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Implantation of Total Artificial Heart in Congenital Heart Disease
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Implantation of Total Artificial Heart in Congenital Heart Disease

Published on: July 18, 2014

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Pacing in congenital heart disease - A four-decade experience in a single tertiary centre

Disha Midha1, Zhong Chen1, David G Jones1

  • 1Heart Rhythm Centre, Royal Brompton and Harefield NHS Foundation Trust, NIHR Cardiovascular Biomedical Research Unit, Imperial College, London, United Kingdom.

International Journal of Cardiology
|March 15, 2017
PubMed

Insights

Patients with congenital heart disease (CHD) requiring cardiac implantable electronic devices (CIEDs) face risks. Older age at CIED implantation and complex CHD anatomy predict later complications, necessitating careful management.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Adult Congenital Heart Disease (ACHD)

Background:

  • Congenital heart disease (CHD) patients have increased risk of arrhythmias, often requiring early cardiac rhythm management devices.
  • Early device implantation in CHD patients leads to a higher incidence of device-related complications.
  • Long-term data on device-related complications in ACHD patients are crucial for risk stratification and management.

Purpose of the Study:

  • To investigate the indications for cardiac implantable electronic devices (CIEDs) in adult congenital heart disease (ACHD) patients.
  • To identify predictors of late device-related complications requiring re-intervention in ACHD patients.
  • To analyze the impact of age at implantation and ACHD complexity on CIED outcomes.

Main Methods:

  • Retrospective review of pacing records from a tertiary ACHD center over 40 years (1970-2009).
  • Inclusion of 238 structural CHD patients (structural group) and 98 patients with congenital conduction disease (electrical group).
  • Primary outcome: device-related complications requiring re-intervention; multivariate analysis used to identify predictors.

Main Results:

  • A total of 72 (21%) patients required re-intervention due to device complications over a mean follow-up of 9.6 years.
  • Older age at CIED implantation was an independent predictor of fewer late device-related complications (HR 0.77, p=0.04).
  • In structural CHD patients, higher ACHD complexity (Bethesda guideline) was the sole predictor of late device-related complications (HR 2.96, p<0.01).

Conclusions:

  • Increasing age at device implantation shows an inverse association with late device-related complications in ACHD patients.
  • ACHD patients with complex cardiac anatomy face a significantly increased risk of device-related complications.
  • These findings highlight the need for tailored management strategies and long-term surveillance for CIEDs in ACHD populations.
Abstract

Keywords:
Adult congenital heart diseaseComplicationPacing

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