Department of Cardiology, Leeds Teaching Hospitals NHS Trust, University of Leeds, Leeds, UK.
Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
J Cardiovasc Electrophysiol. 2020 Aug;31(8):2086-2092. doi: 10.1111/jce.14633. Epub 2020 Jul 7.
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.
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.
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.
成人先天性心脏病（ACHD）患者人群正在迅速扩大。然而，这些患者中有相当一部分会发生心源性猝死。推荐植入式心律转复除颤器（ICD）的植入需要平衡恶性心律失常适当治疗的需求与不适当治疗和程序并发症的后果。在这里，我们呈现了一家大型一级先天性心脏中心 ACHD 患者 ICD 植入的长期随访数据。
确定了 18 年来在我们中心接受 ICD 植入的所有 ACHD 患者。提取了包括人口统计学、初始诊断、心室功能、相关药物和 ICD 植入指征等基线特征的数据。收集了有关设备植入的详细信息以及包括适当和不适当治疗和并发症的随访数据。在此期间共植入了 136 个 ICD：79 个用于一级预防，57 个用于二级预防。两组中最常见的先天性心脏病分别是法洛四联症和大动脉转位。一级预防组中有 22 人接受了适当的抗心动过速起搏（ATP），14 人进行了适当的电复律，17 人接受了不适当的 ATP，15 人接受了不适当的电复律。在二级预防组中，18 人接受了适当的 ATP，8 人进行了适当的电复律，8 人接受了不适当的 ATP，7 人不适当的电复律。我们的数据显示并发症发生率较低，尤其是在没有警报的导联中。
在 ACHD 人群中植入 ICD 需要仔细权衡风险和收益。我们的数据显示，相当一部分患者接受了适当的治疗，表明 ICD 的植入是适当的。
