roos-Hesselink JW, Theuns DAMJ. Evaluation of a novel automatic screening tool for determining eligibility for a subcutaneous implantable cardioverter-defibrillator. Int J Cardiol 2018; 272:97-101. [PMID: 30005832 DOI: 10.1016/j.ijcard.2018.07.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 06/25/2018] [Accepted: 07/05/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND The manufacturer has developed a new ECG screening tool to determine eligibility for the subcutaneous ICD (S-ICD), the "automatic screening tool" (AST), which may render manual ECG-screening unnecessary. The aim of the study was to determine the eligibility for the S-ICD using two methods (manual ECG-screening versus AST) in different patient categories including patients with cardiomyopathy, congenital heart disease and inherited primary arrhythmia syndrome. METHODS We prospectively evaluated the ECG suitability for an S-ICD in consecutive patients at our outpatient clinic between February and June 2017. The primary endpoint of the study was ECG eligibility defined as at least 1 successful vector in both supine and sitting postures. RESULTS A total of 254 patients (167 men; mean age 45 ± 16 years) were screened using both methods. Overall, there was a high ECG eligibility using either method (93% versus 92%, P = 0.45). Overall agreement between both methods was 94%. Patients with hypertrophic cardiomyopathy (HCM) more often had a failed screening test using either test in comparison to the patients without HCM (manual: odds ratio [OR] 3.3, 95% confidence interval [CI] 1.2-9.3, P = 0.02; AST: OR 3.0, 95% CI 1.2-7.6, P = 0.02). CONCLUSION AST showed a high agreement with manual ECG-screening for S-ICD. Overall there was a high ECG eligibility for S-ICD, although patients with HCM had a lower passing rate irrespective of the screening method.
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Affiliation(s)
- Rafi Sakhi
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Sing-Chien Yap
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Michelle Michels
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Arend F L Schinkel
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - R Martijn Kauling
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
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16
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Silvetti MS, Pazzano V, Verticelli L, Battipaglia I, Saputo FA, Albanese S, Lovecchio M, Valsecchi S, Drago F. Subcutaneous implantable cardioverter-defibrillator: is it ready for use in children and young adults? A single-centre study. Europace 2018; 20:1966-1973. [DOI: 10.1093/europace/euy139] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/28/2018] [Indexed: 01/30/2023] Open
Affiliation(s)
- Massimo Stefano Silvetti
- Pediatric Cardiology and Cardiac Arrhythmias Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital and Research Institute, Palidoro, Via Torre di Palidoro 1, Palidoro-Fiumicino, Rome, Italy
| | - Vincenzo Pazzano
- Pediatric Cardiology and Cardiac Arrhythmias Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital and Research Institute, Palidoro, Via Torre di Palidoro 1, Palidoro-Fiumicino, Rome, Italy
| | - Letizia Verticelli
- Pediatric Cardiology and Cardiac Arrhythmias Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital and Research Institute, Palidoro, Via Torre di Palidoro 1, Palidoro-Fiumicino, Rome, Italy
| | - Irma Battipaglia
- Pediatric Cardiology and Cardiac Arrhythmias Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital and Research Institute, Palidoro, Via Torre di Palidoro 1, Palidoro-Fiumicino, Rome, Italy
| | - Fabio Anselmo Saputo
- Pediatric Cardiology and Cardiac Arrhythmias Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital and Research Institute, Palidoro, Via Torre di Palidoro 1, Palidoro-Fiumicino, Rome, Italy
| | - Sonia Albanese
- Heart Surgery Team, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital and Research Institute, Palidoro, Rome, Italy
| | | | - Sergio Valsecchi
- Heart Surgery Team, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital and Research Institute, Palidoro, Rome, Italy
| | - Fabrizio Drago
- Pediatric Cardiology and Cardiac Arrhythmias Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital and Research Institute, Palidoro, Via Torre di Palidoro 1, Palidoro-Fiumicino, Rome, Italy
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17
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Stewart MH, Macicek SL, Morin DP. Implantable Cardioverter-defibrillators in Adult Congenital Heart Disease. J Innov Card Rhythm Manag 2018; 9:3172-3181. [PMID: 32494493 PMCID: PMC7252815 DOI: 10.19102/icrm.2018.090601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 11/29/2017] [Indexed: 11/30/2022] Open
Abstract
With improved surgical techniques and medical therapies, many patients who are born with complex congenital heart defects are now living well into adulthood. As these patients age, an increasingly common cause of mortality is sudden cardiac death (SCD) from ventricular tachyarrhythmias. The implantable cardioverter-defibrillator (ICD) is a therapy with the ability to prevent some of these deaths; however, there are many diagnostic and technical challenges that remain in the congenital heart disease (CHD) population. We performed a literature review, searching PubMed for articles that examined the role of ICDs in CHD. We herein present the evidence for when to place an ICD in CHD patients, stratified by subtype as relevant. Then, we discuss the technical challenges and complications that are unique to this patient population. We conclude that, despite active work in the area, more research is needed given the small event rates and clinical variability within CHD populations.
