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Implantable cardioverter-defibrillators in tetralogy of Fallot.

Abstract：

BACKGROUND:Tetralogy of Fallot is the most common form of congenital heart disease in implantable cardioverter-defibrillator (ICD) recipients, yet little is known about the value of ICDs in this patient population. METHODS AND RESULTS:We conducted a multicenter cohort study in high-risk patients with Tetralogy of Fallot to determine actuarial rates of ICD discharges, identify risk factors, and characterize ICD-related complications. A total of 121 patients (median age 33.3 years; 59.5% male) were enrolled from 11 sites and followed up for a median of 3.7 years. ICDs were implanted for primary prevention in 68 patients (56.2%) and for secondary prevention in 53 (43.8%), defined by clinical sustained ventricular tachyarrhythmia or resuscitated sudden death. Overall, 37 patients (30.6%) received at least 1 appropriate and effective ICD discharge, with a median ventricular tachyarrhythmia rate of 213 bpm. Annual actuarial rates of appropriate ICD shocks were 7.7% and 9.8% in primary and secondary prevention, respectively (P=0.11). A higher left ventricular end-diastolic pressure (hazard ratio 1.3 per mm Hg, P=0.004) and nonsustained ventricular tachycardia (hazard ratio 3.7, P=0.023) independently predicted appropriate ICD shocks in primary prevention. Inappropriate shocks occurred in 5.8% of patients yearly. Additionally, 36 patients (29.8%) experienced complications, of which 6 (5.0%) were acute, 25 (20.7%) were late lead-related, and 7 (5.8%) were late generator-related complications. Nine patients died during follow-up, which corresponds to an actuarial annual mortality rate of 2.2%, which did not differ between the primary and secondary prevention groups. CONCLUSIONS:Patients with tetralogy of Fallot and ICDs for primary and secondary prevention experience high rates of appropriate and effective shocks; however, inappropriate shocks and late lead-related complications are common.

journal_name

Circulation

journal_title

Circulation

authors

Khairy P,Harris L,Landzberg MJ,Viswanathan S,Barlow A,Gatzoulis MA,Fernandes SM,Beauchesne L,Therrien J,Chetaille P,Gordon E,Vonder Muhll I,Cecchin F

doi

10.1161/CIRCULATIONAHA.107.726372

subject

Has Abstract

pub_date

2008-01-22 00:00:00

pages

363-70

issue

eissn

0009-7322

issn

1524-4539

pii

CIRCULATIONAHA.107.726372

journal_volume

117

pub_type

杂志文章,多中心研究

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Implantable cardioverter-defibrillators in tetralogy of Fallot.