Fifteen years’ experience of implantable cardioverter defibrillator in children and young adults: Mortality and complications study

Lewandowski, Michał; Syska, Paweł; Kowalik, Ilona; Maciąg, Aleksander; Sterliński, Maciej; Ateńska-Pawłowska, Joanna; Szwed, Hanna

doi:10.1111/ped.13660

Cited by 7 publications

(13 citation statements)

References 35 publications

(76 reference statements)

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“…Infections of pacing devices and leads has a reported incidence of 2.1–6.2% [[25], [26], [27]]. Complex larger devices like defibrillators and resynchronizing devices in children and young adults are more frequently associated with endocarditis [28].…”

Section: Discussionmentioning

confidence: 99%

Endocardial transvenous pacing in patients with surgically palliated univentricular hearts: A review on different techniques, problems and management

Umamaheshwar

Singh

Sivakumar

2019

Indian Pacing and Electrophysiology Journal

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Fontan surgery and its modifications have improved survival in various forms of univentricular hearts. A regular atrial rhythm with atrioventricular synchrony is one of the most important prerequisite for the long-term effective functioning of this preload dependent circulation. A significant proportion of these survivors need various forms of pacing for bradyarrhythmias, often due to sinus nodal dysfunction and sometimes due to atrioventricular nodal block. The diversion of the venous flows away from the cardiac chambers following this surgery takes away the simpler endocardial pacing options through the superior vena cava. The added risks of thromboembolism associated with endocardial leads in systemic ventricles have made epicardial pacing as the procedure of choice. However challenges in epicardial pacing include surgical adhesions, increased pacing thresholds leading to early battery depletion and frequent lead fractures. When epicardial pacing fails, endocardial lead placement is equally challenging due to lack of access to the cardiac chambers in Fontan circulation. This review discusses the univentricular heart morphologies that may warrant pacing, issues about epicardial pacing, different techniques for endocardial pacing in patients with disconnected superior vena cava, pacing in different modifications of Fontan surgeries, issues of systemic thromboembolism with endocardial leads, atrioventricular valve regurgitation attributed to pacing leads and device infections. In a vast majority of patients following Glenn shunt and Senning surgery, an epicardial pacing and lead replacement is always feasible though technically very difficult. This article highlights the different options of transatrial and transventricular endocardial pacing.

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Section: Discussionmentioning

confidence: 99%

Endocardial transvenous pacing in patients with surgically palliated univentricular hearts: A review on different techniques, problems and management

Umamaheshwar

Singh

Sivakumar

2019

Indian Pacing and Electrophysiology Journal

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“…A prospective multicenter study would further clarify these concerns. Although cardiac computed tomography might have been more accurate or reproducible, due to the Center's long experience with complications of electrotherapy and lack of radiation exposure we decided to use TTE as a reference test to determine the position of the RV lead …”

Section: Discussionmentioning

confidence: 99%

A novel ECG‐based algorithm to determine right ventricular lead placement in permanent pacemaker patients (RVpace study)

Zając

Farkowski

Kowalik

et al. 2019

Cardiovasc electrophysiol

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Introduction Fluoroscopy guidance alone is not sufficient for the accurate localization of the pacing lead (PL) in the right ventricle (RV) during implantation of the cardiac implantable electronic device (CIED). The aim of this study was to create a surface electrocardiogram (ECG) algorithm based on paced QRS (pQRS) morphology to accurately localize PL position in the RV. Methods and Results Thirty consecutive patients scheduled for catheter ablation of right heart arrhythmias were enrolled. After the elimination of index arrhythmia pacing from the RV interventricular septum (IVS), apex and free wall was performed and pQRS were recorded. The pacing site was verified both by fluoroscopy and transthoracic echocardiography. After a careful analysis of pQRS, a stepwise algorithm was developed to aid the proper positioning of the PL in RV. The algorithm was later prospectively validated in 31 pacemaker patients undergoing an elective generator exchange. A clear R wave in I, II, and V5 leads indicated proximal IVS. For a reliable indication of other RV sites, four ECG leads were crucial I, II, V5, and V6. A prospective evaluation of the algorithm revealed 90.3% agreement between RV lead localization obtained by ECG and echocardiography, with sensitivity of 92.5% (95% confidence interval [CI], 83.2%‐100.0%) and a positive predictive value of 96.0% (95% CI, 89.0%‐100.0%) for desired lead locations in RV. Conclusion A simple ECG algorithm can reliably differentiate between the sites of permanent PL implantation in the RV in CIED recipients.

