Article Text

PDF
Original research article
Cardiac implantable electronic devices in adults with tetralogy of Fallot
  1. Alexander C Egbe,
  2. William R Miranda,
  3. Malini Madhavan,
  4. Naser M Ammash,
  5. Venkata R Missula,
  6. Mohammed Al-Otaibi,
  7. Ayotola Fatola,
  8. Srikanth Kothapalli,
  9. Heidi M Connolly
  1. Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
  1. Correspondence to Dr Alexander C Egbe, Mayo Clinic and Foundation, Rochester MN 55905, USA; cegbe2001{at}yahoo.com

Abstract

Background Tachyarrhythmias and bradyarrhythmias affect 20%–50% of adult patients with tetralogy of Fallot (TOF) and some of these patients will require cardiac implantable electronic devices (CIED) such as pacemaker and/or internal cardioverter defibrillator.

Methods The Mayo Adult Congenital Heart Disease database was queried for patients with repaired TOF and history of CIED implantation, 1990–2017. The study objectives were: (1) determine the occurrence of device-related complications defined as lead failure, lead recall, device infection and lead thrombus; and (2) determine the occurrence and risk factors for defibrillator shock.

Results There were 99 patients (age 46±14 years and 66 (66%) men) with CIED, and the CIEDs were 41 (41%) pacemakers and 73 (73%) defibrillators. Indication for defibrillator implantation was for primary prevention in 28 (38%) and secondary prevention in 45 (62%). Device-related complications occurred in 20 (20%) patients (lead failure 17, lead recall 4, device infection 12 and thrombus 3). Twenty-five per cent of all device infections occurred within 30 days from the time of device generator change. Annualised rates of appropriate and inappropriate shocks were 5.7% and 6.2%, respectively. The use of class III antiarrhythmic drug was protective against defibrillator shock.

Conclusion The current study provides useful outcome data to aid patient counselling and clinical decision-making. Further studies are required to explore ways to decrease the risk of postprocedural infection after device generator change, and to determine which patients will benefit from empirical antiarrhythmic therapy as a strategy to decrease incidence of inappropriate defibrillator shock.

  • tetralogy of Fallot

Statistics from Altmetric.com

Footnotes

  • Funding ACE is supported by the National Heart, Lung, and Blood Institute (NHLBI; grant K23 HL141448-01).

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Mayo Clinic Institutional Review Board

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.