Copyright
©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Entirely subcutaneous defibrillator and complex congenital heart disease: Data on long-term clinical follow-up
Paolo Ferrero, Hussam Ali, Palash Barman, Sara Foresti, Pierpaolo Lupo, Emilia D’Elia, Riccardo Cappato, Alan Graham Stuart
Paolo Ferrero, Palash Barman, Alan Graham Stuart, Adult Congenital Heart Disease, Bristol Heart Institute, University of Bristol, Bristol BS2 8HW, United Kingdom
Paolo Ferrero, Emilia D’Elia, Cardiovascular Department, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
Hussam Ali, Sara Foresti, Pierpaolo Lupo, Arrhythmia and Electrophysiology Unit II, Humanitas Gavazzeni Clinics, 24127 Bergamo, Italy
Riccardo Cappato, Arrhythmia and Electrophysiology Research Center, Humanitas Clinical and Research Center, 20089 Rozzano (Milan), Italy
Author contributions: Ferrero P and Stuart AG developed the idea of the study; Ferrerp P and Ali H equally contributed to collection of data; Ferrero P and Barman P wrote the paper; Foresti S and Lupo P contributed to interpret the data; D’Elia E and Cappato R reviewed and edited the manuscript.
Institutional review board statement: The study was reviewed and approved by the Adult Congenital Heart disease unit, Bristol Heart Institute Bristol United Kingdom.
Informed consent statement: All study participants, provided informed written consent prior to device implantation and verbally consented to collect follow-up data.
Conflict-of-interest statement: No conflict of interest relative to this research.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Paolo Ferrero, MD, Adult Congenital Heart Disease, Bristol Heart Institute, University of Bristol, Marlborough Street, Bristol BS2 8HW, United Kingdom. pferrero@asst-pg23.it
Telephone: +44-117-3426551 Fax: +44-117-3426554
Received: October 29, 2016
Peer-review started: November 2, 2016
First decision: January 14, 2017
Revised: May 16, 2017
Accepted: May 22, 2017
Article in press: May 24, 2017
Published online: June 26, 2017
AIM
To 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.
METHODS
Patients 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.
RESULTS
Eight 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.
CONCLUSION
S-ICD appears to be effective and safe in patients with complex congenital heart disease.
Core tip: Implantation of subcutaneous implantable cardiac defibrillator in patients with complex congenital heart disease appears to be effective and reliable at long term follow-up. The high proportion of grossly abnormal baseline electrocardiogram and the significant incidence of atrial arrhythmias does not seem to affect the rate of inappropriate shocks.
