TY - JOUR
T1 - Right parasternal lead placement increases eligibility for subcutaneous implantable cardioverter defibrillator therapy in adults with congenital heart disease
AU - Okamura, Hideo
AU - McLeod, Christopher J.
AU - DeSimone, Christopher V.
AU - Webster, Tracy L.
AU - Bonnichsen, Crystal R.
AU - Grogan, Martha
AU - Phillips, Sabrina D.
AU - Connolly, Heidi M.
AU - Ammash, Naser M.
AU - Warnes, Carole A.
AU - Friedman, Paul A.
N1 - Publisher Copyright:
© 2016, Japanese Circulation Society. All rights reserved.
PY - 2016
Y1 - 2016
N2 - Background:The subcutaneous implantable cardioverter defibrillator (S-ICD) provides an attractive option for patients with congenital heart disease (CHD) in whom a transvenous defibrillator is contraindicated. Given the unusual cardiac anatomy and repolarization strain, the surface electrocardiogram (ECG) is frequently abnormal, potentially increasing the screen failure rate. Methods and Results:We prospectively screened 100 adult CHD patients regardless of the presence of clinical indication for ICD utilizing a standard left sternal lead placement, as well as a right parasternal position. Baseline patient and 12-lead ECG characteristics were examined to assess for predictors of screen failure. Average patient age was 48±14 years, average QRS duration was 134±37 ms, and 13 patients were pacemaker dependent. Using the standard left parasternal electrode position, 21 patients failed screening. Of these 21 patients with screen failure, 9 passed screening with the use of right parasternal electrode positioning, reducing screening failure rate from 21% to 12%. QT interval and inverted T wave anywhere in V2–V6 leads were found to be independent predictors of left parasternal screening failure (P=0.01 and P=0.04, respectively). Conclusions:Utilization of both left and right parasternal screening should be used in evaluation of CHD patients for S-ICD eligibility. ECG repolarization characteristics were also identified as novel predictors of screening failure in this group.
AB - Background:The subcutaneous implantable cardioverter defibrillator (S-ICD) provides an attractive option for patients with congenital heart disease (CHD) in whom a transvenous defibrillator is contraindicated. Given the unusual cardiac anatomy and repolarization strain, the surface electrocardiogram (ECG) is frequently abnormal, potentially increasing the screen failure rate. Methods and Results:We prospectively screened 100 adult CHD patients regardless of the presence of clinical indication for ICD utilizing a standard left sternal lead placement, as well as a right parasternal position. Baseline patient and 12-lead ECG characteristics were examined to assess for predictors of screen failure. Average patient age was 48±14 years, average QRS duration was 134±37 ms, and 13 patients were pacemaker dependent. Using the standard left parasternal electrode position, 21 patients failed screening. Of these 21 patients with screen failure, 9 passed screening with the use of right parasternal electrode positioning, reducing screening failure rate from 21% to 12%. QT interval and inverted T wave anywhere in V2–V6 leads were found to be independent predictors of left parasternal screening failure (P=0.01 and P=0.04, respectively). Conclusions:Utilization of both left and right parasternal screening should be used in evaluation of CHD patients for S-ICD eligibility. ECG repolarization characteristics were also identified as novel predictors of screening failure in this group.
KW - Congenital heart disease
KW - Right parasternal screening
KW - Screening
KW - Subcutaneous implantable cardioverter defibrillator
KW - T wave
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U2 - 10.1253/circj.CJ-16-0153
DO - 10.1253/circj.CJ-16-0153
M3 - Article
C2 - 27109124
AN - SCOPUS:84969722008
SN - 1346-9843
VL - 80
SP - 1328
EP - 1335
JO - Circulation Journal
JF - Circulation Journal
IS - 6
ER -