The Lead Episode 43: A Discussion of Implantable Subcutaneous Cardioverter-Defibrillators in Patients with Congenital Heart Disease-The Lead Episode 43 Speaker Information

The Lead Episode 43 Speaker Information

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This article discusses the use of subcutaneous cardioverter-defibrillators (S-ICDs) in patients with congenital heart disease (CHD). Sudden death is a significant cause of mortality in the CHD population, and traditional transvenous systems have limitations in this population. The objective of the study was to examine the efficacy, burden of complications, and rates of appropriate vs inappropriate therapy using the S-ICD in patients with CHD.<br /><br />The study included 4924 patients who underwent S-ICD, of which 101 (2.1%) had CHD. The majority of CHD patients had conditions such as tetralogy, single ventricle, and D-TGA. Compared to non-CHD patients, CHD patients were younger, more likely to be female, had secondary prevention, and less systemic ventricular dysfunction.<br /><br />The study found that the S-ICDs were highly effective in the CHD population, with 97% of defibrillation tests successful with the first shock. The follow-up period was 1.9 years, and 16% of patients received at least one appropriate shock, which was more common in the CHD group. However, 15% of patients experienced device-related complications, and the risk of infection was higher in the CHD group.<br /><br />The discussion highlights that S-ICDs have higher rates of appropriate therapy, indicating their effectiveness in the CHD population. However, there are also concerns about the higher risk of infections, longer implant times, and challenges in managing anticoagulation and hematomas in immunocompromised CHD patients. The study has some limitations, such as being a retrospective registry with a short follow-up period and lacking data on programming and screening failures.<br /><br />Overall, this study suggests that S-ICDs can be a viable option for patients with CHD who are at risk of sudden death. However, further research is needed to address the associated complications and optimize the use of these devices in this population.

Keywords

subcutaneous cardioverter-defibrillators

S-ICDs

congenital heart disease

CHD

sudden death

transvenous systems

efficacy

complications

appropriate therapy

infections