Eligibility for subcutaneous implantable cardioverter defibrillators in the adult congenital heart disease population

Abstract

Background Patients with adult congenital heart disease (ACHD) have an increased risk of arrhythmic and sudden cardiac death. The subcutaneous implantable cardioverter defibrillator (S‐ICD) provides a potentially safer alternative to transvenous ICDs in ACHD. Suitability for S‐ICD depends on the surface electrocardiogram (ECG), which is often abnormal in ACHD patients. This study investigates the proportion of ACHD patients who meet the screening criteria for S‐ICD implantation. Methods A standard screening ECG was performed in 102 patients with complex ACHD (Tetralogy of Fallot, Fontan circulation, and transposition of the great arteries). This process was repeated postexercise for patients who also had an exercise test. Results Three quarters (75.4%) of ACHD patients meet screening criteria for an S‐ICD with at least one suitable vector. The most common number of acceptable vectors in the eligible group was two (35% of total population). In only 12% of total population, all three vectors were suitable while only one vector was suitable in 28% of total population. The primary vector (equivalent of ECG lead III) was the most common suitable vector, found in 62% of participants who had appropriate sensing vectors. Twenty‐five (24.5%) patients failed to meet the S‐ICD screening criteria. Of these, 14 had repaired tetralogy of Fallot. A total of 92% of patients with a Fontan circulation met ECG screening criteria. Of those who had the protocol repeated following their cardiopulmonary exercise test (n = 14), only one additional patient failed to meet the eligibility criteria. Conclusions A quarter of ACHD patients do not meet the eligibility criteria for the S‐ICD. However, more than 90% of patients with a Fontan circulation are suitable for an S‐ICD.

Eligibility for subcutaneous implantable cardioverter‐defibrillator in adults with congenital heart disease

“…To date, there has been a limited series of studies assessing S-ICD eligibility in patients with ACHD using an ECG-based S-ICD screening test only. [13][14][15] The present study aims to elucidate S-ICD eligibility rates in patients with ACHD utilizing both the ECG-based and the automated S-ICD screening test.…”

Heart failure in congenital heart disease: management options and clinical challenges

“…Further clinical research is required to refine risk stratification for ventricular arrhythmias [107,108] and to minimize the occurrence of inappropriate ICD shocks [109,110]. In a considerable proportion of ACHD patients subcutaneous ICD implantation seems suitable [111]. In addition to risk assessment and technical considerations, special care should be given to the psychological impact of ICDs and the effect it may have on quality of life and mental health, with higher anxiety levels and diminished general health perception and physical functioning reported [112,113].…”

Electromagnetic interference effect of dental equipment on cardiac implantable electrical devices: A systematic review

“…The use of cardiovascular implantable electronic devices (CIEDs) such as pacemakers (PMs), implantable cardioverter defibrillators (ICDs), or cardiac resynchronization therapy (CRT) devices has been a first‐line treatment for life‐prolonging and life‐saving devices 1 . With the success of novel CIED technology in recent years, such as leadless PMs, subcutaneous ICDs, and cardiac contractility modulation, the number of patients receiving CIEDs has rising rapidly 2 . Electromagnetic interference (EMI) is well known to affect the normal function of CIEDs when an electromagnetic field of an electromagnet or the flow of electricity is generated by an instrument 3 .…”