Potential eligibility of congenital heart disease patients for subcutaneous implantable cardioverter-defibrillator based on surface electrocardiogram mapping

Zeb, Mehmood; Curzen, Nicholas; Veldtman, Gruschen; Yue, Arthur M.; Roberts, Paul R.; Wilson, David G.; Morgan, John M.

doi:10.1093/europace/euu375

Cited by 36 publications

(27 citation statements)

References 23 publications

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“…The major cause of ineligibility has been reported to be high T waves, which might lead to T-wave oversensing. [3][4][5][6][7][8][9] Patients with Brugada syndrome (BrS) are usually young and active, do not require pacing, and are likely to benefit greatly from this system. However, inappropriate shocks caused by T-wave oversensing are problems even with conventional transvenous ICDs in patients with BrS.…”

Section: Study Populationmentioning

confidence: 99%

Surface Electrocardiogram Screening for Subcutaneous Implantable Cardioverter-Defibrillators in Japanese Patients With and Without Brugada Syndrome

Kawabata

Goya

Sasaki

et al. 2017

Circ J

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Background: Subcutaneous implantable cardioverter-defibrillators (S-ICD) could eliminate lead-associated complications. We assessed the prevalence of S-ICD ineligibility in conventional ICD recipients and compared it in patients with and without Brugada syndrome (BrS). Methods and Results:Consecutive patients with a transvenous ICD without an indication for antibradycardia pacing were assessed. A patient was considered eligible for S-ICD if the ECG satisfied the screening template, both supine and standing, in ≥1 lead. Among 130 patients (103 men, age 57±15 years), a total of 18 (13.8%) patients were ineligible. The BrS group (n=33) had a significantly higher prevalence of S-ICD screening failure as compared with the non-BrS group (P=0.003; 30% vs. 8.2%). In the BrS group, the body mass index (BMI) was significantly lower, and T/QRS amplitude in lead I was significantly higher in those who were ineligible than that in the patients who were eligible. Of the 10 BrS patients failing the screening, 4 became eligible in the right parasternal electrode position. Conclusions:Among current ICD patients, there was a high incidence of patients with BrS who were unsuitable for S-ICD based on the left parasternal screening test. Suitability screening of patients for S-ICDs should be conducted carefully in patients with BrS, particularly if the BMI is low. Right parasternal electrode positioning should also be tested in such BrS patients.

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Section: Study Populationmentioning

confidence: 99%

Surface Electrocardiogram Screening for Subcutaneous Implantable Cardioverter-Defibrillators in Japanese Patients With and Without Brugada Syndrome

Kawabata

Goya

Sasaki

et al. 2017

Circ J

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“…In 1 patient with pulmonary stenosis accompanied with dextrocardia, electrodes in the The high rate of screen failure is most likely secondary to the altered cardiac anatomy such as chamber enlargement, mechanical strain and augmented repolarization, cardiac position in the chest and relation to standard ECG positioning, all of which may result in prominent and/or non-traditional T-wave morphology. 2, 14 The presence of inverted T wave anywhere in V2-V6 (often seen in patients with bundle branch block or dependent on ventricular pacing), appears to be predictive of such failure. Importantly, a significant number of patients who failed leftsided screening were found to remain as candidates for S-ICD implantation if a right-sided lead position was performed.…”

Section: Patient Characteristicsmentioning

confidence: 99%

Right Parasternal Lead Placement Increases Eligibility for Subcutaneous Implantable Cardioverter Defibrillator Therapy in Adults With Congenital Heart Disease

Okamura

McLeod

DeSimone

et al. 2016

Circ J

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Background:The subcutaneous implantable cardioverter defibrillator (S-ICD) provides an attractive option for patients with congenital heart disease (CHD) in whom a transvenous defibrillator is contraindicated. Given the unusual cardiac anatomy and repolarization strain, the surface electrocardiogram (ECG) is frequently abnormal, potentially increasing the screen failure rate. Methods and Results:We prospectively screened 100 adult CHD patients regardless of the presence of clinical indication for ICD utilizing a standard left sternal lead placement, as well as a right parasternal position. Baseline patient and 12-lead ECG characteristics were examined to assess for predictors of screen failure. Average patient age was 48±14 years, average QRS duration was 134±37 ms, and 13 patients were pacemaker dependent. Using the standard left parasternal electrode position, 21 patients failed screening. Of these 21 patients with screen failure, 9 passed screening with the use of right parasternal electrode positioning, reducing screening failure rate from 21% to 12%. QT interval and inverted T wave anywhere in V2-V6 leads were found to be independent predictors of left parasternal screening failure (P=0.01 and P=0.04, respectively). Conclusions:Utilization of both left and right parasternal screening should be used in evaluation of CHD patients for S-ICD eligibility. ECG repolarization characteristics were also identified as novel predictors of screening failure in this group. (Circ J 2016; 80: 1328 -1335

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“…Although it may be perceived that patients with CHD would have lower rates of eligibility for subcutaneous ICD use due to the presence of complex anatomic abnormalities, CHD patients actually have similar rates of eligibility based on screenings compared with those with structurally normal hearts. 35 It should be kept in mind that patients with bradycardia or those who are expected to develop bradycardia requiring pacing should not be considered for subcutaneous ICD implantation. Epicardial ICDs, which require surgical thoracotomy, are used frequently in the pediatric population, but are implanted less commonly in adults with CHD.…”

Section: S a Goldstein C C Ward And S M Al-khatibmentioning

confidence: 99%

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

Goldstein

Ward

Al‐Khatib

2017

J Innov Cardiac Rhythm Manage

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Potential eligibility of congenital heart disease patients for subcutaneous implantable cardioverter-defibrillator based on surface electrocardiogram mapping

Cited by 36 publications

References 23 publications

Surface Electrocardiogram Screening for Subcutaneous Implantable Cardioverter-Defibrillators in Japanese Patients With and Without Brugada Syndrome

Surface Electrocardiogram Screening for Subcutaneous Implantable Cardioverter-Defibrillators in Japanese Patients With and Without Brugada Syndrome

Right Parasternal Lead Placement Increases Eligibility for Subcutaneous Implantable Cardioverter Defibrillator Therapy in Adults With Congenital Heart Disease

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

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