title: The Role of Conventional and Right-Sided ECG Screening for Subcutaneous ICD in a Tetralogy of Fallot Population.
abstract: BACKGROUND
  Information regarding suitability for subcutaneous implantable cardioverter-defibrillator (S-ICD) implant in tetralogy of Fallot (ToF) population is scarce and needs to be further explored.
  
  
  OBJECTIVE
  (1) to determine the proportion of patients with ToF eligible for S-ICD, (2) to identify the optimal sensing vector in ToF patients, (3) to test specifically the eligibility for S-ICD with right-sided screening, and (4) to compare with the proportion of eligible patients in a nonselected ICD population.
  
  
  METHODS
  We recruited 60 consecutive patients with ToF and 40 consecutive nonselected patients. Conventional electrocardiographic screening was performed as usual. Right-sided alternative screening was studied by positioning the left arm and right arm electrodes 1 cm right lateral to the xiphoid midline. The Boston Scientific electrocardiogram (ECG) screening tool was utilized.
  
  
  RESULTS
  We found a higher proportion of patients with right-sided positive screening in comparison with standard screening (77 ± 0.4% vs. 67 ± 0.4%; P < 0.0001) and a trend to higher number of appropriate leads in right-sided screening (1.3 ± 1 vs. 1.1 ± 1 ms; P = 0.07). Patients who failed the screening had a longer QRS duration and longer QT interval. Standard and right-sided screening showed a higher percent of positive patients in the control group compared to ToF patients (P < 0.001).
  
  
  CONCLUSIONS
  Right-sided screening was associated with a significant 10% increase in S-ICD eligibility in ToF patients. When comparing with an acquired cardiomyopathies group, ToF showed a lower eligibility for S-ICD. The most appropriate ECG vector was the alternate vector in contrast to what is observed in the general population.
authors.affiliation: Electrophysiology Section, Cardiology Department, La Fe University Hospital, Valencia, Spain.
authors.forename: Pau
authors.initials: P
authors.lastname: Alonso
authors.affiliation: Electrophysiology Section, Cardiology Department, La Fe University Hospital, Valencia, Spain.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Osca
authors.affiliation: Electrophysiology Section, Cardiology Department, La Fe University Hospital, Valencia, Spain.
authors.forename: Oscar
authors.initials: O
authors.lastname: Cano
authors.affiliation: Electrophysiology Section, Cardiology Department, La Fe University Hospital, Valencia, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Pimenta
authors.affiliation: Electrophysiology Section, Cardiology Department, La Fe University Hospital, Valencia, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Andrés
authors.affiliation: BioITACA, Polytechnic University of Valencia, Valencia, Spain.
authors.forename: Jaime
authors.initials: J
authors.lastname: Yagüe
authors.affiliation: BioITACA, Polytechnic University of Valencia, Valencia, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Millet
authors.affiliation: Adult Congenital Heart Disease Unit, Cardiology Department, La Fe University Hospital, Valencia, Spain.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Rueda
authors.affiliation: Electrophysiology Section, Cardiology Department, La Fe University Hospital, Valencia, Spain.
authors.forename: María José
authors.initials: MJ
authors.lastname: Sancho-Tello
mesh_terms: D000328:Adult; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D018579:Patient Selection; D011300:Preoperative Care / Q000379:methods; D015995:Prevalence; D011379:Prognosis; D017755:Prosthesis Fitting / Q000379:methods / Q000706:statistics & numerical data; D019919:Prosthesis Implantation / Q000379:methods / Q000706:statistics & numerical data*; D012307:Risk Factors; D013030:Spain; D013771:Tetralogy of Fallot / Q000453:epidemiology* / Q000601:surgery; D016896:Treatment Outcome
keywords: ECG screening; right-sided screening; subcutaneous implantable cardioverter-defibrillator; tetralogy of Fallot