TY - JOUR
T1 - Implantable cardioverter-defibrillator use in catecholaminergic polymorphic ventricular tachycardia
T2 - A systematic review
AU - Roston, Thomas M.
AU - Jones, Karolina
AU - Hawkins, Nathaniel M.
AU - Bos, J. Martijn
AU - Schwartz, Peter J.
AU - Perry, Frances
AU - Ackerman, Michael J.
AU - Laksman, Zachary W.M.
AU - Kaul, Padma
AU - Lieve, Krystien V.V.
AU - Atallah, Joseph
AU - Krahn, Andrew D.
AU - Sanatani, Shubhayan
N1 - Publisher Copyright:
© 2018 Heart Rhythm Society
PY - 2018/12
Y1 - 2018/12
N2 - Background: The implantable cardioverter-defibrillator (ICD) may be associated with a high risk of complications in patients with catecholaminergic polymorphic ventricular tachycardia (CPVT). However, ICDs in this population have not been systematically evaluated. Objective: The purpose of this study was to characterize the use and outcomes of ICDs in CPVT. Methods: We conducted a systematic review using Embase, MEDLINE, PubMed, and Google Scholar to identify studies that included patients with CPVT who had an ICD. Results: Fifty-three studies describing 1429 patients with CPVT were included. In total, 503 patients (35.2%) had an ICD (median age 15.0 years; interquartile range 11.0–21.0 years). Among ICD recipients with a reported medication status, 96.7% were prescribed β-blockers and 13.2% flecainide. Sympathetic denervation was performed in 23.2%. Nearly half of patients received an ICD for primary prevention (47.3%), and 12.8% were prescribed optimal antiarrhythmic therapy. During follow-up, 40.1% had ≥1 appropriate shock, 20.8% experienced ≥1 inappropriate shock, 19.6% had electrical storm, and 7 patients (1.4%) died. An ICD-associated electrical storm was implicated in 4 deaths. Additional complications such as lead failure, endocarditis, or surgical revisions were observed in 96 of 296 patients (32.4%). A subanalysis of the 10 studies encompassing 330 patients with the most detailed ICD-related data showed similar trends. Conclusion: In this population with CPVT, ICDs were common and associated with a high burden of shocks and complications. The reliance on primary prevention ICDs, and poor uptake of adjuvant antiarrhythmic therapies, suggests that improved adherence to guideline-directed management could reduce ICD use and harm.
AB - Background: The implantable cardioverter-defibrillator (ICD) may be associated with a high risk of complications in patients with catecholaminergic polymorphic ventricular tachycardia (CPVT). However, ICDs in this population have not been systematically evaluated. Objective: The purpose of this study was to characterize the use and outcomes of ICDs in CPVT. Methods: We conducted a systematic review using Embase, MEDLINE, PubMed, and Google Scholar to identify studies that included patients with CPVT who had an ICD. Results: Fifty-three studies describing 1429 patients with CPVT were included. In total, 503 patients (35.2%) had an ICD (median age 15.0 years; interquartile range 11.0–21.0 years). Among ICD recipients with a reported medication status, 96.7% were prescribed β-blockers and 13.2% flecainide. Sympathetic denervation was performed in 23.2%. Nearly half of patients received an ICD for primary prevention (47.3%), and 12.8% were prescribed optimal antiarrhythmic therapy. During follow-up, 40.1% had ≥1 appropriate shock, 20.8% experienced ≥1 inappropriate shock, 19.6% had electrical storm, and 7 patients (1.4%) died. An ICD-associated electrical storm was implicated in 4 deaths. Additional complications such as lead failure, endocarditis, or surgical revisions were observed in 96 of 296 patients (32.4%). A subanalysis of the 10 studies encompassing 330 patients with the most detailed ICD-related data showed similar trends. Conclusion: In this population with CPVT, ICDs were common and associated with a high burden of shocks and complications. The reliance on primary prevention ICDs, and poor uptake of adjuvant antiarrhythmic therapies, suggests that improved adherence to guideline-directed management could reduce ICD use and harm.
KW - Catecholaminergic polymorphic ventricular tachycardia
KW - Flecainide
KW - Implantable cardioverter-defibrillator
KW - Sudden cardiac death
KW - Sympathetic denervation
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U2 - 10.1016/j.hrthm.2018.06.046
DO - 10.1016/j.hrthm.2018.06.046
M3 - Article
C2 - 30063211
AN - SCOPUS:85056610212
SN - 1547-5271
VL - 15
SP - 1791
EP - 1799
JO - Heart rhythm
JF - Heart rhythm
IS - 12
ER -