Key result
In adults with congenital heart disease, implantable cardioverter-defibrillators delivered appropriate therapy in 38% of patients and inappropriate therapy in 26% over long-term follow-up.
Why the study?
A significant proportion of the expanding adult congenital heart disease population suffers sudden cardiac death, requiring ICD recommendations to balance appropriate therapy against inappropriate shocks and procedural complications.
Does implantable cardioverter-defibrillator (ICD) insertion provide appropriate therapy with acceptable complication rates in adults with congenital heart disease?
Observational (n=136)
No
Does implantable cardioverter-defibrillator (ICD) insertion provide appropriate therapy with acceptable complication rates in adults with congenital heart disease?
In adults with congenital heart disease, ICD implantation provides appropriate therapy in over a third of patients over long-term follow-up, though this must be balanced against a 26% rate of inappropriate therapy.
High inappropriate therapy rates warrant caution with ICDs in adults with congenital heart disease; leaves open optimal programming strategies.
INTRODUCTION: The adult congenital heart disease (ACHD) population is rapidly expanding. However, a significant proportion of these patients suffer sudden cardiac death. Recommending implantable cardioverter-defibrillator (ICD) insertion requires balancing the need for appropriate therapy in malignant arrhythmia against the consequences of inappropriate therapy and procedural complications. Here we present long-term follow-up data for ICD insertion in patients with ACHD from a large Level 1 congenital cardiac center. METHODS AND RESULTS: All patients with ACHD undergoing ICD insertion over an 18-year period were identified. Data were extracted for baseline characteristics including demographics, initial diagnosis, ventricular function, relevant medication, and indication for ICD insertion. Details regarding device insertion were gathered along with follow-up data including appropriate and inappropriate therapy and complications. A total of 136 ICDs were implanted during this period: 79 for primary and 57 for secondary prevention. The most common congenital cardiac conditions in both groups were tetralogy of Fallot and transposition of the great arteries. Twenty-two individuals in the primary prevention group received appropriate antitachycardia pacing (ATP), 14 underwent appropriate cardioversion, 17 received inappropriate ATP, and 15 received inappropriate cardioversion. In the secondary prevention group, 18 individuals received appropriate ATP, 8 underwent appropriate cardioversion, 8 received inappropriate ATP, and 7 were inappropriately cardioverted. Our data demonstrate low complication rates, particularly with leads without advisories. CONCLUSION: ICD insertion in the ACHD population involves a careful balance of the risks and benefits. Our data show a significant proportion of patients receiving appropriate therapy indicating that ICDs were inserted appropriately.
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Slater et al. (2020) conducted an observational in Adult Congenital Heart Disease (ACHD) (n=136). Implantable cardioverter-defibrillator (ICD) was evaluated on Appropriate ICD therapy. In adults with congenital heart disease, implantable cardioverter-defibrillators delivered appropriate therapy in 38% of patients and inappropriate therapy in 26% over long-term follow-up.
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