Long-term follow-up of children and young adults treated with implantable cardioverter-defibrillator: the authors' own experience with optimal implantable cardioverter-defibrillator programming

Lewandowski, Michał; Sterliński, Maciej; Maciąg, Aleksander; Syska, Paweł; Kowalik, Ilona; Szwed, Hanna; Chojnowska, Lidia; Przybylski, Andrzej

doi:10.1093/europace/euq263

Cited by 24 publications

(25 citation statements)

References 23 publications

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“…In a recent long-term observational study of patients 6 to 21 years of age with ICDs, ATP did not reduce shocks. 71 However, we and others 70 recommend that ATP should be programmed in secondary prevention patients. Finally, because TWOS is a common occurrence in pediatric patients with hypertrophic CRT-D indicates cardiac resynchronization therapy defibrillation; FVT, fast ventricular tachycardia; LVEF, left ventricular ejection fraction; NID, number of intervals needed for detection; VF, ventricular fibrillation.…”

Section: Pediatric Patientsmentioning

confidence: 96%

Minimizing Inappropriate or “Unnecessary” Implantable Cardioverter-Defibrillator Shocks

Koneru

Swerdlow

Wood

et al. 2011

Circ: Arrhythmia and Electrophysiology

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L ife-saving shocks are the raisons d'être of implantable cardioverter-defibrillators (ICDs). Paradoxically, shocks also cause much of the morbidity associated with ICDs. Consistently, shocks reduce quality of life, 1,2 and rarely, they may cause proarrhythmia. 3,4 Additionally, shocks have been reported to be associated with excess mortality. 5 Experts disagree about whether shocks are responsible for this excess mortality, 6 but they do agree that ICDs should deliver the fewest shocks necessary to protect patients from ventricular tachycardia (VT) or ventricular fibrillation (VF).Minimizing ICD shocks requires a comprehensive approach, beginning with patient selection, 7 general medical care (eg, preventing electrolyte abnormalities), and general cardiac care (preventing ischemia and treating heart failure). It includes the use of antiarrhythmic drugs and catheter ablation both to prevent VT or supraventricular tachycardia (SVT) and to control the ventricular rate in atrial fibrillation (AF) as well as the appropriate choice of hardware and device programming. This review focuses on ICD features and programming to minimize shocks. OverviewFigure 1 summarizes the sequential processes required for an ICD to deliver a shock. The sense amplifiers convert the continuous electrogram (EGM) from the tip of the right ventricular (RV) lead into a series of instantaneously sensed events representing ventricular depolarization. This series of sensed events is processed by ICD algorithms, including those for initial detection; SVT-VT discrimination; and in some models of ICDs, enhancements to minimize oversensing. If the rhythm is classified as a VT, antitachycardia pacing (ATP) can be delivered. The ICD then performs a redetection process, which results in determination that the devicedefined VT either has terminated or persists. If VT is redetected, the process iterates until all programmed ATPs are delivered. The ICD then charges the high-voltage capacitors, during which time a final round of ATP may be delivered. After capacitor charging, the ICD confirms that VT/VF is present before delivering a shock. Each step provides opportunities to minimize unnecessary shocks. Although Figure 1 shows the ICD process, we consider features and programming in the approximate order that most electrophysiologists program ICDs: (1) rate and duration for initial detection, (2) SVT-VT discrimination, (3) ATP and shock strength, (4) redetection/confirmation, and (5) sensing enhancements.Historically, shocks were classified as appropriate if delivered during VT/VF and inappropriate if delivered during other rhythms. However, some shocks delivered during VT may be avoided by programming ATP or permitting nonsustained VT to spontaneously terminate. In this review, we classify shocks as either necessary to ensure patient safety or unnecessary. Necessary shocks are those that terminate ventricular tachyarrhythmias that would not spontaneously terminate or cannot be terminated by ATP. Unnecessary shocks include those that have been traditional...

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Section: Pediatric Patientsmentioning

confidence: 96%

Minimizing Inappropriate or “Unnecessary” Implantable Cardioverter-Defibrillator Shocks

Koneru

Swerdlow

Wood

et al. 2011

Circ: Arrhythmia and Electrophysiology

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“…This is a particularly important consideration for young patients because 1 in 4 may be expected to receive at least 1 inappropriate shock. 9 …”

mentioning

confidence: 99%

Anxiety in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy and Implantable Cardioverter Defibrillators

Day

2012

Circ Cardiovasc Genet

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“…82 The frequency of use of ATP and its effectiveness in this population is not well known, although some authors have found the success rate to be low, and have advocated against its routine use. 37 However, in a single-center study of 79 pediatric and CHD patients, ATP was successful at terminating VT in 88% of episodes, with 85% of episodes being terminated within the first ATP attempt. Acceleration of the VT with ATP was seen in three episodes (3%), which either spontaneously terminated, were terminated by additional ATP, or were converted by a shock in one case each.…”

Section: Device-based Interventions In Pediatric and Chd Patientsmentioning

confidence: 98%

“…In larger adult studies, the rate of IS has been reported to range from 10% to 15%. 16,25,27 However, most studies of ICD use in pediatric and CHD patients have found rates of IS to be between 20% and 30% in these patient populations, 10,11,13,14,[34][35][36][37][38][39][40] with some studies observing IS in up to 40% to 50% of patients and, in some instances, with inappropriate shocks being more frequent than appropriate shocks. 12,19,41,42 This is likely a result of a more active lifestyle, faster rates of sinus tachycardia, longer duration of implantation, smaller patient size, and a higher rate of device and lead complications relative to adult patients.…”

Section: Device Therapymentioning

confidence: 99%

Inappropriate ICD Shocks in Pediatric and Congenital Heart Disease Patients

Garnreiter

2017

J Innov Cardiac Rhythm Manage

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ABSTRACT. Although implantable cardioverter-defibrillators (ICDs) have proven to be life-saving devices, there are frequent complications associated with their use, especially in the pediatric and congenital heart disease populations. Inappropriate shocks are a particularly frequent complication in these groups. This review discusses the causes and implications of inappropriate ICD shocks, and presents potential interventions that may assist in safely reducing the rates of inappropriate shocks in pediatric and congenital heart disease patients with ICDs.

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Long-term follow-up of children and young adults treated with implantable cardioverter-defibrillator: the authors' own experience with optimal implantable cardioverter-defibrillator programming

Cited by 24 publications

References 23 publications

Minimizing Inappropriate or “Unnecessary” Implantable Cardioverter-Defibrillator Shocks

Minimizing Inappropriate or “Unnecessary” Implantable Cardioverter-Defibrillator Shocks

Anxiety in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy and Implantable Cardioverter Defibrillators

Inappropriate ICD Shocks in Pediatric and Congenital Heart Disease Patients

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