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Affiliation(s)
- Merrill H Stewart
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA, USA
| | - Scott L Macicek
- Department of Pediatric Cardiology, Ochsner Medical Center, New Orleans, LA, USA
| | - Daniel P Morin
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA, USA.,Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA, USA
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18
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Hernández-Madrid A, Paul T, Abrams D, Aziz PF, Blom NA, Chen J, Chessa M, Combes N, Dagres N, Diller G, Ernst S, Giamberti A, Hebe J, Janousek J, Kriebel T, Moltedo J, Moreno J, Peinado R, Pison L, Rosenthal E, Skinner JR, Zeppenfeld K, Sticherling C, Kautzner J, Wissner E, Sommer P, Gupta D, Szili-Torok T, Tateno S, Alfaro A, Budts W, Gallego P, Schwerzmann M, Milanesi O, Sarquella-Brugada G, Kornyei L, Sreeram N, Drago F, Dubin A. Arrhythmias in congenital heart disease: a position paper of the European Heart Rhythm Association (EHRA), Association for European Paediatric and Congenital Cardiology (AEPC), and the European Society of Cardiology (ESC) Working Group on Grown-up Congenital heart disease, endorsed by HRS, PACES, APHRS, and SOLAECE. Europace 2018; 20:1719-1753. [DOI: 10.1093/europace/eux380] [Citation(s) in RCA: 144] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Antonio Hernández-Madrid
- Department of Cardiology, Arrhythmia Unit, Ramón y Cajal Hospital, Alcalá University, Carretera Colmenar Viejo, km 9, 100, Madrid, Spain
| | - Thomas Paul
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Robert-Koch-Str. 40, Göttingen, Germany
| | - Dominic Abrams
- PACES (Pediatric and Congenital Electrophysiology Society) Representative, Department of Cardiology, Boston Childreńs Hospital, Boston, MA, USA
| | - Peter F Aziz
- HRS Representative, Pediatric Electrophysiology, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Nico A Blom
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Academical Medical Center, Amsterdam, The Netherlands
| | - Jian Chen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Massimo Chessa
- Pediatric and Adult Congenital Heart Centre-University Hospital, IRCCS Policlinico San Donato, Milan, Italy
| | - Nicolas Combes
- Arrhythmia Unit, Department of Pediatric and Adult Congenital Heart Disease, Clinique Pasteur, Toulouse, France
| | - Nikolaos Dagres
- Department of Electrophysiology, University Leipzig Heart Center, Leipzig, Germany
| | | | - Sabine Ernst
- Royal Brompton and Harefield Hospital, London, UK
| | - Alessandro Giamberti
- Congenital Cardiac Surgery Unit, Policlinico San Donato, University and Research Hospital, Milan, Italy
| | - Joachim Hebe
- Center for Electrophysiology at Heart Center Bremen, Bremen, Germany
| | - Jan Janousek
- 2nd Faculty of Medicine, Children's Heart Centre, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Thomas Kriebel
- Westpfalz-Klinikum Kaiserslautern, Children’s Hospital, Kaiserslautern, Germany
| | - Jose Moltedo
- SOLAECE Representative, Head Pediatric Electrophysiology, Section of Pediatric Cardiology Clinica y Maternidad Suizo Argentina, Buenos Aires, Argentina
| | - Javier Moreno
- Department of Cardiology, Arrhythmia Unit, Ramón y Cajal Hospital, Alcalá University, Carretera Colmenar Viejo, km 9, 100, Madrid, Spain
| | - Rafael Peinado
- Department of Cardiology, Arrhythmia Unit, Hospital la Paz, Madrid, Spain
| | - Laurent Pison
- Department of Cardiology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Eric Rosenthal
- Consultant Paediatric and Adult Congenital Cardiologist, Evelina London Children's Hospital, Guy's and St Thomas' Hospital Trust, London, UK
| | - Jonathan R Skinner
- APHRS Representative, Paediatric and Congenital Cardiac Services Starship Childreńs Hospital, Grafton, Auckland, New Zealand
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Joseph Kautzner
