Eligibility for subcutaneous implantable cardioverter-defibrillator in congenital heart disease

Wang, Linda; Javadekar, Neeraj; Rajagopalan, Ananya; Rogovoy, Nichole M.; Haq, Kazi T.; Broberg, Craig S.; Tereshchenko, Larisa G.

doi:10.1016/j.hrthm.2020.01.016

Cited by 28 publications

(15 citation statements)

References 33 publications

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We thank Wang et al for their interest in our article on S-ICD eligibility in adults with congenital heart disease (ACHD). 1 Wang et al emphasize that our results are in contrast to several previous ACHD studies, [2][3][4][5] including one recent study from their group. 2 Carefully reviewing the references, our results regarding S-ICD eligibility in ACHD patients (83%) are obviously in line with previous published data.

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confidence: 96%

“…8,9 The ECG-based screening test was performed as standard of care, but was not the main focus of our study, since this has already been largely examined in ACHD patients in previous studies. 2,3,5,7,10 Furthermore, Wang et al propose a comparison of S-ICD eligibility in different positions (standing and supine) on the left and right parasternal position using McNemar's chi-square test. Clinicians performing S-ICD screening will agree, that the proposed analysis comparing S-ICD eligibility in different positions is irrelevant in clinical practice, since S-ICD eligibility is only met if at least one vector is eligible in both, supine and standing position.…”

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confidence: 99%

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Author reply: S‐ICD eligibilities in adults with congenital heart disease

et al. 2021

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We thank Wang et al. for their interest in our article on S-ICD eligibility in adults with congenital heart disease (ACHD). 1 Wang et al. emphasize that our results are in contrast to several previous ACHD studies, [2][3][4][5] including one recent study from their group. 2 Carefully reviewing the references, our results regarding S-ICD eligibility in ACHD patients (83%) are obviously in line with previous published data. In the studies mentioned by Wang et al., S-ICD eligibility was 75%, 3 77%, 4 and 75.4%. 5 Further studies not mentioned by Wang et al.showed even higher eligibility rates of 93.5% 6 and 86.7%. 7 More precisely, the result of Wang et al. 2 reporting only 60% S-ICD eligibility is exceptionally lower compared to the above-mentioned studies. Our eligibility rate lies even closer to the aforementioned mean of the published data than the eligibility rate from Wang et al. 2 (Figure 1). The references added by Wang et al. therefore nicely extend the well-described underlying evidence in the field.Wang et al. highlight a discrepancy between the reported data in the figures and the results section in a previous version of our manuscript, which has already been corrected

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Author reply: S‐ICD eligibilities in adults with congenital heart disease

et al. 2021

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“…Alonso et al conducted a study to test S-ICD eligibility specifically in congenital heart disease patients at high risk of sudden cardiac death and only 44% of the significant risk subgroup were eligible for an S-ICD [19]. In another study by Wang et al, 101 mostly complex congenital heart disease patients were screened for eligibility for S-ICD and only 61 patients (60%) were deemed eligible for S-ICD screening [20]. In another study by Garside et al, 102 complex ACHD patients were recruited and 75.4% of ACHD patients met the screening criteria for an S-ICD [21].…”

Section: S-icd Screening Eligibility and Inappropriate Shocks Ratesmentioning

confidence: 99%

Deep learning-based insights on T:R ratio behaviour during prolonged screening for S-ICD eligibility

