Cardiac implantable electronic devices in adults with tetralogy of Fallot

Alexander Egbe, William R. Miranda, Malini Madhavan, Naser M. Ammash, Venkata R. Missula, Mohammed Al-Otaibi, Ayotola Fatola, Srikanth Kothapalli, Heidi M. Connolly

Research output: Contribution to journalArticle

4 Citations (Scopus)

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.

Original languageEnglish (US)
JournalHeart
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Tetralogy of Fallot
Defibrillators
Equipment and Supplies
Shock
Infection
Thrombosis
Anti-Arrhythmia Agents
Primary Prevention
Bradycardia
Secondary Prevention
Tachycardia
Counseling
Heart Diseases
Databases

Keywords

  • tetralogy of Fallot

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Egbe, A., Miranda, W. R., Madhavan, M., Ammash, N. M., Missula, V. R., Al-Otaibi, M., ... Connolly, H. M. (Accepted/In press). Cardiac implantable electronic devices in adults with tetralogy of Fallot. Heart. https://doi.org/10.1136/heartjnl-2018-314072

Cardiac implantable electronic devices in adults with tetralogy of Fallot. / Egbe, Alexander; Miranda, William R.; Madhavan, Malini; Ammash, Naser M.; Missula, Venkata R.; Al-Otaibi, Mohammed; Fatola, Ayotola; Kothapalli, Srikanth; Connolly, Heidi M.

In: Heart, 01.01.2018.

Research output: Contribution to journalArticle

Egbe, A, Miranda, WR, Madhavan, M, Ammash, NM, Missula, VR, Al-Otaibi, M, Fatola, A, Kothapalli, S & Connolly, HM 2018, 'Cardiac implantable electronic devices in adults with tetralogy of Fallot', Heart. https://doi.org/10.1136/heartjnl-2018-314072
Egbe, Alexander ; Miranda, William R. ; Madhavan, Malini ; Ammash, Naser M. ; Missula, Venkata R. ; Al-Otaibi, Mohammed ; Fatola, Ayotola ; Kothapalli, Srikanth ; Connolly, Heidi M. / Cardiac implantable electronic devices in adults with tetralogy of Fallot. In: Heart. 2018.
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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.",
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AU - Miranda, William R.

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AU - Missula, Venkata R.

AU - Al-Otaibi, Mohammed

AU - Fatola, Ayotola

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AU - Connolly, Heidi M.

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N2 - 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.

AB - 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.

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