- Institute For Clinical and Experimental Medicine, Prague, Czech Republic
| | - Erik Wissner
- University of Illinois at Chicago, 840 S. Wood St., 905 S (MC715), Chicago, IL, USA
| | - Philipp Sommer
- Heart Center Leipzig, Struempellstr. 39, Leipzig, Germany
| | - Dhiraj Gupta
- Consultant Electrophysiologist Liverpool Heart and Chest Hospital, Honorary Senior Lecturer Imperial College London and University of Liverpool, Liverpool, UK
| | | | - Shigeru Tateno
- Chiba Cerebral and Cardiovascular Center, Tsurumai, Ichihara, Chiba, Japan
| | | | - Werner Budts
- UZ Leuven, Campus Gasthuisberg, Herestraat 49, Leuven, Belgium
| | | | - Markus Schwerzmann
- INSELSPITAL, Universitätsspital Bern, Universitätsklinik für Kardiologie, Zentrum für angeborene Herzfehler ZAH, Bern, Switzerland
| | - Ornella Milanesi
- Department of Woman and Child's Health, University of Padua, Padua Italy
| | - Georgia Sarquella-Brugada
- Pediatric Arrhythmias, Electrophysiology and Sudden Death Unit, Department of Cardiology, Hospital Sant Joan de Déu, Barcelona - Universitat de Barcelona, Passeig Sant Joan de Déu, 2, Esplugues, Barcelona, Catalunya, Spain
| | - Laszlo Kornyei
- Gottsegen Gyorgy Orszagos Kardiologiai, Pediatric, Haller U. 29, Budapest, Hungary
| | - Narayanswami Sreeram
- Department of Pediatric Cardiology, University Hospital Of Cologne, Kerpenerstrasse 62, Cologne, Germany
| | - Fabrizio Drago
- IRCCS Ospedale Pediatrico Bambino Gesù, Piazza Sant'Onofrio 4, Roma
| | - Anne Dubin
- Division of Pediatric Cardiology, 750 Welch Rd, Suite 321, Palo Alto, CA, USA
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19
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Boey E, Kojodjojo P. Optimal Strategies for Mitigating Sudden Cardiac Death Risk in At-risk Patients with Structural Heart Disease. J Innov Card Rhythm Manag 2018; 9:3025-3032. [PMID: 32494485 PMCID: PMC7252838 DOI: 10.19102/icrm.2018.090204] [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: 07/09/2017] [Accepted: 08/29/2017] [Indexed: 12/03/2022] Open
Abstract
This article reviews the strategies used to mitigate sudden death risks in at-risk patients with structural heart disease. The roles of implantable and non-implantable technologies to prevent arrhythmic death are discussed.
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Affiliation(s)
- Elaine Boey
- Division of Cardiology, Ng Teng Fong General Hospital, National University Health System, Singapore
| | - Pipin Kojodjojo
- Division of Cardiology, Ng Teng Fong General Hospital, National University Health System, Singapore,Address correspondence to: Pipin Kojodjojo, PhD, National University Heart Centre, 1E Kent Ridge Road, National University Health System Tower Block, Level 9, Singapore 119228.
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20
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Goldstein SA, Ward CC, Al-Khatib SM. The Use of Implantable Cardioverter-defibrillators in the Prevention of Sudden Cardiac Death: A Focus on Congenital Heart Disease and Inherited Arrhythmia Syndromes. J Innov Card Rhythm Manag 2018; 9:2996-3005. [PMID: 32494470 PMCID: PMC7252881 DOI: 10.19102/icrm.2018.090103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 08/23/2017] [Indexed: 12/18/2022] Open
Abstract
Some congenital heart diseases (CHDs) and inherited arrhythmia syndromes are associated with an increased risk of sudden cardiac death (SCD). Appropriate selection criteria for implantable cardioverter-defibrillator (ICD) implantation in these patients are poorly defined due to a paucity of data available from randomized clinical trials, leading to current guidelines relying more on non-randomized studies and expert opinions to make their recommendations. This review describes available evidence-based risk stratification methods for identifying patients at risk for SCD, as well as current guideline-driven management strategies for the use of ICDs in patients with CHD and inherited arrhythmia syndromes.
