Key result
Cardiac implantable electronic devices in adults with repaired tetralogy of Fallot had a 20% complication rate, with annualized appropriate and inappropriate shock rates of 5.7% and 6.2%.
Cohort (n=99)
No
In adults with repaired tetralogy of Fallot, CIEDs are associated with a 20% complication rate and significant rates of both appropriate and inappropriate shocks, which may be mitigated by class III antiarrhythmic drugs.
Substantial CIED complication and shock rates in repaired tetralogy of Fallot warrant caution; leaves optimal mitigation strategies open for prospective study.
BACKGROUND: Tachyarrhythmias and bradyarrhythmias affect 20%-50% of adult patients with tetralogy of Fallot (TOF) and some of these patients will require cardiac implantable electronic devices (CIED) such as pacemaker and/or internal cardioverter defibrillator. METHODS: The Mayo Adult Congenital Heart Disease database was queried for patients with repaired TOF and history of CIED implantation, 1990-2017. The study objectives were: (1) determine the occurrence of device-related complications defined as lead failure, lead recall, device infection and lead thrombus; and (2) determine the occurrence and risk factors for defibrillator shock. RESULTS: There were 99 patients (age 46±14 years and 66 (66%) men) with CIED, and the CIEDs were 41 (41%) pacemakers and 73 (73%) defibrillators. Indication for defibrillator implantation was for primary prevention in 28 (38%) and secondary prevention in 45 (62%). Device-related complications occurred in 20 (20%) patients (lead failure 17, lead recall 4, device infection 12 and thrombus 3). Twenty-five per cent of all device infections occurred within 30 days from the time of device generator change. Annualised rates of appropriate and inappropriate shocks were 5.7% and 6.2%, respectively. The use of class III antiarrhythmic drug was protective against defibrillator shock. CONCLUSION: The current study provides useful outcome data to aid patient counselling and clinical decision-making. Further studies are required to explore ways to decrease the risk of postprocedural infection after device generator change, and to determine which patients will benefit from empirical antiarrhythmic therapy as a strategy to decrease incidence of inappropriate defibrillator shock.
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Egbe et al. (2018) conducted a cohort in Repaired tetralogy of Fallot with cardiac implantable electronic devices (n=99). Cardiac implantable electronic devices (pacemakers and defibrillators) was evaluated on Device-related complications (lead failure, lead recall, device infection, and lead thrombus). Cardiac implantable electronic devices in adults with repaired tetralogy of Fallot had a 20% complication rate, with annualized appropriate and inappropriate shock rates of 5.7% and 6.2%.
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