Key result
Implantable cardioverter-defibrillators save lives in congenital heart disease, but their use is limited by a lack of evidence-based data, anatomic complexities, and high complication rates.
While ICDs are critical for preventing sudden cardiac death in CHD patients, their use is complicated by anatomical challenges and a high rate of long-term complications, highlighting the need for tailored approaches and better evidence.
Requires cautious ICD selection in CHD due to complications; leaves open need for prospective trials to close evidence gaps.
PURPOSE OF REVIEW: Sudden cardiac death is a leading cause of mortality in patients with congenital heart disease (CHD), such that implantable cardioverter-defibrillators (ICDs) are a critical component of care. Objectives of this review are to highlight recent advances regarding ICDs in CHD, with a focus on clinical indications, technical issues and solutions, and patient outcomes. RECENT FINDING: Evolving ICD indications in CHD are primarily derived from observational research or extrapolations from the general adult literature. Technical challenges to device implantation include obstructed vasculature or conduits, intracardiac shunts with their attendant risk for systemic thromboemboli, and lack of venous access to the heart. In selected patients, tailored epicardial systems may be considered that include subcutaneous, retrocardiac, and/or venous (e.g., azygous) coils. Alternatively, an entirely subcutaneous ICD may be a reasonable option in patients with no bradycardia or antitachycardia pacing indications. Long-term complications include inappropriate shocks, lead failure, reduction in quality of life, shock-related anxiety, and impaired sexual function. SUMMARY: Although ICDs undeniably save lives, challenges to applying this technology to patients with CHD include the paucity of evidence-based data to guide patient selection, technical challenges related to venous access, patient size, anatomic complexities, and a high rate of complications.
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Mondésert et al. (2013) conducted a review in congenital heart disease. Implantable cardioverter-defibrillators was evaluated. Implantable cardioverter-defibrillators save lives in congenital heart disease, but their use is limited by a lack of evidence-based data, anatomic complexities, and high complication rates.
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