Zormpas Christos, Silber-Peest Ann Sophie, Eiringhaus Jörg, Hillmann Henrike A K, Hohmann Stephan, Müller-Leisse Johanna, Westhoff-Bleck Mechthild, Veltmann Christian, Duncker David
Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, D-30625, Germany.
Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
ESC Heart Fail. 2021 Apr;8(2):1502-1508. doi: 10.1002/ehf2.13243. Epub 2021 Feb 3.
Patients with adult congenital heart disease (ACHD) carry an increased risk for sudden cardiac death. Implantable cardioverter-defibrillator (ICD) therapy may be challenging in these patients due to anatomical barriers, repeated cardiac surgery, or complicated transvenous access. Thus, the subcutaneous ICD (S-ICD) can be a promising alternative in this patient population. Patients with ACHD show significant electrocardiogram (ECG) abnormalities, which could affect S-ICD sensing because it depends on surface ECG.
One hundred patients with ACHD were screened for S-ICD eligibility. Standard ECG-based screening test and automated S-ICD screening test were performed in all patients. Sixty-six patients (66%) were male. Underlying congenital heart disease (CHD) was mainly CHD of great complexity (71%) and moderate complexity (29%), including repaired tetralogy of Fallot (20%), which was the most common entity. Thirty-seven patients (37%) already had a pacemaker (23%) or ICD (14%) implanted. Automated screening test identified 83 patients (83%) eligible for S-ICD implantation in either left parasternal position (78%) or right parasternal position (75%). Absence of sinus rhythm, QRS duration, and a paced QRS complex were associated with S-ICD screening failure in univariate analysis. Receiver operating characteristic curve and multivariate analysis revealed a QRS duration ≥148 ms as the only independent predictor for S-ICD screening failure.
Patients with ACHD show satisfactory eligibility rates (83%) for S-ICD implantation utilizing the automated screening test, including patients with CHD of high complexity. S-ICD therapy should be considered with caution in ACHD patients with a QRS duration ≥148 ms and/or need for ventricular pacing.
成人先天性心脏病（ACHD）患者心脏性猝死风险增加。由于解剖结构障碍、多次心脏手术或经静脉通路复杂，植入式心律转复除颤器（ICD）治疗在这些患者中可能具有挑战性。因此，皮下ICD（S-ICD）可能是这一患者群体中有前景的替代选择。ACHD患者存在显著的心电图（ECG）异常，这可能会影响S-ICD的感知，因为它依赖于体表ECG。
对100例ACHD患者进行S-ICD植入资格筛查。所有患者均进行了基于标准ECG的筛查测试和S-ICD自动筛查测试。66例（66%）为男性。潜在的先天性心脏病（CHD）主要是复杂性高的CHD（71%）和中度复杂性CHD（29%），包括法洛四联症修补术后（20%），这是最常见的类型。37例（37%）患者已植入起搏器（23%）或ICD（14%）。自动筛查测试确定83例（83%）患者适合在左胸骨旁位置（78%）或右胸骨旁位置（75%）植入S-ICD。单因素分析显示，无窦性心律、QRS波时限和起搏QRS波群与S-ICD筛查失败相关。受试者工作特征曲线和多因素分析显示，QRS波时限≥148 ms是S-ICD筛查失败的唯一独立预测因素。
利用自动筛查测试，ACHD患者S-ICD植入的合格率令人满意（83%），包括复杂性高的CHD患者。对于QRS波时限≥148 ms和/或需要心室起搏的ACHD患者，应谨慎考虑S-ICD治疗。
