Implantable cardioverter-defibrillators in adults with congenital heart disease: a systematic review and meta-analysis

Abstract

In ACHD, remarkably high rates of appropriate ICD therapy were reported, both in primary and secondary prevention. Because of the young age and lower death rates, the cumulative beneficial effects are likely greater in ACHD patients than in acquired heart disease patients. However, considering the high rates of inappropriate shocks and complications, case-by-case weighing of costs and benefits, remains essential.

The Use of Implantable Cardioverter-defibrillators in the Prevention of Sudden Cardiac Death: A Focus on Congenital Heart Disease and Inherited Arrhythmia Syndromes

“…18 Patients with TOF are the most common recipients of ICDs among patients with CHD. 19 Studies aimed at identifying predictors of SCD in patients with TOF have yielded numerous potential risk factors based on surgical history, clinical parameters, electrocardiographic and electrophysiological metrics, and functional parameters. 15 The patient factors that are most strongly associated with increased SCD risk are summarized in Table 1.…”

“…14,19,[36][37][38] In all CHD patients, the risks and benefits of ICD implantation should be weighed carefully, with an emphasis placed on shared decision-making. As with other patients who receive a primary prevention ICD, programming parameters should be optimized to avoid inappropriate shocks through long detection times and high detection rates.…”

The year in cardiology 2016: arrhythmias and cardiac implantable electronic devices

“…40 Overall, 2162 patients (66% males) with a mean age of 37 years at implant were included from 24 studies. The devices were implanted for primary prevention in 53% of patients (95% CI = 43.5-62.7%), with non-sustained VT representing the most frequent indication, followed by impaired LV function, inducible VT, syncope, and palpitations or presyncope.…”

“…napravili su iscrpan pregled i metaanalizu indikacija, učinkovitosti i sigurnosti liječenja ugradnjom ICD uređaja u odraslih bolesnika s kongenitalnom srčanom bolesti. 40 Sveukupno, 2162 bolesnika (66 % muškog spola) srednje dobi od 37 godina pri ugradnji bila su uključeno iz 24 studije. Uređaji su bili ugrađeni radi primarne prevencije u 53 % bolesnika (95 %-tni interval pouzdanosti CI = 43,5 -62,7%), s nepostojanom VT koja je činila najčešću indikaciju, a potom su slijedile oslabljena funkcija LV-a, inducibilna VT, sinkopa, palpitacije ili presinkopa.…”

Clinical Experience With the Subcutaneous Implantable Cardioverter–Defibrillator in Adults With Congenital Heart Disease

“…[5][6][7] The S-ICD has been advocated as a means of circumventing many of these limitations and, therefore, may be ideally suited to the ACHD population. [8][9][10][11] Although there are emerging data regarding eligibility for the S-ICD among patients with ACHD, 9,12 there is little clinical experience with this technology. Knowledge of the forms of congenital heart disease most likely to benefit, reasons for device placement, and clinical performance are needed.…”