Garside Hannah, Leyva Francisco, Hudsmith Lucy, Marshall Howard, de Bono Joseph
Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom.
Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, United Kingdom.
Pacing Clin Electrophysiol. 2019 Jan;42(1):65-70. doi: 10.1111/pace.13537. Epub 2018 Dec 4.
Patients with adult congenital heart disease (ACHD) have an increased risk of arrhythmic and sudden cardiac death. The subcutaneous implantable cardioverter defibrillator (S-ICD) provides a potentially safer alternative to transvenous ICDs in ACHD. Suitability for S-ICD depends on the surface electrocardiogram (ECG), which is often abnormal in ACHD patients. This study investigates the proportion of ACHD patients who meet the screening criteria for S-ICD implantation.
A standard screening ECG was performed in 102 patients with complex ACHD (Tetralogy of Fallot, Fontan circulation, and transposition of the great arteries). This process was repeated postexercise for patients who also had an exercise test.
Three quarters (75.4%) of ACHD patients meet screening criteria for an S-ICD with at least one suitable vector. The most common number of acceptable vectors in the eligible group was two (35% of total population). In only 12% of total population, all three vectors were suitable while only one vector was suitable in 28% of total population. The primary vector (equivalent of ECG lead III) was the most common suitable vector, found in 62% of participants who had appropriate sensing vectors. Twenty-five (24.5%) patients failed to meet the S-ICD screening criteria. Of these, 14 had repaired tetralogy of Fallot. A total of 92% of patients with a Fontan circulation met ECG screening criteria. Of those who had the protocol repeated following their cardiopulmonary exercise test (n = 14), only one additional patient failed to meet the eligibility criteria.
A quarter of ACHD patients do not meet the eligibility criteria for the S-ICD. However, more than 90% of patients with a Fontan circulation are suitable for an S-ICD.
成人先天性心脏病（ACHD）患者发生心律失常和心源性猝死的风险增加。皮下植入式心律转复除颤器（S-ICD）为ACHD患者提供了一种潜在更安全的经静脉植入式心律转复除颤器替代方案。S-ICD的适用性取决于体表心电图（ECG），而ACHD患者的体表心电图通常异常。本研究调查了符合S-ICD植入筛查标准的ACHD患者比例。
对102例患有复杂ACHD（法洛四联症、Fontan循环和大动脉转位）的患者进行了标准筛查心电图检查。对于同时进行运动试验的患者，运动后重复该过程。
四分之三（75.4%）的ACHD患者符合S-ICD筛查标准，至少有一个合适的向量。符合条件组中最常见的可接受向量数量为两个（占总人口的35%）。在总人口中，只有12%的患者所有三个向量都合适，而只有一个向量合适的患者占总人口的28%。主要向量（相当于心电图导联III）是最常见的合适向量，在有合适感知向量的参与者中占62%。25例（24.5%）患者未达到S-ICD筛查标准。其中，14例患者曾接受法洛四联症修复术。共有92%的Fontan循环患者符合心电图筛查标准。在心肺运动试验后重复该方案的患者中（n = 14），只有另外1例患者未达到入选标准。
四分之一的ACHD患者不符合S-ICD的入选标准。然而，超过90%的Fontan循环患者适合植入S-ICD。
