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Silvetti MS, Colonna D, Gabbarini F, Porcedda G, Rimini A, D’Onofrio A, Leoni L. New Guidelines of Pediatric Cardiac Implantable Electronic Devices: What Is Changing in Clinical Practice? J Cardiovasc Dev Dis 2024; 11:99. [PMID: 38667717 PMCID: PMC11050217 DOI: 10.3390/jcdd11040099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/15/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024] Open
Abstract
Guidelines are important tools to guide the diagnosis and treatment of patients to improve the decision-making process of health professionals. They are periodically updated according to new evidence. Four new Guidelines in 2021, 2022 and 2023 referred to pediatric pacing and defibrillation. There are some relevant changes in permanent pacing. In patients with atrioventricular block, the heart rate limit in which pacemaker implantation is recommended was decreased to reduce too-early device implantation. However, it was underlined that the heart rate criterion is not absolute, as signs or symptoms of hemodynamically not tolerated bradycardia may even occur at higher rates. In sinus node dysfunction, symptomatic bradycardia is the most relevant recommendation for pacing. Physiological pacing is increasingly used and recommended when the amount of ventricular pacing is presumed to be high. New recommendations suggest that loop recorders may guide the management of inherited arrhythmia syndromes and may be useful for severe but not frequent palpitations. Regarding defibrillator implantation, the main changes are in primary prevention recommendations. In hypertrophic cardiomyopathy, pediatric risk calculators have been included in the Guidelines. In dilated cardiomyopathy, due to the rarity of sudden cardiac death in pediatric age, low ejection fraction criteria were demoted to class II. In long QT syndrome, new criteria included severely prolonged QTc with different limits according to genotype, and some specific mutations. In arrhythmogenic cardiomyopathy, hemodynamically tolerated ventricular tachycardia and arrhythmic syncope were downgraded to class II recommendation. In conclusion, these new Guidelines aim to assess all aspects of cardiac implantable electronic devices and improve treatment strategies.
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Affiliation(s)
- Massimo Stefano Silvetti
- Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Bambino Gesù Children’s Hospital IRCCS, European Reference Network for Rare and Low Prevalence Complex Disease of the Heart (ERN GUARD-Heart), 00100 Rome, Italy
| | - Diego Colonna
- Adult Congenital Heart Disease Unit, Monaldi Hospital, 80131 Naples, Italy;
| | - Fulvio Gabbarini
- Paediatric Cardiology and Adult Congenital Heart Disease Unit, Regina Margherita Hospital, 10126 Torino, Italy;
| | - Giulio Porcedda
- Paediatric Cardiology Unit, A. Meyer Children’s Hospital, 50139 Florence, Italy;
| | - Alessandro Rimini
- Paediatric Cardiology Unit, G. Gaslini Children’s Hospital IRCCS, 16147 Genoa, Italy;
| | - Antonio D’Onofrio
- Departmental Unit of Electrophysiology, Evaluation and Treatment of Arrhythmia, Monaldi Hospital, 80131 Naples, Italy;
| | - Loira Leoni
- Cardiology Unit, Department of Cardio-Thoracic-Vascular Science and Public Health, Padua University Hospital (ERN GUARD-Heart), 35121 Padua, Italy;
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2
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Kay B, Lampert R. Devices and Athletics: Decision-Making Around Return to Play. Card Electrophysiol Clin 2024; 16:81-92. [PMID: 38280816 DOI: 10.1016/j.ccep.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
Until recently, implantable cardioverter defibrillators (ICDs) were considered a contraindication to competitive athletics. Recent prospective observational registry data in athletes with ICDs who participated in sports against the societal recommendations at the time have demonstrated the safety of sports participation. While athletes did receive both appropriate and inappropriate shocks, these were not more frequent during sports participation than other activity, and there were no sports-related deaths or need for external resuscitation in the 440 athlete cohort (median followup 44 months). Optimization of medical therapies, device settings and having an emergency action plan allow many athletes to safely continue athletic activity.
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Affiliation(s)
- Bradley Kay
- Section of Cardiovascular Medicine, Yale School of Medicine, 789 Howard Avenue, Dana 319, New Haven, CT 06520, USA
| | - Rachel Lampert
- Section of Cardiovascular Medicine, Yale School of Medicine, 789 Howard Avenue, Dana 319, New Haven, CT 06520, USA.
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3
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Leng T, Griffeth E, Stephens EH, Dearani JA, Cannon BC, Ackerman MJ, Wackel PL. Utility of routine follow-up defibrillation safety margin testing in young patients with epicardial implantable cardioverter-defibrillators. Pacing Clin Electrophysiol 2024; 47:392-397. [PMID: 38341633 DOI: 10.1111/pace.14948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/12/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Routine defibrillation threshold testing (DFT) of transvenous implantable defibrillators (ICDs) has largely been in decline. In patients with non-transvenous ICDs that utilize subcutaneous and pleural ICD leads, serial DFT testing can detect a significant number of failures. Data about the utility of follow-up defibrillation safety margin testing (DSM) testing in pediatric patients and young adults with an epicardial ICD are lacking. METHODS Patients aged < 25 years old who underwent epicardial ICD placement at Mayo Clinic from 2014 to 2023 with at least one follow-up DSM test were included. The patients were divided into a "routine" (R) and "clinically indicated" (CI) group based on the index of clinical concern. Inadequate DSM was defined as unsuccessful defibrillation at an output of less than 10 J below the maximum output of the device. The purpose of this study was to assess the utility of follow-up DSM testing. RESULTS An epicardial ICD system was placed in 122 patients. A total of 26 patients met inclusion criteria and underwent a total of 47 DSM follow up tests. Inadequate DSM occurred in 1/33 (3%) in the R group and 2/14 (14%) DSM tests in the CI group. The median follow-up period was 54 and 36 months for the R and CI group, respectively. CONCLUSIONS Our data suggest that epicardial ICDs are reliable and routine follow-up DSM testing may not be necessary for all patients. DSM testing should be performed in individuals with epicardial ICD systems when there is clinical concern about lead or coil performance.
