Outcome of implantable cardioverter defibrillators in adults with congenital heart disease: a multi-centre study.
OBJECTIVE
To investigate outcome and complications of implantable cardioverter defibrillators (ICDs) in adults with congenital heart disease (CHD) and to identify predictors of (in-) appropriate shocks.


RESULTS
Sixty-four CHD patients >/= 18 years at first ICD implantation [63% tetralogy of Fallot (TOF) and age at implantation 37 +/- 13 years] were identified using the Dutch adult CHD registry and a Belgian tertiary care centre database. Median follow-up duration was 3.7 years. Early complications included pocket haematoma (n = 3), lead failure (n = 2), and pneumothorax (n = 2). Late complications occurred in 11 (17%) patients, including lead failure (n = 6) and and electrical storm (n = 3). Overall, 30 device-related re-interventions were performed in 20 patients (31%), including four premature generator changes and seven lead replacements. Half of the patients received one or more shocks, and 46 shocks in 15 patients (23%) were classified as appropriate. One hundred and sixty shocks in 26 patients (41%) were classified as inappropriate. No predictors of (in-)appropriate shocks were identified, except TOF being associated with less appropriate shocks than patients with other CHD (HR 0.29, P = 0.02).


CONCLUSIONS
The ICD provided effective therapy in a quarter of adults with CHD with low complication rates. The incidence of inappropriate shocks, however, appeared to be excessive and warrants further attention.
Yap
Sing-Chien
SC
Department of Cardiology, Thoraxcentre, Erasmus MC, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. s.c.yap@erasmusmc.nl
Roos-Hesselink
Jolien W
JW
Hoendermis
Elke S
ES
Budts
Werner
W
Vliegen
Hubert W
HW
Mulder
Barbara J M
BJ
van Dijk
Arie P J
AP
Schalij
Martin J
MJ
Drenthen
Willem
W
D000328:Adult; D003324:Coronary Artery Disease / Q000628:therapy*; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D005260:Female; D006305:Health Status Indicators; D006330:Heart Defects, Congenital / Q000628:therapy*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012042:Registries; D012720:Severity of Illness Index; D013771:Tetralogy of Fallot / Q000628:therapy; D017211:Treatment Failure; D016896:Treatment Outcome