ElRefai

Abouelasaad

Wiles

et al. 2022

J Interv Card Electrophysiol

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Background A major predictor of eligibility of subcutaneous implantable cardiac defibrillators (S-ICD) is the T:R ratio. The eligibility cut-off of the T:R ratio incorporates a safety margin to accommodate for fluctuations of ECG signal amplitudes. We introduce a deep learning-based tool that accurately measures the degree of T:R ratio fluctuations and explore its role in S-ICD screening. Methods Patients were fitted with Holters for 24 h to record their S-ICD vectors. Our tool was used to assess the T:R ratio over the duration of the recordings. Multiple T:R ratio cut-off values were applied, identifying patients at high risk of T-wave oversensing (TWO) at each of the proposed values. The purpose of our study is to identify the ratio that recognises patients at high risk of TWO while not inappropriately excluding true S-ICD candidates. Results Thirty-seven patients (age 54.5 + / − 21.3 years, 64.8% male) were recruited. Fourteen patients had heart-failure, 7 hypertrophic cardiomyopathy, 7 had normal hearts, 6 had congenital heart disease, and 3 had prior inappropriate S-ICD shocks due to TWO. 54% of patients passed the screening at a T: R of 1:3. All patients passed the screening at a T: R of 1:1. The only subgroup to wholly pass the screening utilising all the proposed ratios are the participants with normal hearts. Conclusion We propose adopting prolonged screening to select patients eligible for S-ICD with low probability of TWO and inappropriate shocks. The appropriate T:R ratio likely lies between 1:3 and 1:1. Further studies are required to identify the optimal screening thresholds.

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“…The limitations in the study design and conduct could at least partially explain the difference in the reported results with other studies. [2][3][4] Also, the study 1 raised questions about the appropriateness of utilized statistical analyses. For appropriate paired comparison of S-ICD ineligibility in different positions (standing and supine) on the left and right sides, McNemar's χ 2 statistic has to be used.…”

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confidence: 99%

“…Similar to the discussed study, previous studies of S-ICD eligibility in ACHD are relatively small. [2][3][4][5] To summarize research evidence, future systematic reviews and meta-analyses will likely be needed. An accurate, detailed, and reproducible methods and results have the greatest impact on what new studies can expand on in the ACHD population.…”

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To the editor: S‐ICD eligibility in adult congenital heart disease

2021

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We read with concern the recent article by Zormpas et al., 'Eligibility for subcutaneous implantable cardioverterdefibrillator in adults with congenital heart disease'. 1 The authors reported a high (83%) rate of eligibility for subcutaneous implantable cardioverter-defibrillator (S-ICD) in the adult congenital heart disease (ACHD) population, which is in sharp contrast to several previous ACHD studies: by Wang et al. 2 (60% eligibility), by Alonso et al. 3 in mixed ACHD (75% eligibility) and tetralogy of Fallot (77% eligibility), 4 and by Garside et al. 5 (75% eligibility; left-sided only).One discrepancy is between the reported data in figures and what is discussed in the results section. Figure 1 in the manuscript 1 shows that 22% of patients failed the left-sided automated screening test and 25% of patients failed the right-sided automated test. The authors stated that only 'two patients were found eligible in the left parasternal but not in the right parasternal position, while all patients found eligible in the right parasternal position were also eligible in the left parasternal position'. Mathematically, it is not possible to achieve the reported 83% rate of eligibility per written findings, but, instead, figure 1 provides results more consistent with previous studies. [2][3][4] The authors 1 did not discuss possible reasons for disagreement of their findings with previous studies. It is essential to discuss the limitations of the study in order for the reader to gain perspective of the study.The methods included the use of an automated Boston-Scientific screening test. However, details about the Boston-Scientific programmer settings of the test and whether or not SMART Pass S-ICD function (ECG filtering settings) 6 was considered were not included. Furthermore, it is unusual for the automated screening test to yield 'no results.' Further details of the automated test with 'no results' would be helpful for troubleshooting and meaningful interpretation. It would be necessary if the authors compared their results with a previous comprehensive evaluation of the automatic screening tool. 7 An important limitation of the study was that a single investigator performed the ECG-based screening test, and therefore, inter-rater and intra-rater agreement has not been investigated. There was also no mention of investigator

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Eligibility for subcutaneous implantable cardioverter-defibrillator in congenital heart disease

Abstract: doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.

Cited by 28 publications

References 33 publications

Author reply: S‐ICD eligibilities in adults with congenital heart disease

Author reply: S‐ICD eligibilities in adults with congenital heart disease

Deep learning-based insights on T:R ratio behaviour during prolonged screening for S-ICD eligibility

To the editor: S‐ICD eligibility in adult congenital heart disease

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