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Affiliation(s)
- Tomas Leng
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Elaine Griffeth
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Bryan C Cannon
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Ackerman
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo Clinic, Rochester, Minnesota, USA
- Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Philip L Wackel
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA
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Tan RB, Stephenson EA, Bulic A. Epicardial Devices in Pediatrics and Congenital Heart Disease. Card Electrophysiol Clin 2023; 15:467-480. [PMID: 37865520 DOI: 10.1016/j.ccep.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Epicardial cardiac implantable electronic device implant remains a common option in pediatric patients and certain patients with congenital heart disease due to patient size, complex anatomy, residual intracardiac shunts, and prior surgery precluding transvenous implant. Advantages include the lack of thromboembolic and vascular risks and ability to implant during concomitant surgery. Significant disadvantages include the occurrence of lead dysfunction that can result in bradycardia events in pacemaker patients, inappropriate shocks in implantable cardiac defibrillator patients, and overall a more invasive procedure.
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Affiliation(s)
- Reina Bianca Tan
- Division of Cardiology, Department of Pediatrics, NYU Langone Health and Hassenfeld Children's Hospital, 403 East 34th Street, Level 4, New York, NY 10017, USA.
| | - Elizabeth A Stephenson
- University of Toronto, The Hospital for Sick Children, Labatt Family Heart Centre, 555 University Avenue, Room 1725, Toronto, Ontario M5G1X8, Canada
| | - Anica Bulic
- University of Toronto, The Hospital for Sick Children, Labatt Family Heart Centre, 555 University Avenue, Room 1725, Toronto, Ontario M5G1X8, Canada
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Guarracini F, Preda A, Bonvicini E, Coser A, Martin M, Quintarelli S, Gigli L, Baroni M, Vargiu S, Varrenti M, Forleo GB, Mazzone P, Bonmassari R, Marini M, Droghetti A. Subcutaneous Implantable Cardioverter Defibrillator: A Contemporary Overview. Life (Basel) 2023; 13:1652. [PMID: 37629509 PMCID: PMC10455445 DOI: 10.3390/life13081652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023] Open
Abstract
The difference between subcutaneous implantable cardioverter defibrillators (S-ICDs) and transvenous ICDs (TV-ICDs) concerns a whole extra thoracic implantation, including a defibrillator coil and pulse generator, without endovascular components. The improved safety profile has allowed the S-ICD to be rapidly taken up, especially among younger patients. Reports of its role in different cardiac diseases at high risk of SCD such as hypertrophic and arrhythmic cardiomyopathies, as well as channelopathies, is increasing. S-ICDs show comparable efficacy, reliability, and safety outcomes compared to TV-ICD. However, some technical issues (i.e., the inability to perform anti-bradycardia pacing) strongly limit the employment of S-ICDs. Therefore, it still remains only an alternative to the traditional ICD thus far. This review aims to provide a contemporary overview of the role of S-ICDs compared to TV-ICDs in clinical practice, including technical aspects regarding device manufacture and implantation techniques. Newer outlooks and future perspectives of S-ICDs are also brought up to date.
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Affiliation(s)
- Fabrizio Guarracini
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Alberto Preda
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Eleonora Bonvicini
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Alessio Coser
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Marta Martin
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Silvia Quintarelli
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Lorenzo Gigli
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Matteo Baroni
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Sara Vargiu
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Marisa Varrenti
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Giovanni Battista Forleo
- Department of Thoracic Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Turin, Italy;
| | - Patrizio Mazzone
- Electrophysiology Unit, Cardio-Thoraco-Vascular Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (A.P.); (L.G.); (M.B.); (S.V.); (M.V.); (P.M.)
| | - Roberto Bonmassari
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Massimiliano Marini
- Department of Cardiology, S. Chiara Hospital, 38122 Trento, Italy; (E.B.); (A.C.); (M.M.); (S.Q.); (R.B.); (M.M.)
| | - Andrea Droghetti
- Cardiology Unit, Luigi Sacco University Hospital, 20157 Milan, Italy;
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Griffeth EM, Krishnan P, Dearani JA, Pahwa S, Ackerman MJ, Wackel PL, Todd A, Cannon BC. Pediatric Epicardial Devices: Early and Midterm Outcomes. World J Pediatr Congenit Heart Surg 2023; 14:451-458. [PMID: 36851830 PMCID: PMC10330933 DOI: 10.1177/21501351231157374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Lead performance is suboptimal in young patients and a main cause of device system failure. Our objective was to assess early and midterm outcomes after epicardial device implantation in a contemporary pediatric cohort. METHODS A total of 116 consecutive pediatric patients underwent 137 epicardial device implantations from 2010 to 2019. Forty pacemakers and 97 implantable cardioverter defibrillators (ICDs) were implanted. Lead failure was defined as leads repaired, replaced, or abandoned due to fracture, dislodgement, or dysfunction. Freedom from device system failure was determined using Kaplan-Meier analysis. RESULTS Mean age at implantation was 10 ± 5 years, 46 (34%) were younger than 8 years old, 41 (30%) had prior cardiac surgery, and 38 (28%) had prior devices. Main indications were acquired heart block (17/40 [43%]), sinus node dysfunction (14/40 [35%]), and congenital heart block (7/40 [18%]) for pacemakers, and hypertrophic cardiomyopathy (46/97 [47%]), long QT syndrome (31/97 [32%]), and ventricular arrhythmia (17/97 [18%]) for ICDs. There were no early deaths. Three-year freedom from device system failure was 80% (95% CI 73%, 88%) for all patients and 88% (95% CI 79%, 99%) for patients <8 years old. Device system failure causes included lead fracture (20/34 [59%]), lead dysfunction (5/34 [15%]), lead dislodgement (5/34 [15%]), infection (3/34 [9%]), and pericarditis (1/34 [3%]). Reintervention was required in 26/34 (76%) device system failures. CONCLUSIONS Epicardial device implantation is safe, shows acceptable midterm outcomes in children, and is an effective option in patients younger than 8 years old. Close device surveillance continues to be essential to detect lead failure early and ensure timely reintervention.
