Right Parasternal Lead Placement Increases Eligibility for Subcutaneous Implantable Cardioverter Defibrillator Therapy in Adults With Congenital Heart Disease.
BACKGROUND
The subcutaneous implantable cardioverter defibrillator (S-ICD) provides an attractive option for patients with congenital heart disease (CHD) in whom a transvenous defibrillator is contraindicated. Given the unusual cardiac anatomy and repolarization strain, the surface electrocardiogram (ECG) is frequently abnormal, potentially increasing the screen failure rate.


RESULTS
We prospectively screened 100 adult CHD patients regardless of the presence of clinical indication for ICD utilizing a standard left sternal lead placement, as well as a right parasternal position. Baseline patient and 12-lead ECG characteristics were examined to assess for predictors of screen failure. Average patient age was 48±14 years, average QRS duration was 134±37 ms, and 13 patients were pacemaker dependent. Using the standard left parasternal electrode position, 21 patients failed screening. Of these 21 patients with screen failure, 9 passed screening with the use of right parasternal electrode positioning, reducing screening failure rate from 21% to 12%. QT interval and inverted T wave anywhere in V2-V6 leads were found to be independent predictors of left parasternal screening failure (P=0.01 and P=0.04, respectively).


CONCLUSIONS
Utilization of both left and right parasternal screening should be used in evaluation of CHD patients for S-ICD eligibility. ECG repolarization characteristics were also identified as novel predictors of screening failure in this group. (Circ J 2016; 80: 1328-1335).
Division of Cardiovascular Diseases, Mayo Clinic.
Hideo
H
Okamura
Christopher J
CJ
McLeod
Christopher V
CV
DeSimone
Tracy L
TL
Webster
Crystal R
CR
Bonnichsen
Martha
M
Grogan
Sabrina D
SD
Phillips
Heidi M
HM
Connolly
Naser M
NM
Ammash
Carole A
CA
Warnes
Paul A
PA
Friedman
D000328:Adult; D017147:Defibrillators, Implantable; D004562:Electrocardiography / Q000379:methods; D004566:Electrodes; D006330:Heart Defects, Congenital / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D018579:Patient Selection; D011446:Prospective Studies