Conventional and right-sided screening for subcutaneous ICD in a population with congenital heart disease at high risk of sudden cardiac death

Autores de IIS La Fe

• Pau Alonso Fernández

  Autor

• Joaquín Osca Asensi

  Autor

• Joaquín Rueda Soriano

  Autor

• Óscar Cano Pérez

  Autor

• Pedro Pimenta Fermisson-Ramos

  Autor

• Ana Andrés Lahuerta

  Autor

• María Jesus Sancho Gonzalez

  Autor

• Laura Martinez Barbarroja

  Autor

Grupos

• Grupo de Investigación Clínica y Traslacional en Cardiología

• Regeneración y Trasplante Cardíaco

Abstract

BackgroundInformation regarding suitability for subcutaneous defibrillator (sICD) implantation in tetralogy of Fallot (ToF) and systemic right ventricle is scarce and needs to be further explored. The main objective of our study was to determine the proportion of patients with ToF and systemic right ventricle eligible for sICD with both, standard and right-sided screening methods. Secondary objectives were: (i) to study sICD eligibility specifically in patients at high risk of sudden cardiac death, (ii) to identify independent predictors for sICD eligibility, and (iii) to compare the proportion of eligible patients in a nonselected ICD population. MethodsWe recruited 102 patients with ToF, 33 with systemic right ventricle, and 40 consecutive nonselected patients. Conventional electrocardiographic screening was performed as usual. Right-sided alternative screening was studied by positioning the left-arm and right-arm electrodes 1cm right lateral of the xiphoid midline. The Boston Scientific ECG screening tool was utilized. ResultsIn high-risk patients with ToF, eligibility was higher with right-sided screening in comparison with standard screening (61% vs. 44%; p=.018). Eligibility in high-risk right ventricle population was identical with both screening methods (77%, p=ns). The only independent predictor for sICD eligibility was QRS duration. ConclusionIn high-risk patients with ToF, right-sided implantation of the sICD could be an alternative to a conventional ICD. In patients with a systemic right ventricle, implantation of a sICD is an alternative to a conventional sICD.

Keywords

• ECG screening; right-sided screening; subcutaneous implantable cardioverter-defibrillator; systemic right ventricle; tetralogy of Fallot