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Leng T, Griffeth E, Stephens EH, Dearani JA, Cannon BC, Ackerman MJ, Wackel PL. Utility of routine follow-up defibrillation safety margin testing in young patients with epicardial implantable cardioverter-defibrillators. Pacing Clin Electrophysiol 2024; 47:392-397. [PMID: 38341633 DOI: 10.1111/pace.14948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/12/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Routine defibrillation threshold testing (DFT) of transvenous implantable defibrillators (ICDs) has largely been in decline. In patients with non-transvenous ICDs that utilize subcutaneous and pleural ICD leads, serial DFT testing can detect a significant number of failures. Data about the utility of follow-up defibrillation safety margin testing (DSM) testing in pediatric patients and young adults with an epicardial ICD are lacking. METHODS Patients aged < 25 years old who underwent epicardial ICD placement at Mayo Clinic from 2014 to 2023 with at least one follow-up DSM test were included. The patients were divided into a "routine" (R) and "clinically indicated" (CI) group based on the index of clinical concern. Inadequate DSM was defined as unsuccessful defibrillation at an output of less than 10 J below the maximum output of the device. The purpose of this study was to assess the utility of follow-up DSM testing. RESULTS An epicardial ICD system was placed in 122 patients. A total of 26 patients met inclusion criteria and underwent a total of 47 DSM follow up tests. Inadequate DSM occurred in 1/33 (3%) in the R group and 2/14 (14%) DSM tests in the CI group. The median follow-up period was 54 and 36 months for the R and CI group, respectively. CONCLUSIONS Our data suggest that epicardial ICDs are reliable and routine follow-up DSM testing may not be necessary for all patients. DSM testing should be performed in individuals with epicardial ICD systems when there is clinical concern about lead or coil performance.
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Affiliation(s)
- Tomas Leng
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Elaine Griffeth
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Bryan C Cannon
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Ackerman
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo Clinic, Rochester, Minnesota, USA
- Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Philip L Wackel
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA
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Clark BC, Olen M, Dechert B, Brateng C, Jarosz B, Smoots K, Connell P, Dupanovic ST, Fenrich A, Hill AC, LaPage M, Mah D, McCanta A, Malloy-Walton L, Pflaumer A, Radbill A, Tanel R, Whitehill R, Dalal A. Current State of Cardiac Implantable Electronic Device Remote Monitoring in Pediatrics and Congenital Heart Disease: A PACES-Sponsored Quality Improvement Initiative. Pediatr Cardiol 2024; 45:114-120. [PMID: 38036754 DOI: 10.1007/s00246-023-03348-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/07/2023] [Indexed: 12/02/2023]
Abstract
Cardiac implantable electronic device (CIED) remote transmissions are an integral part of longitudinal follow-up in pediatric and adult congenital heart disease (ACHD) patients. To evaluate baseline CIED remote monitoring (RM) data among pediatric and ACHD centers prior to implementation of a Pediatric and Congenital Electrophysiology Society (PACES)-sponsored quality improvement (QI) project. This is a cross-sectional study of baseline CIED RM. Centers self-reported baseline data: individual center RM compliance was defined as high if there was > 80% achievement and low if < 50%. A total of 22 pediatric centers in the USA and Australia submitted baseline data. Non-physicians were responsible for management of the RM program in most centers: registered nurse (36%), advanced practice provider (27%), combination (23%), and third party (9%). Fifteen centers (68%) reported that > 80% of their CIED patients are enrolled in RM and only two centers reported < 50% participation. 36% reported high compliance of device transmission within 14 days of implant and 77% of centers reported high compliance of CIED patients enrolled in RM. The number of centers achieving high compliance differed by device type: 36% for pacemakers, 50% for ICDs, and 55% for Implantable Cardiac Monitors (ICM). All centers reported at least 50% adherence to recommended follow-up for PM and ICD, with 23% low compliance rate for ICMs. Based on this cross-sectional survey of pediatric and ACHD centers, compliance with CIED RM is sub-optimal. The PACES-sponsored QI initiative will provide resources and support to participating centers and repeat data will be evaluated after PDSA cycles.
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Affiliation(s)
- Bradley C Clark
- Division of Cardiology, Department of Pediatrics, Masonic Children's Hospital, University of Minnesota, 2450 Riverside Ave, AO-405, Minneapolis, MN, 55454, USA.
| | - Melissa Olen
- Division of Cardiology, Nicklaus Children's Hospital, Miami, FL, USA
| | - Brynn Dechert
- Division of Pediatric Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Caitlin Brateng
- Division of Cardiology, Children's Hospital of Colorado, Aurora, CO, USA
| | - Beth Jarosz
- Division of Cardiology, Children's National Medical Center, Washington, DC, USA
| | - Karen Smoots
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Patrick Connell
- Division of Cardiology, Texas Children's Hospital, Houston, TX, USA
| | | | - Arnold Fenrich
- Division of Cardiology, Dell Children's Medical Center, Austin, TX, USA
| | - Allison C Hill
- Division of Cardiology, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Martin LaPage
- Division of Pediatric Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Douglas Mah
- Division of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - Anthony McCanta
- Division of Cardiology, Children's Hospital of Orange County, Orange, CA, USA
| | | | - Andreas Pflaumer
- Royal Children's Hospital, MCRI and University of Melbourne, Melbourne, AU, USA
| | - Andrew Radbill
- Division of Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ronn Tanel
- Division of Pediatric Cardiology, University of California-San Francisco, San Francisco, CA, USA
| | - Robert Whitehill
- Division of Cardiology, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Aarti Dalal
- Division of Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
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Griffeth EM, Stephens EH, Dearani JA. Hypertrophic Cardiomyopathy: Preadolescence, Mitral Valve Disease, and Midventricular Obstruction. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2023; 27:69-77. [PMID: 38522876 DOI: 10.1053/j.pcsu.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/16/2023] [Accepted: 12/02/2023] [Indexed: 03/26/2024]
Abstract
Septal myectomy is indicated in patients with obstructive hypertrophic cardiomyopathy (HCM) who have persistent symptoms despite medical therapy, intolerance of medication side effects, or severe resting or provocable gradients. Septal myectomy at high volume centers is safe, with low operative mortality (1%) and low rates of complications such as complete heart block or ventricular septal defect (3% and 0.5%, respectively). Additionally, improved survival following myectomy has been observed when compared to patients with obstructive HCM managed medically or those with nonobstructive HCM. As a longstanding, quaternary referral center for septal myectomy, our institution has built significant experience and expertise in the surgical and medical management of HCM, including atypical HCM, defined as preadolescent patients, those with mitral valve disease, and those with isolated midventricular obstruction. The most important factor of septal myectomy in achieving complete resolution of obstruction and avoiding recurrence is the apical extent of the myectomy trough, which must extend to the septum opposite the papillary muscles. If this cannot be fully achieved via a transaortic exposure, especially in preadolescents and patients with midventricular obstruction, then a transapical approach may be needed. Mitral valve repair is rarely necessary as SAM-mediated MR resolves with adequate myectomy alone, but mitral repair is performed in cases of intrinsic valvular disease. In this manuscript we provide a summary of current operative techniques and outcomes data from our institution on the management of these various categories of HCM.
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Affiliation(s)
- Elaine M Griffeth
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
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