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Affiliation(s)
- Elaine M Griffeth
- Department of Cardiovascular Surgery, Mayo Clinic,
Rochester, MN, USA
| | - Prasad Krishnan
- Department of Cardiovascular Surgery, Mayo Clinic,
Rochester, MN, USA
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic,
Rochester, MN, USA
| | - Siddharth Pahwa
- Department of Cardiovascular Surgery, Mayo Clinic,
Rochester, MN, USA
| | | | - Philip L Wackel
- Division of Pediatric Cardiology, Mayo Clinic, Rochester,
MN, USA
| | - Austin Todd
- Department of Quantitative Health Sciences, Mayo Clinic,
Rochester, MN, USA
| | - Bryan C Cannon
- Division of Pediatric Cardiology, Mayo Clinic, Rochester,
MN, USA
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7
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Kumthekar RN, Opfermann JD, Mass P, Contento JM, Berul CI. Percutaneous epicardial pacing in infants using direct visualization: A feasibility animal study. J Cardiovasc Electrophysiol 2023; 34:1452-1458. [PMID: 37172303 DOI: 10.1111/jce.15926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/20/2023] [Accepted: 04/29/2023] [Indexed: 05/14/2023]
Abstract
BACKGROUND Pacemaker implantation in infants and small children is limited to epicardial lead placement via open chest surgery. We propose a minimally invasive solution using a novel percutaneous access kit. OBJECTIVE To evaluate the acute safety and feasibility of a novel percutaneous pericardial access tool kit to implant pacemaker leads on the epicardium under direct visualization. METHODS A custom sheath with optical fiber lining the inside wall was built to provide intrathoracic illumination. A Veress needle inside the illumination sheath was inserted through a skin nick just to the left of the xiphoid process and angled toward the thorax. A needle containing a fiberscope within the lumen was inserted through the sheath and used to access the pericardium under direct visualization. A custom dilator and peel-away sheath with pre-tunneled fiberscope was passed over a guidewire into the pericardial space via modified Seldinger technique. A side-biting multipolar pacemaker lead was inserted through the sheath and affixed against the epicardium. RESULTS Six piglets (weight 3.7-4.0 kg) had successful lead implantation. The pericardial space could be visualized and entered in all animals. Median time from skin nick to sheath access of the pericardium was 9.5 (interquartile range [IQR] 8-11) min. Median total procedure time was 16 (IQR 14-19) min. Median R wave sensing was 5.4 (IQR 4.0-7.3) mV. Median capture threshold was 2.1 (IQR 1.7-2.4) V at 0.4 ms and 1.3 (IQR 1.2-2.0) V at 1.0 ms. There were no complications. CONCLUSION Percutaneous epicardial lead implantation under direct visualization was successful in six piglets of neonatal size and weight with clinically acceptable acute pacing parameters.
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Affiliation(s)
- Rohan N Kumthekar
- Division of Cardiology, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Justin D Opfermann
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Paige Mass
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Washington, District of Columbia, USA
- Division of Cardiology, Children's National Hospital, Washington, District of Columbia, USA
| | - Jacqueline M Contento
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Washington, District of Columbia, USA
- Division of Cardiology, Children's National Hospital, Washington, District of Columbia, USA
| | - Charles I Berul
- Division of Cardiology, Children's National Hospital, Washington, District of Columbia, USA
- Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia, USA
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8
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Le Bos PA, Pontailler M, Maltret A, Kraiche D, Gaudin R, Barbanti C, Marijon E, Raisky O, Bonnet D, Waldmann V. Epicardial vs. transvenous implantable cardioverter defibrillators in children. Europace 2023; 25:961-968. [PMID: 36735263 PMCID: PMC10062323 DOI: 10.1093/europace/euad015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/23/2022] [Indexed: 02/04/2023] Open
Abstract
AIMS The implantable cardioverter defibrillator (ICD) has been increasingly used in children. Both epicardial and transvenous approaches are used, with controversy regarding the best option with no specific recommendations. We aimed to compare outcomes associated with epicardial vs. transvenous ICDs in children. METHODS AND RESULTS Data were analysed from a retrospective study including all patients <18-year-old implanted with an ICD in a tertiary centre from 2003 to 2021. Outcomes were compared between epicardial and transvenous ICDs. A total of 122 children with an ICD (mean age 11.5 ± 3.8 years, 57.4% males) were enrolled, with 84 (64.1%) epicardial ICDs and 38 (29.0%) transvenous ICDs. Early (<30 days) ICD-related complications were reported in 17 (20.2%) patients with an epicardial ICD vs. 0 (0.0%) with a transvenous ICD (P = 0.002). Over a mean follow-up of 4.8 ± 4.0 years, 25 (29.8%) patients with an epicardial ICD and 9 (23.7%) patients with a transvenous ICD experienced at least one late ICD-related complication [hazard ratio (HR) 1.8, 95% confidence interval (CI) 0.8-4.0]. Implantable cardioverter defibrillator lead dysfunction occurred in 19 (22.6%) patients with an epicardial ICD vs. 3 (7.9%) with a transvenous ICD (HR 5.7, 95% CI 1.3-24.5) and was associated with a higher incidence of ICD-related reintervention (HR 3.0, 95% CI 1.3-7.0). After considering potential confounders, especially age and weight at implantation, this association was no longer significant (P = 0.112). The freedom from ICD lead dysfunction was greater in patients with pleural coils than in those with epicardial coils (HR 0.38, 95% CI 0.15-0.96). CONCLUSION In children, after a consideration of patient characteristics at implantation, the burden of complications and ICD lead dysfunction appears to be similar in patients with epicardial and transvenous devices. Pleural coils seem to be associated with better outcomes than epicardial coils in this population. CLINICAL TRIAL REGISTRATION NCT05349162.