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Affiliation(s)
| | - Cary C Ward
- Division of Cardiology, Duke University Hospital, Durham, NC, USA.,Duke Clinical Research Institute, Duke University Hospital, Durham, NC, USA
| | - Sana M Al-Khatib
- Division of Cardiology, Duke University Hospital, Durham, NC, USA.,Duke Clinical Research Institute, Duke University Hospital, Durham, NC, USA
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21
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Koyak Z, de Groot JR, Bouma BJ, Zwinderman AH, Silversides CK, Oechslin EN, Budts W, Van Gelder IC, Mulder BJM, Harris L. Sudden cardiac death in adult congenital heart disease: can the unpredictable be foreseen? Europace 2017; 19:401-406. [PMID: 27247006 DOI: 10.1093/europace/euw060] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 02/20/2016] [Indexed: 11/12/2022] Open
Abstract
Aims Sudden cardiac death (SCD) is a major cause of mortality in adults with congenital heart disease (CHD). Several risk factors for SCD including conduction disturbances and ventricular dysfunction have been described previously. However, electrocardiogram (ECG) and echocardiographic parameters may change over time, and the predictive value of such temporal changes, rather than their point estimates, for SCD remains unknown. Methods and results This was a retrospective case-control study in adults with CHD and proven or presumed SCD and matched controls. Data were obtained from three databases including 25 000 adults with CHD. Sequential measurements were performed on electrocardiograms and echocardiograms. Ventricular function was assessed by echocardiography and graded on a four-point ordinal scale: 1, normal [ejection fraction (EF) ≥50%]; 2, mildly impaired (EF 40-49%); 3, moderately impaired (EF 30-39%); and 4, severely impaired (EF < 30%). Overall, 131 SCDs (mean age 36 ± 14 years, 67% male) and 260 controls (mean age 37 ± 13 years, 63% male) were included. At baseline, median QRS duration was 108 ms (range 58-168 ms) in SCDs and 97 ms (range 50-168 ms) in controls and increased over time at a rate of 1.6 ± 0.5 vs. 0.5 ± 0.2 ms/year in SCDs and controls, respectively (P = 0.011). QT dispersion at baseline was 61 ms (range 31-168 ms) in SCDs and 50 ms (range 21-129 ms) in controls. QT dispersion increased at a rate of 1.1 ± 0.4 ms/year in SCD victims and decreased at a rate of 0.2 ± 0.2 ms/year in controls (P = 0.004). Increase of QRS duration ≥5 ms/year was associated with an increased risk of SCD [OR 1.9, 95% confidence interval (CI) 1.1-3.3, P = 0.013]. Change from any baseline systemic ventricular function (normal, mild, or moderately impaired) to severe ventricular dysfunction over time was associated with the highest risk of SCD (OR 16.9, 95% CI 1.8-120.1, P = 0.008). Conclusion In adults with CHD, QRS duration and ventricular dysfunction progress over time. Progression of QRS duration and the rate of impairment of ventricular function served to identify those at increased risk of SCD.
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Affiliation(s)
- Zeliha Koyak
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.,Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
| | - Joris R de Groot
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Berto J Bouma
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Aeilko H Zwinderman
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands
| | - Candice K Silversides
- Department of Cardiology, Peter Munk Cardiac Center, Toronto Congenital Cardiac Center for Adults, and University of Toronto, Toronto, Canada
| | - Erwin N Oechslin
- Department of Cardiology, Peter Munk Cardiac Center, Toronto Congenital Cardiac Center for Adults, and University of Toronto, Toronto, Canada
| | - Werner Budts
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Isabelle C Van Gelder
- Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands.,Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Barbara J M Mulder
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.,Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
| | - Louise Harris
- Department of Cardiology, Peter Munk Cardiac Center, Toronto Congenital Cardiac Center for Adults, and University of Toronto, Toronto, Canada
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22
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Thomas VC, Peterson M, McDaniel M, Restrepo H, Rothman A, Jain A. Analysis of Screening Electrocardiogram for the Subcutaneous Defibrillator in Adults with Congenital Heart Disease. Pediatr Cardiol 2017; 38:1162-1168. [PMID: 28534239 DOI: 10.1007/s00246-017-1635-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 05/13/2017] [Indexed: 01/04/2023]
Abstract
Candidates for the subcutaneous implantable cardioverter-defibrillator (S-ICD) are screened using an electrocardiogram (S-ECG) tool to measure appropriate detection. We sought to define the S-ICD candidacy of congenital heart disease patients using the S-ECG tool. We also analyzed the reliability of the (S-ECG) tool between measurers in this population. Patients above the age of 12 and with a diagnosis associated with either a higher incidence of cardiac arrest or vascular access challenges were asked to undergo screening. S-ECGs were then analyzed by a pediatric electrophysiologist, an S-ICD device engineer, and an S-ICD clinical representative for candidacy. Results were compared for interobserver variability and S-ECGs were analyzed by t test to determine variables that differ among passing and failing leads. Thirty-one patients underwent screening. Two of the 31 (6.5%) patients failed S-ICD screening. Analysis of the screening leads demonstrated the highest passing rates using lead III at a 5 mm/mV amplitude setting with 71 and 62% pass rate in the supine and standing positions, respectively. Interobserver analysis correlated well among the three measurers. There was a higher amplitude difference between QRS and T waves among passing versus failing S-ECG. Congenital heart disease patients have acceptable passage rates utilizing the S-ECG algorithm. Interobserver measurements were well correlated and these data suggest that the proximal coil to device (lead III) vector would be best utilized in this patient population. A larger difference between QRS and T wave amplitudes was associated with a higher S-ECG passing rate.
