David Backhoff1, Gunter Kerst2, Andrea Peters2, Monika Lüdemann2, Christian Frische3, Michaela Horndasch4, Gabriele Hessling4, Thomas Paul5, Ulrich Krause5. 1. Department of Pediatric Cardiology, Georg-August-University, Göttingen, Germany. David.Backhoff@med.uni-goettingen.de. 2. Pediatric Heart Center, Justus-Liebig-University, Gießen, Germany. 3. Department of Pediatric Cardiology, University Children's Hospital, Tübingen, Germany. 4. German Heart Center, Technical University, München, Germany. 5. Department of Pediatric Cardiology, Georg-August-University, Göttingen, Germany.
Abstract
BACKGROUND: Sudden cardiac death (SCD) is the most important cause of late mortality after atrial baffle procedure for d-transposition of the great arteries (d-TGA). Experience with internal cardioverter defibrillator (ICD) therapy in this population is limited. We conducted a multicenter cohort study to determine the current state of ICD therapy in individuals after atrial baffle procedure. METHODS: Demographic and clinical data as well as data on device implantation, programming, ICD discharges, and complications after atrial baffle procedure for d-TGA from four German centers were analyzed retrospectively. RESULTS: ICD implantation was undertaken in 33 subjects. ICD implantation was undertaken as primary prevention in 29 (88%) and secondary prevention in four (12%) individuals. There were 21 (64%) subjects with atrial reentrant tachycardia (IART). During a median follow-up of 4.8 years, seven appropriate ICD therapies were delivered in three (10%) individuals with primary prevention indication. No appropriate shocks were documented in subjects with secondary prevention indication. A total of 12 inappropriate ICD discharges occurred in eight (24%) individuals due to IART (n = 6) or lead failure (n = 2). ICD-related complications were noted in seven individuals (21%): lead dislodgement/failure in five (15%) and ICD infection in two subjects (6%). CONCLUSIONS: The majority of individuals received an ICD for primary prevention of SCD, thus representing a liberal attitude of physicians for ICD implantation. During a median follow-up of 4.8 years, the rate of appropriate ICD therapies was low and clearly exceeded by inappropriate ICD discharges. Lead failure and IART were present in >20% of the individuals and were frequent reasons for inappropriate ICD discharges. Facing these results, rigorous treatment of IART and careful ICD programming seems mandatory.
BACKGROUND:Sudden cardiac death (SCD) is the most important cause of late mortality after atrial baffle procedure for d-transposition of the great arteries (d-TGA). Experience with internal cardioverter defibrillator (ICD) therapy in this population is limited. We conducted a multicenter cohort study to determine the current state of ICD therapy in individuals after atrial baffle procedure. METHODS: Demographic and clinical data as well as data on device implantation, programming, ICD discharges, and complications after atrial baffle procedure for d-TGA from four German centers were analyzed retrospectively. RESULTS:ICD implantation was undertaken in 33 subjects. ICD implantation was undertaken as primary prevention in 29 (88%) and secondary prevention in four (12%) individuals. There were 21 (64%) subjects with atrial reentrant tachycardia (IART). During a median follow-up of 4.8 years, seven appropriate ICD therapies were delivered in three (10%) individuals with primary prevention indication. No appropriate shocks were documented in subjects with secondary prevention indication. A total of 12 inappropriate ICD discharges occurred in eight (24%) individuals due to IART (n = 6) or lead failure (n = 2). ICD-related complications were noted in seven individuals (21%): lead dislodgement/failure in five (15%) and ICD infection in two subjects (6%). CONCLUSIONS: The majority of individuals received an ICD for primary prevention of SCD, thus representing a liberal attitude of physicians for ICD implantation. During a median follow-up of 4.8 years, the rate of appropriate ICD therapies was low and clearly exceeded by inappropriate ICD discharges. Lead failure and IART were present in >20% of the individuals and were frequent reasons for inappropriate ICD discharges. Facing these results, rigorous treatment of IART and careful ICD programming seems mandatory.
Authors: Craig S Broberg; Anne Marie Valente; Jennifer Huang; Luke J Burchill; Jonathan Holt; Ryan Van Woerkom; Andrew J Powell; George A Pantely; Michael Jerosch-Herold Journal: Int J Cardiol Date: 2018-11-15 Impact factor: 4.164
Authors: Prashanth Venkatesh; Arthur T Evans; Anna M Maw; Raymond A Pashun; Agam Patel; Luke Kim; Dmitriy Feldman; Robert Minutello; S Chiu Wong; Judy C Stribling; Damian LaPar; Ralf Holzer; Jonathan Ginns; Emile Bacha; Harsimran S Singh Journal: J Am Heart Assoc Date: 2019-10-23 Impact factor: 5.501