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Affiliation(s)
- Pierre Antoine Le Bos
- M3C-Necker, Hôpital Universitaire Necker-Enfants Malades, 149 rue de Sèvres, 75015 Paris, France
| | - Margaux Pontailler
- Department of Pediatric Cardiac Surgery, Necker Hospital, 149 rue de Sèvres, 75015 Paris, France
| | - Alice Maltret
- M3C-Necker, Hôpital Universitaire Necker-Enfants Malades, 149 rue de Sèvres, 75015 Paris, France
| | - Diala Kraiche
- M3C-Necker, Hôpital Universitaire Necker-Enfants Malades, 149 rue de Sèvres, 75015 Paris, France
| | - Regis Gaudin
- Department of Pediatric Cardiac Surgery, Necker Hospital, 149 rue de Sèvres, 75015 Paris, France
| | - Claudio Barbanti
- Pediatric Cardiac Anesthesia and Cardiopulmonary Unit, Necker Hospital, 149 rue de Sèvres, 75015 Paris, France
| | - Eloi Marijon
- Université de Paris Cité, INSERM, Paris Cardiovascular Research Centre, 56 rue Leblanc, 75015 Paris, France.,Electrophysiology Unit, European Georges Pompidou Hospital, 20 rue Leblanc, 75015 Paris, France
| | - Olivier Raisky
- Department of Pediatric Cardiac Surgery, Necker Hospital, 149 rue de Sèvres, 75015 Paris, France.,Université de Paris Cité, INSERM, Paris Cardiovascular Research Centre, 56 rue Leblanc, 75015 Paris, France
| | - Damien Bonnet
- M3C-Necker, Hôpital Universitaire Necker-Enfants Malades, 149 rue de Sèvres, 75015 Paris, France.,Université de Paris Cité, INSERM, Paris Cardiovascular Research Centre, 56 rue Leblanc, 75015 Paris, France.,Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, 20 rue Leblanc, 75015 Paris, France
| | - Victor Waldmann
- M3C-Necker, Hôpital Universitaire Necker-Enfants Malades, 149 rue de Sèvres, 75015 Paris, France.,Université de Paris Cité, INSERM, Paris Cardiovascular Research Centre, 56 rue Leblanc, 75015 Paris, France.,Electrophysiology Unit, European Georges Pompidou Hospital, 20 rue Leblanc, 75015 Paris, France.,Adult Congenital Heart Disease Medico-Surgical Unit, European Georges Pompidou Hospital, 20 rue Leblanc, 75015 Paris, France
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Teixeira RA, Fagundes AA, Baggio Junior JM, Oliveira JCD, Medeiros PDTJ, Valdigem BP, Teno LAC, Silva RT, Melo CSD, Elias Neto J, Moraes Júnior AV, Pedrosa AAA, Porto FM, Brito Júnior HLD, Souza TGSE, Mateos JCP, Moraes LGBD, Forno ARJD, D'Avila ALB, Cavaco DADM, Kuniyoshi RR, Pimentel M, Camanho LEM, Saad EB, Zimerman LI, Oliveira EB, Scanavacca MI, Martinelli Filho M, Lima CEBD, Peixoto GDL, Darrieux FCDC, Duarte JDOP, Galvão Filho SDS, Costa ERB, Mateo EIP, Melo SLD, Rodrigues TDR, Rocha EA, Hachul DT, Lorga Filho AM, Nishioka SAD, Gadelha EB, Costa R, Andrade VSD, Torres GG, Oliveira Neto NRD, Lucchese FA, Murad H, Wanderley Neto J, Brofman PRS, Almeida RMS, Leal JCF. Brazilian Guidelines for Cardiac Implantable Electronic Devices - 2023. Arq Bras Cardiol 2023; 120:e20220892. [PMID: 36700596 PMCID: PMC10389103 DOI: 10.36660/abc.20220892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | - Rodrigo Tavares Silva
- Universidade de Franca (UNIFRAN), Franca, SP - Brasil
- Centro Universitário Municipal de Franca (Uni-FACEF), Franca, SP - Brasil
| | | | - Jorge Elias Neto
- Universidade Federal do Espírito Santo (UFES), Vitória, ES - Brasil
| | - Antonio Vitor Moraes Júnior
- Santa Casa de Ribeirão Preto, Ribeirão Preto, SP - Brasil
- Unimed de Ribeirão Preto, Ribeirão Preto, SP - Brasil
| | - Anisio Alexandre Andrade Pedrosa
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Luis Gustavo Belo de Moraes
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | | | | | - Mauricio Pimentel
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | | | - Eduardo Benchimol Saad
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil
- Hospital Samaritano, Rio de Janeiro, RJ - Brasil
| | | | | | - Mauricio Ibrahim Scanavacca
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Martino Martinelli Filho
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Carlos Eduardo Batista de Lima
- Hospital Universitário da Universidade Federal do Piauí (UFPI), Teresina, PI - Brasil
- Empresa Brasileira de Serviços Hospitalares (EBSERH), Brasília, DF - Brasil
| | | | - Francisco Carlos da Costa Darrieux
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Sissy Lara De Melo
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Eduardo Arrais Rocha
- Hospital Universitário Walter Cantídio, Universidade Federal do Ceará (UFC), Fortaleza, CE - Brasil
| | - Denise Tessariol Hachul
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Silvana Angelina D'Orio Nishioka
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Roberto Costa
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Gustavo Gomes Torres
- Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN - Brasil
| | | | | | - Henrique Murad
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | - Rui M S Almeida
- Centro Universitário Fundação Assis Gurgacz, Cascavel, PR - Brasil
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10
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Huang AL, MacNamara J, Link MS, Martinez M, Dearani JA, Cannon BC, Levine BD, Ackerman MJ. Asymptomatic Apical Hypertrophic Cardiomyopathy in an Elite Competitive Athlete. JACC Case Rep 2022; 6:101705. [PMID: 36704059 PMCID: PMC9871207 DOI: 10.1016/j.jaccas.2022.101705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/01/2022] [Accepted: 11/15/2022] [Indexed: 12/15/2022]
Abstract
A 17-year-old male elite athlete presented for evaluation after an abnormal pre-competitive college screening electrocardiogram. Subsequent evaluation revealed the presence of hypertrophic cardiomyopathy. He remained asymptomatic throughout four years of follow-up. Through shared decision making, he continued to play competitively and is now a professional athlete. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Athena L. Huang
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - James MacNamara
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mark S. Link
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | | | | | | | - Michael J. Ackerman
- Mayo Clinic, Rochester, Minnesota, USA,Address for correspondence: Dr Michael J. Ackerman, Mayo Clinic, Guggenheim Building, Room 501, 200 First Street SW, Rochester, Minnesota 55905, USA.