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Affiliation(s)
- Vincent C Thomas
- University of Nebraska Medical Center, Children's Hospital and Medical Center, 8200 Dodge Street, Omaha, NE, 68164, USA.
| | | | | | | | - Abraham Rothman
- Children's Heart Center Nevada, Las Vegas, NV, USA
- University of Nevada School of Medicine, Reno, NV, USA
| | - Amit Jain
- University of Nevada School of Medicine, Reno, NV, USA
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23
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Alonso P, Osca J, Rueda J, Cano O, Pimenta P, Andres A, Sancho MJ, Martinez L. Conventional and right-sided screening for subcutaneous ICD in a population with congenital heart disease at high risk of sudden cardiac death. Ann Noninvasive Electrocardiol 2017; 22. [PMID: 28508439 DOI: 10.1111/anec.12461] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 03/22/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Information regarding suitability for subcutaneous defibrillator (sICD) implantation in tetralogy of Fallot (ToF) and systemic right ventricle is scarce and needs to be further explored. The main objective of our study was to determine the proportion of patients with ToF and systemic right ventricle eligible for sICD with both, standard and right-sided screening methods. Secondary objectives were: (i) to study sICD eligibility specifically in patients at high risk of sudden cardiac death, (ii) to identify independent predictors for sICD eligibility, and (iii) to compare the proportion of eligible patients in a nonselected ICD population. METHODS We recruited 102 patients with ToF, 33 with systemic right ventricle, and 40 consecutive nonselected patients. Conventional electrocardiographic screening was performed as usual. Right-sided alternative screening was studied by positioning the left-arm and right-arm electrodes 1 cm right lateral of the xiphoid midline. The Boston Scientific ECG screening tool was utilized. RESULTS In high-risk patients with ToF, eligibility was higher with right-sided screening in comparison with standard screening (61% vs. 44%; p = .018). Eligibility in high-risk right ventricle population was identical with both screening methods (77%, p = ns). The only independent predictor for sICD eligibility was QRS duration. CONCLUSION In high-risk patients with ToF, right-sided implantation of the sICD could be an alternative to a conventional ICD. In patients with a systemic right ventricle, implantation of a sICD is an alternative to a conventional sICD.
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Affiliation(s)
- Pau Alonso
- Electrophysiology Section, Department of Cardiology, La Fe University Hospital, Valencia, Spain
| | - Joaquín Osca
- Electrophysiology Section, Department of Cardiology, La Fe University Hospital, Valencia, Spain
| | - Joaquín Rueda
- Adult Congenital Heart Disease Unit, Department of Cardiology, La Fe University Hospital, Valencia, Spain
| | - Oscar Cano
- Electrophysiology Section, Department of Cardiology, La Fe University Hospital, Valencia, Spain
| | - Pedro Pimenta
- Electrophysiology Section, Department of Cardiology, La Fe University Hospital, Valencia, Spain
| | - Ana Andres
- Electrophysiology Section, Department of Cardiology, La Fe University Hospital, Valencia, Spain
| | - María José Sancho
- Electrophysiology Section, Department of Cardiology, La Fe University Hospital, Valencia, Spain
| | - Luis Martinez
- Department of Cardiology, La Fe University Hospital, Valencia, Spain
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24
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Cecchin F, Halpern DG. Cardiac Arrhythmias in Adults with Congenital Heart Disease: Pacemakers, Implantable Cardiac Defibrillators, and Cardiac Resynchronization Therapy Devices. Card Electrophysiol Clin 2017; 9:319-328. [PMID: 28457245 DOI: 10.1016/j.ccep.2017.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Implanting cardiac rhythm medical devices in adults with congenital heart disease requires training in congenital heart disease. The techniques and indications for device implantation are specific to the anatomic diagnosis and state of disease progression. It often requires a team of physicians and is best performed at a specialized adult congenital heart center.