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“…IT causes are described in our previous report in detail. 7 Mortality analysis The mortality rate was 6/80 (7.5%) including 2 deaths caused by ventricular lead dysfunction, described in the previous report in detail. 7 Two patients developed end stage heart failure.…”

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confidence: 84%

“…7 Mortality analysis The mortality rate was 6/80 (7.5%) including 2 deaths caused by ventricular lead dysfunction, described in the previous report in detail. 7 Two patients developed end stage heart failure. The first one with the fatal outcome of heart transplantation (HTX) 20 years after ICD implantation occurred in a 37-year -old female patient with hypertrophic cardiomyopathy (HCM).…”

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confidence: 84%

“…On one hand, there is a continuum between this paper and our previous reports. [4][5][6][7] On the other hand, it also includes very important new information concerning mortality and our own experience with S -ICD in this population. To our knowledge, this study represents the largest group of patients with the T -ICD and S -ICD implanted at a young age in a single center in Poland.…”

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confidence: 99%

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Children and young adults treated with transvenous and subcutaneous implantable cardioverter-defibrillators: a 22-year single-center experience and new perspectives

2020

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BACKGROUND Over the last several years the evolution of transvenous implantable cardioverter -defibrillator (T -ICD) system and the introduction of subcutaneous ICD (S -ICD) have contributed to the development of the sudden cardiac death (SCD) prevention in clinical practice. AIMS To report our clinical experience with ICD therapy in children and young adults during the twenty--two years of the follow -up. METHODS We reviewed the database of ICD recipients choosing 80 consecutive patients (pts) implanted at the age of 6-21 in 1996-2018. We analyzed the rate of appropriate (AT) and inappropriate therapies (IT), mortality, complications and new treatment options. RESULTS A total of 21/80 patients (26.25%) received ≥1 AT for ventricular tachycardia/ventricular fibrillation (anti -tachycardia pacing or shock) and 25/80 patients (31.25%) had one or multiple IT (P = 0.47). Nine patients (11%) had both AT and IT interventions. During follow -up, 2 (2.5%) cardiac resynchronization therapy (CRT) systems, and 8 (10%) S -ICDs were implanted, 3 heart transplantations were performed, and 1 severe tricuspid valve regurgitation occurred. A total of 6/80 patients (7.5%) died. All deaths occurred in the hypertrophic cardiomyopathy group. CONCLUSIONS The mortality rate was 6/80 (7.5%) in the twenty -two -year follow -up. The rate of AT vs. IT was almost equal and remained steady in the long observation period. Severe TR might be a serious clinical problem in some patients. Entirely S -ICD for SCD prevention is a feasible and safe therapy in young recipients.

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Fifteen years’ experience of implantable cardioverter defibrillator in children and young adults: Mortality and complications study

Cited by 7 publications

References 35 publications

Endocardial transvenous pacing in patients with surgically palliated univentricular hearts: A review on different techniques, problems and management

Endocardial transvenous pacing in patients with surgically palliated univentricular hearts: A review on different techniques, problems and management

A novel ECG‐based algorithm to determine right ventricular lead placement in permanent pacemaker patients (RVpace study)

Children and young adults treated with transvenous and subcutaneous implantable cardioverter-defibrillators: a 22-year single-center experience and new perspectives

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