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11
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Contento JM, Mass PN, Kumthekar RN, Berul CI, Opfermann JD. Design and Functionality of a Multilumen Thoracic Access Port for Pericardial Access Under Direct Visualization. J Med Device 2022; 16:041005. [PMID: 36353367 PMCID: PMC9445317 DOI: 10.1115/1.4054999] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/30/2022] [Indexed: 09/23/2023] Open
Abstract
Small vasculature, venous obstruction, or congenital anomalies can preclude transvenous access to the heart, often resulting in open chest surgery to implant cardiac therapy leads for pacing, defibrillation, or cardiac resynchronization. A minimally invasive approach under direct visualization could reduce tissue damage, minimize pain, shorten recovery time, and obviate the need for fluoroscopy. Therefore, PeriPath was designed as a single-use, low-cost pericardial access tool based on clinical requirements. Its mechanical design aids in safe placement of conductive leads to the pericardium using a modified Seldinger technique. The crossed working channels provide an optimal view of the surgical field under direct visualization. Finite element analysis (FEA) confirms that the device is likely not to fail under clinical working conditions. Mechanical testing demonstrates that the tensile strength of its components is sufficient for use, with minimal risk of fracture. The PeriPath procedure is also compatible with common lead implantation tools and can be readily adopted by interventional cardiologists and electrophysiologists, allowing for widespread implementation. Prior animal work and a physician preliminary validation study suggest that PeriPath functions effectively for minimally invasive lead implantation procedures.
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Affiliation(s)
- Jacqueline M. Contento
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, 111 Michigan Avenue NW, Washington, DC 20010
| | - Paige N. Mass
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, 111 Michigan Avenue NW, Washington, DC 20010
| | - Rohan N. Kumthekar
- Division of Cardiology, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43205; Department of Pediatrics, The Ohio State University College of Medicine, 370 W 9th Avenue, Columbus, OH 43210
| | - Charles I. Berul
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Division of Cardiology, Children's National Hospital, 111 Michigan Avenue NW, Washington, DC 20010; Department of Pediatrics, George Washington School of Medicine, 2300 I Street NW, Washington, DC 20052
| | - Justin D. Opfermann
- Department of Mechanical Engineering, Johns Hopkins University, 3400 N Charles Street, Baltimore, MD 21218
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12
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Kay B, Lampert R. Devices and Athletics. Cardiol Clin 2022; 41:81-92. [DOI: 10.1016/j.ccl.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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13
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Wieniawski P, Buczyński M, Grabowski M, Winter J, Werner B. Subcutaneous Implantable Cardioverter Defibrillators for the Prevention of Sudden Cardiac Death: Pediatric Single-Center Experience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11661. [PMID: 36141934 PMCID: PMC9517274 DOI: 10.3390/ijerph191811661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The subcutaneous implantable cardioverter defibrillator (S-ICD) was developed as an alternative to the transvenous ICD, to prevent lead-related complications associated with the latter. The absence of intravascular or intracardiac components offers potential advantages to pediatric patients. AIMS The aim of the study is to present an overview of our experience with S-ICDs in the pediatric center that, currently, has performed the largest number of implantations in children in Poland. METHODS Retrospective analysis of data from medical history, qualification, implantation procedure, and S-ICD post-implantation observations in 11 pediatric patients were performed. RESULTS S-ICDs were implanted in 11 patients, 8 boys and 3 girls, aged 12-17 years. The S-ICD was implanted for primary prevention in seven patients: four with hypertrophic cardiomyopathy (HCM), two with dilated cardiomyopathy (DCM), and one with arrhythmogenic right ventricular cardiomyopathy (ARVC). It was implanted for secondary prevention in four patients: two with sudden cardiac arrest (SCA) in the course of idiopathic ventricular fibrillation (IVF), one with long QT syndrome (LQTS) after probable SCA, and one with Brugada syndrome after SCA. In all patients, the device was implanted intramuscularly. One patient did not have a defibrillation test performed due to the presence of an intracardiac thrombus. In one patient, during screening, it was decided to implant an electrode on the right side of the sternum. There were no early or late complications with any of the procedures. So far, no inadequate discharges have been observed. CONCLUSIONS Our results prove the efficacy of the S-ICD treatment option along with technically simple surgery, which supports its further and more widespread application in children.
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Affiliation(s)
- Piotr Wieniawski
- Department of Paediatric Cardiology and General Paediatrics, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Michał Buczyński
- Department of Cardiac and General Paediatric Surgery, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Marcin Grabowski
- 1st Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Joachim Winter
- Division of Cardiac Surgery, University of Düsseldorf, 40225 Düsseldorf, Germany
| | - Bożena Werner
- Department of Paediatric Cardiology and General Paediatrics, Medical University of Warsaw, 02-091 Warsaw, Poland
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14
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Zahedivash A, Hanisch D, Dubin AM, Trela A, Chubb H, Motonaga KS, Goodyer WR, Maeda K, Reinhartz O, Ma M, Martin E, Ceresnak SR. Implantable Cardioverter Defibrillators in Infants and Toddlers: Indications, Placement, Programming, and Outcomes. Circ Arrhythm Electrophysiol 2022; 15:e010557. [PMID: 35089800 DOI: 10.1161/circep.121.010557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Limited data exist regarding implantable cardioverter defibrillator (ICD) usage in infants and toddlers. This study evaluates ICD placement indications, procedural techniques, programming strategies, and outcomes of ICDs in infants and toddlers. METHODS This is a single-center retrospective review of all patients ≤3 years old who received an ICD from 2009 to 2021. RESULTS Fifteen patients received an ICD at an age of 1.2 years (interquartile range [IQR], 0.1-2.4; 12 [80%] women; weight, 8.2 kg [IQR, 4.2-12.6]) and were followed for a median of 4.28 years (IQR, 1.40-5.53) or 64.2 patient-years. ICDs were placed for secondary prevention in 12 patients (80%). Diagnoses included 8 long-QT syndromes (53%), 4 idiopathic ventricular tachycardias/ventricular fibrillations (VFs; 27%), 1 recurrent ventricular tachycardia with cardiomyopathy (7%), 1 VF with left ventricular noncompaction (7%), and 1 catecholaminergic polymorphic ventricular tachycardia (7%). All implants were epicardial, with a coil in the pericardial space. Intraoperative defibrillation safety testing was attempted in 11 patients (73%), with VF induced in 8 (53%). Successful restoration of sinus rhythm was achieved in all tested patients with a median of 9 (IQR, 7.3-11.3) J or 0.90 (IQR, 0.68-1.04) J/kg. Complications consisted of 1 postoperative chylothorax and 3 episodes of feeding intolerance. VF detection was programmed to 250 (IQR, 240-250) ms with first shock delivering 10 (IQR, 5-15) J or 1.1 (IQR, 0.8-1.4) J/kg. Three patients (20%) received appropriate shocks for ventricular tachycardia/VF. No patient received an inappropriate shock. There were 2 (13%) ventricular lead fractures (at 2.6 and 4.2 years post-implant), 1 (7%) pocket-site infection, and 2 (13%) generator exchanges. All patients were alive, and 1 patient (7%) received a heart transplant. CONCLUSIONS ICDs can be safely and effectively placed for sudden death prevention in infants and toddlers with good midterm outcomes.