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Affiliation(s)
- Frank Cecchin
- NYU Langone Medical Center, 550 First Avenue, New York, NY 10016, USA.
| | - Daniel G Halpern
- NYU Langone Medical Center, 550 First Avenue, New York, NY 10016, USA
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25
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ALONSO PAU, OSCA JOAQUÍN, CANO OSCAR, PIMENTA PEDRO, ANDRÉS ANA, YAGÜE JAIME, MILLET JOSÉ, RUEDA JOAQUÍN, SANCHO-TELLO MARÍAJOSÉ. The Role of Conventional and Right-Sided ECG Screening for Subcutaneous ICD in a Tetralogy of Fallot Population. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:145-153. [DOI: 10.1111/pace.13017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/28/2016] [Accepted: 12/21/2016] [Indexed: 11/29/2022]
Affiliation(s)
- PAU ALONSO
- Electrophysiology Section, Cardiology Department; La Fe University Hospital; Valencia Spain
| | - JOAQUÍN OSCA
- Electrophysiology Section, Cardiology Department; La Fe University Hospital; Valencia Spain
| | - OSCAR CANO
- Electrophysiology Section, Cardiology Department; La Fe University Hospital; Valencia Spain
| | - PEDRO PIMENTA
- Electrophysiology Section, Cardiology Department; La Fe University Hospital; Valencia Spain
| | - ANA ANDRÉS
- Electrophysiology Section, Cardiology Department; La Fe University Hospital; Valencia Spain
| | - JAIME YAGÜE
- BioITACA; Polytechnic University of Valencia; Valencia Spain
| | - JOSÉ MILLET
- BioITACA; Polytechnic University of Valencia; Valencia Spain
| | - JOAQUÍN RUEDA
- Adult Congenital Heart Disease Unit, Cardiology Department; La Fe University Hospital; Valencia Spain
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26
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Kawabata M, Goya M, Sasaki T, Maeda S, Yagishita A, Shirai Y, Kaneko M, Shiohira S, Isobe M, Hirao K. Surface Electrocardiogram Screening for Subcutaneous Implantable Cardioverter-Defibrillators in Japanese Patients With and Without Brugada Syndrome. Circ J 2017; 81:981-987. [DOI: 10.1253/circj.cj-16-1295] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Masahiko Goya
- Heart Rhythm Center, Tokyo Medical and Dental University
| | - Takeshi Sasaki
- Heart Rhythm Center, Tokyo Medical and Dental University
| | - Shingo Maeda
- Heart Rhythm Center, Tokyo Medical and Dental University
| | | | | | | | | | - Mitsuaki Isobe
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Kenzo Hirao
- Heart Rhythm Center, Tokyo Medical and Dental University
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27
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Moore JP, Mondésert B, Lloyd MS, Cook SC, Zaidi AN, Pass RH, John AS, Fish FA, Shannon KM, Aboulhosn JA, Khairy P. Clinical Experience With the Subcutaneous Implantable Cardioverter–Defibrillator in Adults With Congenital Heart Disease. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.116.004338. [DOI: 10.1161/circep.116.004338] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 08/15/2016] [Indexed: 11/16/2022]
Abstract
Background—
Sudden cardiac death is a major contributor to mortality for adults with congenital heart disease. The subcutaneous implantable cardioverter–defibrillator (ICD) has emerged as a novel tool for prevention of sudden cardiac death, but clinical performance data for adults with congenital heart disease are limited.
Methods and Results—
A retrospective study involving 7 centers over a 5-year period beginning in 2011 was performed. Twenty-one patients (median 33.9 years) were identified. The most common diagnosis was single ventricle physiology (52%), 9 palliated by Fontan operation and 2 by aortopulmonary shunts:
d
-transposition of the great arteries after Mustard/Senning (n=2), tetralogy of Fallot (n=2), aortic valve disease (n=2), and other biventricular surgery (n=4). A prior cardiac device had been implanted in 7 (33%). The ICD indication was primary prevention in 67% and secondary in 33% patients. The most common reason for subcutaneous ICD placement was limited transvenous access for ventricular lead placement (n=10) followed by intracardiac right-to-left shunt (n=5). Ventricular arrhythmia was induced in 17 (81%) and was converted with ≤80 Joules in all. There was one implant complication related to infection, not requiring device removal. Over a median follow-up of 14 months, 4 patients (21%) received inappropriate and 1 (5%) patient received appropriate shocks. There was one arrhythmic death related to asystole in a single ventricle patient.
