Long-term follow-up of adult patients with congenital heart disease and an implantable cardioverter defibrillator.

Congenit Heart Dis 2019 Jul 19;14(4):525-533. Epub 2019 Mar 19.

Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.

Objective: Sudden cardiac death is common in the adult congenital heart disease (ACHD) population. Knowledge and experience about the use of implantable cardioverter defibrillators (ICD) in ACHD patients is very limited. We aimed to characterize a cohort of patients with ACHD and ICDs.

Design: Thirty consecutive ACHD patients submitted to an ICD implantation in a single tertiary center were evaluated. Data on baseline clinical features, heart defect, indication for ICD, type of device, appropriate therapies, ICD-related complication, and mortality during follow-up were collected.

Results: Of the 30 patients, 56.7% received appropriate therapies due to ventricular tachycardia (VT) or ventricular fibrillation (VF). The rate of inappropriate therapies and device-related complications was 33.3%. Secondary prevention and primary prevention patients with class I indications for ICD had more appropriate therapies than complication, but this relationship was reversed for patients with class II indications. Remote monitoring played an important role in diagnosing new atrial arrhythmias before scheduled visits in 46.2% of patients, leading to a change in medication. VT/VF episodes were associated with a composite of death, cardiac transplantation, and hospital admission (OR 13.0; 95% CI: 2.1-81.5).

Conclusion: ICDs are not only useful in preventing SCD, but also have a major role in diagnosing atrial tachyarrhythmias ahead of scheduled visits. Although improvements in ICD technology might reduce complications and inappropriate therapies, adequate selection of candidates for primary prevention still remains difficult because of the lack of clear indications.

Download full-text PDF

Source
https://onlinelibrary.wiley.com/doi/abs/10.1111/chd.12767
Publisher Site
http://dx.doi.org/10.1111/chd.12767DOI Listing
July 2019
17 Reads

Publication Analysis

Top Keywords

appropriate therapies
12
role diagnosing
8
diagnosing atrial
8
scheduled visits
8
class indications
8
patients class
8
inappropriate therapies
8
primary prevention
8
heart disease
8
achd patients
8
congenital heart
8
patients
7
therapies
5
icd
5
prevention patients
4
remains difficult
4
difficult lack
4
secondary prevention
4
complications 333%
4
333% secondary
4

References

(Supplied by CrossRef)
AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society
Al‐Khatib SM et al.
Circulation 2018
2015 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: the Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC)
Priori SG et al.
Eur Heart J 2015

Similar Publications