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Affiliation(s)
- Aydin Zahedivash
- Department of Pediatrics, Pediatric Cardiology (A.Z., A.M.D., H.C., K.S.M., W.R.G., S.R.C., D.H., A.T.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA
| | - Debra Hanisch
- Department of Pediatrics, Pediatric Cardiology (A.Z., A.M.D., H.C., K.S.M., W.R.G., S.R.C., D.H., A.T.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA
| | - Anne M Dubin
- Department of Pediatrics, Pediatric Cardiology (A.Z., A.M.D., H.C., K.S.M., W.R.G., S.R.C., D.H., A.T.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA
| | - Anthony Trela
- Department of Pediatrics, Pediatric Cardiology (A.Z., A.M.D., H.C., K.S.M., W.R.G., S.R.C., D.H., A.T.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA
| | - Henry Chubb
- Department of Pediatrics, Pediatric Cardiology (A.Z., A.M.D., H.C., K.S.M., W.R.G., S.R.C., D.H., A.T.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA
| | - Kara S Motonaga
- Department of Pediatrics, Pediatric Cardiology (A.Z., A.M.D., H.C., K.S.M., W.R.G., S.R.C., D.H., A.T.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA.,Department of Cardiothoracic Surgery, Children's Hospital of Philadelphia, University of Pennsylvania (K.S.M.)
| | - William Rowland Goodyer
- Department of Pediatrics, Pediatric Cardiology (A.Z., A.M.D., H.C., K.S.M., W.R.G., S.R.C., D.H., A.T.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA
| | | | - Olaf Reinhartz
- Department of Cardiothoracic Surgery (O.R., M.M., E.M.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA
| | - Michael Ma
- Department of Cardiothoracic Surgery (O.R., M.M., E.M.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA
| | - Elisabeth Martin
- Department of Cardiothoracic Surgery (O.R., M.M., E.M.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA
| | - Scott R Ceresnak
- Department of Pediatrics, Pediatric Cardiology (A.Z., A.M.D., H.C., K.S.M., W.R.G., S.R.C., D.H., A.T.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA
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15
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Maltret A, Benaich FA, Rendu J, Fressart V, Roux-Buisson N, Bonnet D, Denjoy I. Challenging indication of cardioverter defibrillator implantation after sudden cardiac arrest in the very young: a case series of catecholaminergic polymorphic ventricular tachycardia secondary to de novo calmodulin p.Asn98Ser. Eur Heart J Case Rep 2021; 5:ytab393. [PMID: 34729453 PMCID: PMC8557678 DOI: 10.1093/ehjcr/ytab393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/07/2021] [Accepted: 09/20/2021] [Indexed: 11/14/2022]
Abstract
Background Calmodulinopathy is an emerging group of primary electrical disease with various, severe, and early onset phenotype. Sudden cardiac arrest (SCA)/death can be the first symptom and current medical management seems insufficient to prevent recurrences. Implantable cardioverter-defibrillator (ICD) in the young is challenging and can be harmful. Case summary We report the management of two very young boys (aged 3.5 and 5.5 years old) who survived an SCA due to calmodulin mutation responsible of a catecholaminergic polymorphic ventricular tachycardia phenotype. In both case, SCA had an adrenergic trigger. Despite SCA, ICD implantation was denied by the parents. After thorough discussion with the family, the patients were managed with solely betablocker treatment and loop recorder implantation. At last follow-up of 30 and 23 months, respectively, there were no recurrence of any cardiac event. Discussion The benefits of ICD implantation at a very young age must be weighed against the risk complication. In the youngest, whom recreative activities are under constant supervision, the decision, jointly made with the parents, could be to postpone ICD.
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Affiliation(s)
- Alice Maltret
- Hôpital Marie Lannelongue-M3C, GHPSJ, Université Paris Saclay, service de cardiologie congénitale, Le Plessis-Robinson, France
- Corresponding author. Tel: +33 140 942 303,
| | | | - John Rendu
- Centre Hospitalier Universitaire Grenoble Alpes, Laboratoire de Biochimie et Génétique Moléculaire, Univ. Grenoble Alpes, Inserm U1216, Grenoble Institut Neurosciences, Grenoble, France
| | - Véronique Fressart
- Groupe Hospitalier Pitié-Salpêtrière, Service de Biochimie Métabolique, Unité de Cardiogénétique et Myogénétique, APHP, Paris, France
| | - Nathalie Roux-Buisson
- Centre Hospitalier Universitaire Grenoble Alpes, Laboratoire de Biochimie et Génétique Moléculaire, Univ. Grenoble Alpes, Inserm U1216, Grenoble Institut Neurosciences, Grenoble, France
| | - Damien Bonnet
- M3C-Necker, Hôpital Universitaire Necker-Enfants Malades, APHP, Paris, France
| | - Isabelle Denjoy
- CNMR, Maladies Cardiaques Héréditaires Rares, Service de cardiologie, Hôpital Bichat, APHP, Paris, France
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16
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Kaczmarek K, Kempa M, Grabowski M, Tajstra M, Sokal A, Cygankiewicz I, Zwoliński R, Michalak M, Kowara M, Budrejko S, Kurek A, Wranicz JK, Raczak G, Opolski G, Gąsior M, Kowalski O, Ptaszyński P. Multicentre early experience with totally subcutaneous cardioverter-defibrillators in Poland. Arch Med Sci 2020; 16:764-771. [PMID: 32542076 PMCID: PMC7286329 DOI: 10.5114/aoms.2019.83817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 01/19/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Implantable cardioverter-defibrillators (ICD) have a strong position in the prevention of sudden death. Nowadays, the most commonly used high-energy cardiac devices are transvenous ICDs. A new technology of totally subcutaneous ICDs (S-ICD) was invented and recently introduced into clinical practice in order to reduce lead-related complications of conventional ICDs. The aim of this paper is to present early experience with this new technology implemented in a few centres in Poland. MATERIAL AND METHODS Medical records of patients who had S-ICD-related interventions in Poland were retrospectively analysed. RESULTS During the first year of S-ICD introduction into the Polish health system 18 patients underwent surgery connected with S-ICDs. Majority of them (17 patients) were implanted de novo. In one patient surgical revision of a device implanted abroad was performed. Most of patients (78%) had S-ICDs implanted for secondary prevention. Inability of transvenous system implantation due to venous access obstruction or high risk of infection related with transvenous leads accounted for 83% of indications for S-ICD. Only in three patients were S-ICDs implanted due to young age and active mode of life. The implantations of S-ICDs were performed without important early or late complications. During follow-up one patient had episodes of ventricular arrhythmia successfully terminated with high-energy shocks. One patient died due to progression of heart failure. CONCLUSIONS S-ICD implantation procedure has been successfully and safely introduced in Polish clinical routine. Nevertheless, despite clear indications in recent ESC guidelines, this therapy is not directly reimbursed in Poland and needs individual application for refund.
