Utility of routine follow-up defibrillation safety margin testing in young patients with epicardial implantable cardioverter-defibrillators.
defibrillation safety margin
epicardial implantable cardioverter-defibrillator
pediatrics
Journal
Pacing and clinical electrophysiology : PACE
ISSN: 1540-8159
Titre abrégé: Pacing Clin Electrophysiol
Pays: United States
ID NLM: 7803944
Informations de publication
Date de publication:
03 2024
03 2024
Historique:
revised:
12
01
2024
received:
19
12
2023
accepted:
30
01
2024
medline:
12
3
2024
pubmed:
11
2
2024
entrez:
11
2
2024
Statut:
ppublish
Résumé
Routine defibrillation threshold testing (DFT) of transvenous implantable defibrillators (ICDs) has largely been in decline. In patients with non-transvenous ICDs that utilize subcutaneous and pleural ICD leads, serial DFT testing can detect a significant number of failures. Data about the utility of follow-up defibrillation safety margin testing (DSM) testing in pediatric patients and young adults with an epicardial ICD are lacking. Patients aged < 25 years old who underwent epicardial ICD placement at Mayo Clinic from 2014 to 2023 with at least one follow-up DSM test were included. The patients were divided into a "routine" (R) and "clinically indicated" (CI) group based on the index of clinical concern. Inadequate DSM was defined as unsuccessful defibrillation at an output of less than 10 J below the maximum output of the device. The purpose of this study was to assess the utility of follow-up DSM testing. An epicardial ICD system was placed in 122 patients. A total of 26 patients met inclusion criteria and underwent a total of 47 DSM follow up tests. Inadequate DSM occurred in 1/33 (3%) in the R group and 2/14 (14%) DSM tests in the CI group. The median follow-up period was 54 and 36 months for the R and CI group, respectively. Our data suggest that epicardial ICDs are reliable and routine follow-up DSM testing may not be necessary for all patients. DSM testing should be performed in individuals with epicardial ICD systems when there is clinical concern about lead or coil performance.
Sections du résumé
BACKGROUND
Routine defibrillation threshold testing (DFT) of transvenous implantable defibrillators (ICDs) has largely been in decline. In patients with non-transvenous ICDs that utilize subcutaneous and pleural ICD leads, serial DFT testing can detect a significant number of failures. Data about the utility of follow-up defibrillation safety margin testing (DSM) testing in pediatric patients and young adults with an epicardial ICD are lacking.
METHODS
Patients aged < 25 years old who underwent epicardial ICD placement at Mayo Clinic from 2014 to 2023 with at least one follow-up DSM test were included. The patients were divided into a "routine" (R) and "clinically indicated" (CI) group based on the index of clinical concern. Inadequate DSM was defined as unsuccessful defibrillation at an output of less than 10 J below the maximum output of the device. The purpose of this study was to assess the utility of follow-up DSM testing.
RESULTS
An epicardial ICD system was placed in 122 patients. A total of 26 patients met inclusion criteria and underwent a total of 47 DSM follow up tests. Inadequate DSM occurred in 1/33 (3%) in the R group and 2/14 (14%) DSM tests in the CI group. The median follow-up period was 54 and 36 months for the R and CI group, respectively.
CONCLUSIONS
Our data suggest that epicardial ICDs are reliable and routine follow-up DSM testing may not be necessary for all patients. DSM testing should be performed in individuals with epicardial ICD systems when there is clinical concern about lead or coil performance.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
392-397Informations de copyright
© 2024 Wiley Periodicals LLC.
Références
Wilkoff BL, Fauchier L, Stiles MK, et al. 2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement on optimal implantable cardioverter-defibrillator programming and testing. Europace. 2016;18:159-183. doi:10.1093/europace/euv411
Prutkin JM, Wang Y, Escudero CA, et al. Prevalence, predictors and complications with defibrillation threshold testing in pediatric patients: results from the NCDR. Int J Cardiol. 2020;305:44-49. doi:10.1016/j.ijcard.2020.01.027
Prutkin JM, Wang Y, Escudero CA, et al. Defibrillation safety margin testing in patients with congenital heart disease: results from the NCDR. JACC Clin Electrophysiol. 2021;7:1145-1154. doi:10.1016/j.jacep.2021.02.019
Adler Y, Charron P, Imazio M, et al. 2015 ESC guidelines for the diagnosis and management of pericardial diseases: the task force for the diagnosis and management of pericardial diseases of the European Society of Cardiology (ESC)endorsed by: the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2015;36:2921-2964. doi:10.1093/eurheartj/ehv318
Bauersfeld U, Tomaske M, Dodge-Khatami A, Rahn M, Kellenberger CJ, Prêtre R. Initial experience with implantable cardioverter defibrillator systems using epicardial and pleural electrodes in pediatric patients. Ann Thorac Surg. 2007;84:303-305. doi:10.1016/j.athoracsur.2006.10.001
Fortescue EB, Berul CI, Cecchin F, Walsh EP, Triedman JK, Alexander ME. Patient, procedural, and hardware factors associated with pacemaker lead failures in pediatrics and congenital heart disease. Heart Rhythm. 2004;1:150-159. doi:10.1016/j.hrthm.2004.02.020
Kriebel T, Müller MJ, Ruschewski W, Krause U, Paul T, Schneider H. Value of regular defibrillation threshold testing after extracardiac implantable cardioverter defibrillator placement in small children during mid-term follow-up. JACC Clin Electrophysiol. 2018;4:936-943. doi:10.1016/j.jacep.2018.03.012
Schneider AE, Burkhart HM, Ackerman MJ, Dearani JA, Wackel P, Cannon BC. Minimally invasive epicardial implantable cardioverter-defibrillator placement for infants and children: an effective alternative to the transvenous approach. Heart Rhythm. 2016;13:1905-1912. doi:10.1016/j.hrthm.2016.06.024
Griffeth EM, Krishnan P, Dearani JA, et al. Pediatric epicardial devices: early and midterm outcomes. World J Pediatr Congenit Heart Surg. 2023;14:451-458. doi:10.1177/21501351231157374
Stephenson EA, Cecchin F, Walsh EP, Berul CI. Utility of routine follow-up defibrillator threshold testing in congenital heart disease and pediatric populations. J Cardiovasc Electrophysiol. 2005;16:69-73. doi:10.1046/j.1540-8167.2005.04528.x