Right Parasternal Lead Placement Increases Eligibility for Subcutaneous Implantable Cardioverter Defibrillator Therapy in Adults With Congenital Heart Disease

Okamura, Hideo; McLeod, Christopher J.; DeSimone, Christopher V.; Webster, Tracy L.; Bonnichsen, Crystal R.; Grogan, Martha; Phillips, Sabrina D.; Connolly, Heidi M.; Ammash, Naser M.; Warnes, Carole A.; Friedman, Paul A.

doi:10.1253/circj.cj-16-0153

Cited by 33 publications

(22 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…8,25,26 In the present study, right parasternal screening also improved the eligibility of patients with BrS. The 4 BrS patients who failed the left parasternal screening test, but passed the right parasternal screening, had significantly lower BMI.…”

Section: Utility Of Right Parasternal Electrode Placement For Patientsupporting

confidence: 57%

Surface Electrocardiogram Screening for Subcutaneous Implantable Cardioverter-Defibrillators in Japanese Patients With and Without Brugada Syndrome

Kawabata

Goya

Sasaki

et al. 2017

Circ J

View full text Add to dashboard Cite

Background: Subcutaneous implantable cardioverter-defibrillators (S-ICD) could eliminate lead-associated complications. We assessed the prevalence of S-ICD ineligibility in conventional ICD recipients and compared it in patients with and without Brugada syndrome (BrS). Methods and Results:Consecutive patients with a transvenous ICD without an indication for antibradycardia pacing were assessed. A patient was considered eligible for S-ICD if the ECG satisfied the screening template, both supine and standing, in ≥1 lead. Among 130 patients (103 men, age 57±15 years), a total of 18 (13.8%) patients were ineligible. The BrS group (n=33) had a significantly higher prevalence of S-ICD screening failure as compared with the non-BrS group (P=0.003; 30% vs. 8.2%). In the BrS group, the body mass index (BMI) was significantly lower, and T/QRS amplitude in lead I was significantly higher in those who were ineligible than that in the patients who were eligible. Of the 10 BrS patients failing the screening, 4 became eligible in the right parasternal electrode position. Conclusions:Among current ICD patients, there was a high incidence of patients with BrS who were unsuitable for S-ICD based on the left parasternal screening test. Suitability screening of patients for S-ICDs should be conducted carefully in patients with BrS, particularly if the BMI is low. Right parasternal electrode positioning should also be tested in such BrS patients.

show abstract

Section: Utility Of Right Parasternal Electrode Placement For Patientsupporting

confidence: 57%

Surface Electrocardiogram Screening for Subcutaneous Implantable Cardioverter-Defibrillators in Japanese Patients With and Without Brugada Syndrome

Kawabata

Goya

Sasaki

et al. 2017

Circ J

View full text Add to dashboard Cite

show abstract

“…In contrast, they found no additional benefit of right‐sided screening in patients with a single ventricle. Okamura et al . showed a much lower rate of ineligibility (21%) using standard screening in a cohort of 100 ACHD patients.…”

Section: Discussionmentioning

confidence: 99%

Eligibility for subcutaneous implantable cardioverter defibrillators in the adult congenital heart disease population

Garside

Leyva

Hudsmith

et al. 2018

Pacing Clinical Electrophis

View full text Add to dashboard Cite

Background 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. Methods 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. Results 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. Conclusions 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.

show abstract

“…In congenital heart patients, a particular concern is the presence of a large percentage of T wave inversion or enlargement throughout the precordial leads, secondary to ventricular hypertrophy, right bundle branch block, or a paced QRS complex. These features, have been reported as a risk factor for ECG screening failure in the S-ICD[14,15]. Despite the fact that most of our patient had right bundle branch block and two had a paced ventricular complex, all passed the preimplant screening.…”

Section: Discussionmentioning

confidence: 67%

Entirely subcutaneous defibrillator and complex congenital heart disease: Data on long-term clinical follow-up

Ferrero

Ali

Barman

et al. 2017

WJC

View full text Add to dashboard Cite

AIMTo describe the long-term follow-up of patients with complex congenital heart disease who underwent subcutaneous implantable cardiac defibrillator (S-ICD), focusing on local complications, appropriate and inappropriate shocks.METHODSPatients with complex congenital heart disease underwent S-ICD implant in two centers with the conventional technique. Data at follow-up were retrieved from clinical notes and institutional database.RESULTSEight patients were implanted in two centres between 2010 and 2016. Median age at implant was 37.5 years (range 13-57). All patients who were deemed suitable for S-ICD implant passed the pre-procedural screening. Three patients were previously implanted with a anti-bradycardia device, one of whom with CRT. In one patient the device was explanted due to local infection. During the total median follow-up of 874 d, one patient had an appropriate and one inappropriate shock triggered by fast atrial tachycardia. None of the patients had inappropriate shocks secondary to T wave oversensing or electrical interference with anti- bradycardia devices.CONCLUSIONS-ICD appears to be effective and safe in patients with complex congenital heart disease.

show abstract

Right Parasternal Lead Placement Increases Eligibility for Subcutaneous Implantable Cardioverter Defibrillator Therapy in Adults With Congenital Heart Disease

Cited by 33 publications

References 41 publications

Surface Electrocardiogram Screening for Subcutaneous Implantable Cardioverter-Defibrillators in Japanese Patients With and Without Brugada Syndrome

Surface Electrocardiogram Screening for Subcutaneous Implantable Cardioverter-Defibrillators in Japanese Patients With and Without Brugada Syndrome

Eligibility for subcutaneous implantable cardioverter defibrillators in the adult congenital heart disease population

Entirely subcutaneous defibrillator and complex congenital heart disease: Data on long-term clinical follow-up

Contact Info

Product

Resources

About