Conclusions—
Subcutaneous ICD implantation is feasible for adults with congenital heart disease patients. Most candidates have single ventricle heart disease and limited transvenous options for ICD placement. Despite variable anatomy, this study demonstrates successful conversion of induced ventricular arrhythmia and reasonable rhythm discrimination during follow-up.
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Affiliation(s)
- Jeremy P. Moore
- From the Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, CA (J.P.M., K.M.S., J.A.A.); Montreal Heart Institute, Montreal, QC, Canada (B.M., P.K.); Emory University School of Medicine, Atlanta, GA (M.S.L.); Children’s Heart Institute of Pittsburgh, Pittsburgh, PA (S.C.C.); Montefiore Medical Center, Bronx, NY (A.N.Z., R.H.P.); Children’s National Medical Center, Washington, DC (A.S.J.); and Vanderbilt University, Nashville, TN (F.A.F.)
| | - Blandine Mondésert
- From the Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, CA (J.P.M., K.M.S., J.A.A.); Montreal Heart Institute, Montreal, QC, Canada (B.M., P.K.); Emory University School of Medicine, Atlanta, GA (M.S.L.); Children’s Heart Institute of Pittsburgh, Pittsburgh, PA (S.C.C.); Montefiore Medical Center, Bronx, NY (A.N.Z., R.H.P.); Children’s National Medical Center, Washington, DC (A.S.J.); and Vanderbilt University, Nashville, TN (F.A.F.)
| | - Michael S. Lloyd
- From the Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, CA (J.P.M., K.M.S., J.A.A.); Montreal Heart Institute, Montreal, QC, Canada (B.M., P.K.); Emory University School of Medicine, Atlanta, GA (M.S.L.); Children’s Heart Institute of Pittsburgh, Pittsburgh, PA (S.C.C.); Montefiore Medical Center, Bronx, NY (A.N.Z., R.H.P.); Children’s National Medical Center, Washington, DC (A.S.J.); and Vanderbilt University, Nashville, TN (F.A.F.)
| | - Stephen C. Cook
- From the Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, CA (J.P.M., K.M.S., J.A.A.); Montreal Heart Institute, Montreal, QC, Canada (B.M., P.K.); Emory University School of Medicine, Atlanta, GA (M.S.L.); Children’s Heart Institute of Pittsburgh, Pittsburgh, PA (S.C.C.); Montefiore Medical Center, Bronx, NY (A.N.Z., R.H.P.); Children’s National Medical Center, Washington, DC (A.S.J.); and Vanderbilt University, Nashville, TN (F.A.F.)
| | - Ali N. Zaidi
- From the Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, CA (J.P.M., K.M.S., J.A.A.); Montreal Heart Institute, Montreal, QC, Canada (B.M., P.K.); Emory University School of Medicine, Atlanta, GA (M.S.L.); Children’s Heart Institute of Pittsburgh, Pittsburgh, PA (S.C.C.); Montefiore Medical Center, Bronx, NY (A.N.Z., R.H.P.); Children’s National Medical Center, Washington, DC (A.S.J.); and Vanderbilt University, Nashville, TN (F.A.F.)
| | - Robert H. Pass
- From the Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, CA (J.P.M., K.M.S., J.A.A.); Montreal Heart Institute, Montreal, QC, Canada (B.M., P.K.); Emory University School of Medicine, Atlanta, GA (M.S.L.); Children’s Heart Institute of Pittsburgh, Pittsburgh, PA (S.C.C.); Montefiore Medical Center, Bronx, NY (A.N.Z., R.H.P.); Children’s National Medical Center, Washington, DC (A.S.J.); and Vanderbilt University, Nashville, TN (F.A.F.)
| | - Anitha S. John
- From the Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, CA (J.P.M., K.M.S., J.A.A.); Montreal Heart Institute, Montreal, QC, Canada (B.M., P.K.); Emory University School of Medicine, Atlanta, GA (M.S.L.); Children’s Heart Institute of Pittsburgh, Pittsburgh, PA (S.C.C.); Montefiore Medical Center, Bronx, NY (A.N.Z., R.H.P.); Children’s National Medical Center, Washington, DC (A.S.J.); and Vanderbilt University, Nashville, TN (F.A.F.)
