Single-center experience with implantable cardioverter-defibrillators in adults with complex congenital heart disease

Area of Science:

• Cardiology
• Electrophysiology
• Congenital Heart Disease

Background:

• Adults with congenital heart disease face risks of lethal ventricular arrhythmias.
• Implantable cardiac defibrillator (ICD) therapy is a potential treatment, but risks and outcomes are not well-defined.
• Understanding ICD performance in this population is crucial for patient management.

Purpose of the Study:

• To evaluate the safety and efficacy of transvenous ICD implantation in adults with congenital heart disease.
• To characterize implant-related complications, long-term outcomes, and rates of appropriate and inappropriate ICD therapies.
• To assess the overall benefit of ICD therapy in this high-risk patient group.

Main Methods:

• Retrospective review of clinical, implantation, and follow-up data for adults with congenital heart disease receiving transvenous ICDs at Mayo Clinic (1991-2008).
• Analysis of implantation diagnoses, indications (secondary vs. primary prevention), and complications.
• Assessment of follow-up duration, mortality, transplant rates, and ICD shock occurrences.

Main Results:

• No major implant-related complications were observed in 73 adults receiving 85 ICDs.
• Appropriate shocks for ventricular arrhythmias occurred in 19% of patients; inappropriate shocks in 15%.
• Increased subpulmonic ventricular pressure was associated with a higher likelihood of appropriate shocks.

Conclusions:

• Transvenous ICD implantation is associated with low complication rates in adults with congenital heart disease.
• ICD therapy demonstrates a high likelihood of appropriate treatment for lethal ventricular arrhythmias in this population.
• The data suggest a net benefit of ICD therapy for adults with congenital heart disease requiring arrhythmia management.