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Incidence and Clinical Predictors of Early and Late Complications of Implantable Cardioverter-Defibrillators in Adults with Congenital Heart Disease

Canadian Journal of Cardiology(2023)SCI 2区SCI 3区

Univ Hlth Network Toronto | Okayama Univ

Cited 3|Views19
Abstract
Background: The implantable cardioverter-defibrillator (ICD) has been proven to improve survival in adults with congenital heart disease (ACHD), but it is associated with a high rate of complications. We aimed to quantify the incidence of early (< 3 months; ECs) and late (> 3 months; LCs) complications in ACHD patients implanted with an ICD and to identify their clinical predictors. Methods: We retrospectively reviewed 207 patients who had ICD follow-up at Toronto General Hospital from 1996 to 2019. Results: The most common diagnoses were tetralogy of Fallot (32.4%), dextro-transposition of the great arteries (17.9%), and congenital corrected transposition of the great arteries (13%). No intraprocedural complications were observed. Median follow-up was 3.4 years (IQR 0.1-23). 24 patients (12%) developed EC (4 hema-tomas, 20 lead dislodgements). A total of 56 LCs occurred (46% lead failure, 21% infection, 11% prophylactic lead extraction, 9% neurologic pain, 9% erosion, 4% other) with an incidence rate of LCs of 18% per 5 person-years. Anatomic complexity (odds ratio 2.9; P = 0.02) and cardiac resynchronization therapy defibrillator implant (odds ratio 2.5; P = 0.04) were associated with ECs. Survival rates free from LCs were 92%, 86%, and 65%, respectively, after 1, 5, and 10 years. Presence of legacy leads (hazard ratio 2.9; P = 0.006) and subpulmonary ejection fraction (5% increase, hazard ratio 1.35; P = 0.031) were associated with LCs. Conclusions: ACHD patients at risk of sudden cardiac death continue to benefit from newer device technology. However, these patients, particularly those with greater anatomic and device complexity, remain at increased risk of developing complications over their lifetime. Given the life expectancy of this population, careful consideration needs to be given when a device for primary prevention is being contemplated.
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Implantable Cardioverter-Defibrillator,Adult Congenital Heart Disease,Congenital Heart Disease,Fetal Cardiac Disease
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要点】:研究探讨了成人先天性心脏病患者植入心脏除颤器(ICD)后早期和晚期并发症的发病率及其临床预测因素,发现解剖复杂性增加和设备复杂性较高的患者并发症风险更高。

方法】:通过回顾性分析207名在多伦多总医院接受ICD随访的先天性心脏病患者的数据。

实验】:研究未观察到术中并发症,中位随访时间为3.4年。早期并发症发生率为12%,晚期并发症发生率为18%每5人年。解剖复杂性增加和心脏再同步化治疗除颤器植入与早期并发症相关;遗留导线和肺下射血分数增加与晚期并发症相关。结果显示,无晚期并发症的生存率在1年、5年和10年后分别为92%、86%和65%。