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Affiliation(s)
- Krzysztof Kaczmarek
- Department of Electrocardiology, Medical University of Lodz, Lodz, Poland
- Corresponding author: Krzysztof Kaczmarek MD, PhD, Department of Electrocardiology, Medical University of Lodz, 1/3 Sterlinga St, 91-425 Lodz, Poland, E-mail:
| | - Maciej Kempa
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Marcin Grabowski
- 1 Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Mateusz Tajstra
- 3 Chair and Department of Cardiology, Silesian Medical University, Katowice, Poland
| | - Adam Sokal
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, SIlesian Medical University, Katowice, Poland
| | - Iwona Cygankiewicz
- Department of Electrocardiology, Medical University of Lodz, Lodz, Poland
| | | | - Marcin Michalak
- 1 Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Michal Kowara
- 1 Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Szymon Budrejko
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Anna Kurek
- 3 Chair and Department of Cardiology, Silesian Medical University, Katowice, Poland
| | - Jerzy K. Wranicz
- Department of Electrocardiology, Medical University of Lodz, Lodz, Poland
| | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland
| | - Grzegorz Opolski
- 1 Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Mariusz Gąsior
- 3 Chair and Department of Cardiology, Silesian Medical University, Katowice, Poland
| | - Oskar Kowalski
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, SIlesian Medical University, Katowice, Poland
| | - Paweł Ptaszyński
- Department of Electrocardiology, Medical University of Lodz, Lodz, Poland
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Müller MJ, Dieks JK, Backhoff D, Schneider HE, Ruschewski W, Tirilomis T, Paul T, Krause U. Efficacy and safety of non-transvenous cardioverter defibrillators in infants and young children. J Interv Card Electrophysiol 2018; 54:151-159. [PMID: 30255451 DOI: 10.1007/s10840-018-0451-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 09/07/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Implantable cardioverter defibrillators (ICD) protect from sudden cardiac death (SCD). In infants and young children, ICD implantation and programming is challenging due to small body size, elevated heart rates, and high physical activity. PURPOSE We report our experience applying a non-transvenous ICD (NT-ICD) system to infants and children < 12 years of age and < 45-kg body weight. METHODS Between 07/2004 and 07/2016, NT-ICD had been implanted in 36 patients. Nine out of 36 patients (25%) had NT-ICD implantation for primary and 27/36 (75%) for secondary prevention. Underlying diseases included inherited primary electrical arrhythmogenic diseases (n = 26; 72%), cardiomyopathies (n = 8; 22%), and congenital heart defects (n = 2; 6%). The median (interquartile range) age at implantation was 6 (1.9-8.4) years, and the median body weight was 21.7 (11.2-26.8) kg. Three different NT-ICD implantation techniques had been applied over time: (1) abdominal device/subcutaneous shock coil, (2) abdominal device/pleural shock coil, and (3) subcardiac device/pleural shock coil. RESULTS During median follow-up of 5.2 (2.7-7.2) years, appropriate ICD discharges were documented in 12 (33.3%) and inappropriate shocks in 4 patients (11.1%). In 12/36 individuals (33.3%), a total of 25 surgical revisions were required due to NT-ICD malfunction. Eighteen out of 25 (72%) surgical revisions were necessary in patients with subcutaneous shock coil/abdominal device position. Surgical revisions (3/25, 12%) were significantly reduced (p < 0.001) after modifying the implantation technique to subcardiac device/pleural shock coil. CONCLUSIONS NT-ICD was safe and effective in infants and young children. Appropriate ICD discharges occurred in a considerable number of patients. After modifying the implantation technique, the need for surgical revision could significantly be decreased.
