Cardiac implantable electronic devices in adults with tetralogy of Fallot.
Cardiac implantable electronic devices in adults with tetralogy of Fallot.
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DOI：
10.1136/heartjnl-2018-314072
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发表时间：
2019-04
期刊：
影响因子：
--
通讯作者：
Connolly HM
中科院分区：
文献类型：
--
作者：
Egbe AC;Miranda WR;Madhavan M;Ammash NM;Missula VR;Al-Otaibi M;Fatola A;Kothapalli S;Connolly HM
tachyarrhythmias and bradyarrhythmias affect 20%–50% of adult patients with tetralogy of Fallot (TOF) and some of these patients will require cardiac implantable electronic devices (CIED) such as pacemaker and/or internal cardioverter defibrillator. the Mayo adult congenital heart Disease database was queried for patients with repaired TOF and history of CIED implantation, 1990–2017. The study objectives were: (1) determine the occurrence of device-related complications defined as lead failure, lead recall, device infection and lead thrombus; and (2) determine the occurrence and risk factors for defibrillator shock. there were 99 patients (age 46±14 years and 66 (66%) men) with CIED, and the CIEDs were 41 (41%) pacemakers and 73 (73%) defibrillators. indication for defibrillator implantation was for primary prevention in 28 (38%) and secondary prevention in 45 (62%). Device-related complications occurred in 20 (20%) patients (lead failure 17, lead recall 4, device infection 12 and thrombus 3). Twenty-five per cent of all device infections occurred within 30 days from the time of device generator change. Annualised rates of appropriate and inappropriate shocks were 5.7% and 6.2%, respectively. The use of class III antiarrhythmic drug was protective against defibrillator shock. the current study provides useful outcome data to aid patient counselling and clinical decision-making. Further studies are required to explore ways to decrease the risk of postprocedural infection after device generator change, and to determine which patients will benefit from empirical antiarrhythmic therapy as a strategy to decrease incidence of inappropriate defibrillator shock.
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