Chubb Henry, O'Neill Mark, Rosenthal Eric
Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK; Department of Congenital Heart Disease, Evelina Children's Hospital, London, UK.
Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK; Adult Congenital Heart Disease Group, Departments of Cardiology at Guy's and St Thomas' NHS Foundation Trust and Evelina Children's Hospital, London, UK.
Arrhythm Electrophysiol Rev. 2016 May;5(1):57-64. doi: 10.15420/aer.2016.2.3.
Device therapy in the complex congenital heart disease (CHD) population is a challenging field. There is a myriad of devices available, but none designed specifically for the CHD patient group, and a scarcity of prospective studies to guide best practice. Baseline cardiac anatomy, prior surgical and interventional procedures, existing tachyarrhythmias and the requirement for future intervention all play a substantial role in decision making. For both pacing systems and implantable cardioverter defibrillators, numerous factors impact on the merits of system location (endovascular versus non-endovascular), lead positioning, device selection and device programming. For those with Fontan circulation and following the atrial switch procedure there are also very specific considerations regarding access and potential complications. This review discusses the published guidelines, device indications and the best available evidence for guidance of device implantation in the complex CHD population.
复杂先天性心脏病（CHD）患者群体的器械治疗是一个具有挑战性的领域。现有大量器械，但没有专门为CHD患者群体设计的，且前瞻性研究匮乏，难以指导最佳实践。基线心脏解剖结构、既往手术和介入操作、现有的快速性心律失常以及未来干预的需求，在决策过程中都起着重要作用。对于起搏系统和植入式心脏复律除颤器而言，许多因素都会影响系统植入部位（血管内与非血管内）、导线定位、器械选择和器械程控的优缺点。对于接受Fontan循环和心房调转术的患者，在入路和潜在并发症方面也有非常特殊的考虑。本文综述讨论了已发表的指南、器械适应证以及指导复杂CHD患者群体器械植入的最佳现有证据。