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Affiliation(s)
- Matthias J Müller
- Department of Pediatric Cardiology and Intensive Care, University Medical Center, Georg August University Goettingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
| | - Jana K Dieks
- Department of Pediatric Cardiology and Intensive Care, University Medical Center, Georg August University Goettingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - David Backhoff
- Department of Pediatric Cardiology and Intensive Care, University Medical Center, Georg August University Goettingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Heike E Schneider
- Department of Pediatric Cardiology and Intensive Care, University Medical Center, Georg August University Goettingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Wolfgang Ruschewski
- Department of Thoracic, Heart, and Cardiovascular Surgery, University Medical Center, Georg August University Goettingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Theodor Tirilomis
- Department of Thoracic, Heart, and Cardiovascular Surgery, University Medical Center, Georg August University Goettingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Thomas Paul
- Department of Pediatric Cardiology and Intensive Care, University Medical Center, Georg August University Goettingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Ulrich Krause
- Department of Pediatric Cardiology and Intensive Care, University Medical Center, Georg August University Goettingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
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18
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Clark BC, Opfermann JD, Davis TD, Krieger A, Berul CI. Single-incision percutaneous pericardial ICD lead placement in a piglet model. J Cardiovasc Electrophysiol 2017; 28:1098-1104. [PMID: 28569424 DOI: 10.1111/jce.13263] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 04/25/2017] [Accepted: 05/22/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Our group has demonstrated the feasibility of percutaneous pericardial ICD lead placement in a piglet model utilizing direct visualization from a lateral thoracoscopic approach. Development of a novel delivery tool that incorporates visualization allows for the procedure to be performed with a 1 cm subxiphoid incision. METHODS AND RESULTS A 1 cm incision is made in the subxiphoid area and a novel self-anchoring delivery tool is inserted. A rigid thoracoscope and needle are inserted into two crossed working channels of the tool. After needle visualization, pericardial needle access, followed by sheath access is obtained. A modified side-biting ICD lead is inserted and fixated to the ventricular epicardial surface. The lead is connected to an ICD generator and lead testing followed by defibrillation threshold testing (DFT) is performed. Single-incision ICD lead placement was performed in 6 piglets without acute complications. Median time from subxiphoid incision to DFT testing was 64 minutes; median time from thoracoscope insertion to lead fixation was 16.5 minutes (range 9-30). All had adequate ventricular sensing and pacing at implant and underwent successful defibrillation (range 3-5 J). Survival period ranged from 1 to 16 weeks. Two piglets had survival periods of 12 and 16 weeks with mean weight gain of 7 kg; both had successful repeat DFT at 10 J. All survival animals had stable lead impedances and R-wave amplitudes throughout the survival period. CONCLUSION Percutaneous pericardial placement of an ICD lead using our novel access tool can be safely performed through a 1 cm incision without complications.
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Affiliation(s)
- Bradley C Clark
- Division of Cardiology, Children's National Health System, Washington, DC, USA.,Department of Pediatrics, George Washington University School of Medicine, Washington, DC, USA
| | - Justin D Opfermann
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA
| | - Tanya D Davis
- Division of Urology, Children's National Health System, Washington, DC, USA
| | - Axel Krieger
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA
| | - Charles I Berul
- Division of Cardiology, Children's National Health System, Washington, DC, USA.,Department of Pediatrics, George Washington University School of Medicine, Washington, DC, USA.,Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA
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19
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Nouvelles techniques de stimulation dans le domaine des cardiopathies congénitales. Presse Med 2017; 46:594-605. [DOI: 10.1016/j.lpm.2017.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 04/25/2017] [Accepted: 05/11/2017] [Indexed: 11/30/2022] Open
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20
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Holst KA, Said SM, Nelson TJ, Cannon BC, Dearani JA. Current Interventional and Surgical Management of Congenital Heart Disease: Specific Focus on Valvular Disease and Cardiac Arrhythmias. Circ Res 2017; 120:1027-1044. [PMID: 28302746 DOI: 10.1161/circresaha.117.309186] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 02/20/2017] [Accepted: 02/20/2017] [Indexed: 01/15/2023]
Abstract
Successful outcome in the care of patients with congenital heart disease depends on a comprehensive multidisciplinary team. Surgery is offered for almost every heart defect, despite complexity. Early mortality for cardiac surgery in the neonatal period is ≈10% and beyond infancy is <5%, with 90% to 95% of patients surviving with a good quality of life into the adult years. Advances in imaging have facilitated accurate diagnosis and planning of interventions and surgical procedures. Similarly, advances in the perioperative medical management of patients, particularly with intensive care, has also contributed to improving outcomes. Arrhythmias and heart failure are the most common late complications for the majority of defects, and reoperation for valvar problems is common. Lifelong surveillance for monitoring of recurrent or residual structural heart defects, as well as periodic assessment of cardiac function and arrhythmia monitoring, is essential for all patients. The field of congenital heart surgery is poised to incorporate new innovations such as bioengineered cells and scaffolds that will iteratively move toward bioengineered patches, conduits, valves, and even whole organs.
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Affiliation(s)
- Kimberly A Holst
- From the Department of Cardiovascular Surgery (K.A.H., S.M.S., J.A.D.), Departments of Pediatric and Adolescent Medicine, and Molecular Pharmacology and Experimental Therapeutics (T.J.N., B.C.C.), and Division of Pediatric Cardiology (T.J.N., B.C.C.), Mayo Clinic, Rochester, MN
| | - Sameh M Said
- From the Department of Cardiovascular Surgery (K.A.H., S.M.S., J.A.D.), Departments of Pediatric and Adolescent Medicine, and Molecular Pharmacology and Experimental Therapeutics (T.J.N., B.C.C.), and Division of Pediatric Cardiology (T.J.N., B.C.C.), Mayo Clinic, Rochester, MN
| | - Timothy J Nelson
- From the Department of Cardiovascular Surgery (K.A.H., S.M.S., J.A.D.), Departments of Pediatric and Adolescent Medicine, and Molecular Pharmacology and Experimental Therapeutics (T.J.N., B.C.C.), and Division of Pediatric Cardiology (T.J.N., B.C.C.), Mayo Clinic, Rochester, MN
| | - Bryan C Cannon
- From the Department of Cardiovascular Surgery (K.A.H., S.M.S., J.A.D.), Departments of Pediatric and Adolescent Medicine, and Molecular Pharmacology and Experimental Therapeutics (T.J.N., B.C.C.), and Division of Pediatric Cardiology (T.J.N., B.C.C.), Mayo Clinic, Rochester, MN
| | - Joseph A Dearani
- From the Department of Cardiovascular Surgery (K.A.H., S.M.S., J.A.D.), Departments of Pediatric and Adolescent Medicine, and Molecular Pharmacology and Experimental Therapeutics (T.J.N., B.C.C.), and Division of Pediatric Cardiology (T.J.N., B.C.C.), Mayo Clinic, Rochester, MN.
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Retrosternal Implantation of the Cardioverter-Defibrillator Lead in an Infant. Ann Thorac Surg 2017; 103:e449-e451. [DOI: 10.1016/j.athoracsur.2016.10.063] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 10/18/2016] [Accepted: 10/18/2016] [Indexed: 11/24/2022]
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