| | - Frank A. Fish
- From the Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, CA (J.P.M., K.M.S., J.A.A.); Montreal Heart Institute, Montreal, QC, Canada (B.M., P.K.); Emory University School of Medicine, Atlanta, GA (M.S.L.); Children’s Heart Institute of Pittsburgh, Pittsburgh, PA (S.C.C.); Montefiore Medical Center, Bronx, NY (A.N.Z., R.H.P.); Children’s National Medical Center, Washington, DC (A.S.J.); and Vanderbilt University, Nashville, TN (F.A.F.)
| | - Kevin M. Shannon
- From the Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, CA (J.P.M., K.M.S., J.A.A.); Montreal Heart Institute, Montreal, QC, Canada (B.M., P.K.); Emory University School of Medicine, Atlanta, GA (M.S.L.); Children’s Heart Institute of Pittsburgh, Pittsburgh, PA (S.C.C.); Montefiore Medical Center, Bronx, NY (A.N.Z., R.H.P.); Children’s National Medical Center, Washington, DC (A.S.J.); and Vanderbilt University, Nashville, TN (F.A.F.)
| | - Jamil A. Aboulhosn
- From the Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, CA (J.P.M., K.M.S., J.A.A.); Montreal Heart Institute, Montreal, QC, Canada (B.M., P.K.); Emory University School of Medicine, Atlanta, GA (M.S.L.); Children’s Heart Institute of Pittsburgh, Pittsburgh, PA (S.C.C.); Montefiore Medical Center, Bronx, NY (A.N.Z., R.H.P.); Children’s National Medical Center, Washington, DC (A.S.J.); and Vanderbilt University, Nashville, TN (F.A.F.)
| | - Paul Khairy
- From the Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, CA (J.P.M., K.M.S., J.A.A.); Montreal Heart Institute, Montreal, QC, Canada (B.M., P.K.); Emory University School of Medicine, Atlanta, GA (M.S.L.); Children’s Heart Institute of Pittsburgh, Pittsburgh, PA (S.C.C.); Montefiore Medical Center, Bronx, NY (A.N.Z., R.H.P.); Children’s National Medical Center, Washington, DC (A.S.J.); and Vanderbilt University, Nashville, TN (F.A.F.)
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Timmers L, Van Heuverswyn F, De Wilde H, Jordaens L. Evaluating current implantable cardioverter defibrillator implantation procedures: can common complications be minimised? Expert Rev Cardiovasc Ther 2016; 14:579-89. [DOI: 10.1586/14779072.2016.1144471] [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: 11/08/2022]
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Okamura H, McLeod CJ, DeSimone CV, Webster TL, Bonnichsen CR, Grogan M, Phillips SD, Connolly HM, Ammash NM, Warnes CA, Friedman PA. Right Parasternal Lead Placement Increases Eligibility for Subcutaneous Implantable Cardioverter Defibrillator Therapy in Adults With Congenital Heart Disease. Circ J 2016; 80:1328-35. [PMID: 27109124 DOI: 10.1253/circj.cj-16-0153] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The subcutaneous implantable cardioverter defibrillator (S-ICD) provides an attractive option for patients with congenital heart disease (CHD) in whom a transvenous defibrillator is contraindicated. Given the unusual cardiac anatomy and repolarization strain, the surface electrocardiogram (ECG) is frequently abnormal, potentially increasing the screen failure rate. METHODS AND RESULTS We prospectively screened 100 adult CHD patients regardless of the presence of clinical indication for ICD utilizing a standard left sternal lead placement, as well as a right parasternal position. Baseline patient and 12-lead ECG characteristics were examined to assess for predictors of screen failure. Average patient age was 48±14 years, average QRS duration was 134±37 ms, and 13 patients were pacemaker dependent. Using the standard left parasternal electrode position, 21 patients failed screening. Of these 21 patients with screen failure, 9 passed screening with the use of right parasternal electrode positioning, reducing screening failure rate from 21% to 12%. QT interval and inverted T wave anywhere in V2-V6 leads were found to be independent predictors of left parasternal screening failure (P=0.01 and P=0.04, respectively). CONCLUSIONS Utilization of both left and right parasternal screening should be used in evaluation of CHD patients for S-ICD eligibility. ECG repolarization characteristics were also identified as novel predictors of screening failure in this group. (Circ J 2016; 80: 1328-1335).
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30
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Panna ME, Miles WM. The Subcutaneous Implantable Cardioverter-Defibrillator: A Practical Review and Real-World Use and Application. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2016. [DOI: 10.15212/cvia.2015.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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31
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Crozier IG, Theuns DA. Patients with congenital heart disease: how to determine the eligibility for implantation of a subcutaneous implantable defibrillator? Europace 2015; 17:1003-4. [DOI: 10.1093/europace/euv087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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