The validity of current implantable cardioverter-defibrillator guidelines in a real-world population of adults with congenital heart disease: A single-center experience

Satoshi Kawada, MD, PhD; Praloy Chakraborty, DM, FACC; Jared Nanthakumar; Lisa Albertini, MD; Erwin N. Oechslin, MD; Susan Lucy Roche, MD; Candice Silversides, MD; Rachel M. Wald, MD; Eugene Downar, MD; Louise Harris, MD; Lorna Swan, MD; Rafael Alonso-Gonzalez, MD; Sara Thorne, MD; Kumaraswamy Nanthakumar, MD; Blandine Mondésert, MD; Paul Khairy, MD, PhD; Krishnakumar Nair, DM

International Journal of Cardiology Congenital Heart Disease (Jun 2022)

The validity of current implantable cardioverter-defibrillator guidelines in a real-world population of adults with congenital heart disease: A single-center experience

Satoshi Kawada, MD, PhD,
Praloy Chakraborty, DM, FACC,
Jared Nanthakumar,
Lisa Albertini, MD,
Erwin N. Oechslin, MD,
Susan Lucy Roche, MD,
Candice Silversides, MD,
Rachel M. Wald, MD,
Eugene Downar, MD,
Louise Harris, MD,
Lorna Swan, MD,
Rafael Alonso-Gonzalez, MD,
Sara Thorne, MD,
Kumaraswamy Nanthakumar, MD,
Blandine Mondésert, MD,
Paul Khairy, MD, PhD,
Krishnakumar Nair, DM

Affiliations

Satoshi Kawada, MD, PhD: University Health Network Toronto, Peter Munk Cardiac Centre, and University of Toronto, Toronto, Ontario, Canada
Praloy Chakraborty, DM, FACC: University Health Network Toronto, Peter Munk Cardiac Centre, and University of Toronto, Toronto, Ontario, Canada
Jared Nanthakumar: University Health Network Toronto, Peter Munk Cardiac Centre, and University of Toronto, Toronto, Ontario, Canada
Lisa Albertini, MD: University Health Network Toronto, Peter Munk Cardiac Centre, and University of Toronto, Toronto, Ontario, Canada
Erwin N. Oechslin, MD: University Health Network Toronto, Peter Munk Cardiac Centre, and University of Toronto, Toronto, Ontario, Canada
Susan Lucy Roche, MD: University Health Network Toronto, Peter Munk Cardiac Centre, and University of Toronto, Toronto, Ontario, Canada
Candice Silversides, MD: University Health Network Toronto, Peter Munk Cardiac Centre, and University of Toronto, Toronto, Ontario, Canada
Rachel M. Wald, MD: University Health Network Toronto, Peter Munk Cardiac Centre, and University of Toronto, Toronto, Ontario, Canada
Eugene Downar, MD: University Health Network Toronto, Peter Munk Cardiac Centre, and University of Toronto, Toronto, Ontario, Canada
Louise Harris, MD: University Health Network Toronto, Peter Munk Cardiac Centre, and University of Toronto, Toronto, Ontario, Canada
Lorna Swan, MD: University Health Network Toronto, Peter Munk Cardiac Centre, and University of Toronto, Toronto, Ontario, Canada
Rafael Alonso-Gonzalez, MD: University Health Network Toronto, Peter Munk Cardiac Centre, and University of Toronto, Toronto, Ontario, Canada
Sara Thorne, MD: University Health Network Toronto, Peter Munk Cardiac Centre, and University of Toronto, Toronto, Ontario, Canada
Kumaraswamy Nanthakumar, MD: University Health Network Toronto, Peter Munk Cardiac Centre, and University of Toronto, Toronto, Ontario, Canada
Blandine Mondésert, MD: Adult Congenital Heart Disease Center, Department of Medicine, Montreal Heart Institute, University of Montreal, Montreal, Canada
Paul Khairy, MD, PhD: Adult Congenital Heart Disease Center, Department of Medicine, Montreal Heart Institute, University of Montreal, Montreal, Canada
Krishnakumar Nair, DM: University Health Network Toronto, Peter Munk Cardiac Centre, and University of Toronto, Toronto, Ontario, Canada; Corresponding author. 3rd Floor, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, 200 Elizabeth Street, Toronto, M5G 2C4, Canada.

Journal volume & issue: Vol. 8
p. 100355

Abstract

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Aims: Sudden cardiac death (SCD) is a major cause of mortality in adults with congenital heart disease (ACHD). The role of implantable cardioverter-defibrillator (ICDs) in preventing SCD has been established, however, robust, clinical evidence-based guidelines are lacking in ACHD. The aim of this study was to evaluate the ICD guidelines in ACHD patients. Methods and Results: A total of 131 ACHD patients (male: n = 96 (73.3%), mean age: 42.8 ± 14.7 years, mean follow-up: 40.9 ± 28.3 months) undergoing ICDs implantation between 2010 and 2017 were reviewed. Sixty-nine patients (52.6%) received ICDs for a primary prevention indication. 122 (93.3%) patients had congenital heart disease of moderate to severe complexity. CRT-D (implantable cardiac resynchronization defibrillator) was implanted in 55 (42.0%) patients. During follow-up, 23 patients (17.6%) received appropriate ICD therapy. According to the current guideline (PACES/HRS 2014), 84 (64.1%), 8 (6.1%), and 39 (29.8%) could be classified as Class Ⅰ, Class Ⅱa, and Class Ⅱb indication, respectively. Compared to patients with Class Ⅱa and IIb indication, those with Class Ⅰ indication received more appropriate therapy (P = 0.030). Multivariate analysis showed that age (per 10-years decrease; P = 0.015, HR 1.254 CI; 1.045–1.505) and creatinine (per 100-μmol/L increase; P = 0.019, HR 1.555 CI; 1.076–2.247) were associated with appropriate therapy. Conclusion: Implantation of ICDs for preventing SCD based on current guidelines is reasonable. For patients with a borderline indication, younger age and renal dysfunction may aid in the selection of ICDs candidates.

Published in International Journal of Cardiology Congenital Heart Disease

ISSN: 2666-6685 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system
Website: https://www.journals.elsevier.com/international-journal-of-cardiology-congenital-heart-disease

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