Combined subcutaneous implantable cardioverter defibrillator and pacemaker devices in complex congenital heart...

Area of Science:

• Cardiology
• Medical Devices
• Electrophysiology

Background:

• Subcutaneous implantable cardioverter defibrillators (S-ICD) are established for congenital heart disease (CHD) patients at risk of sudden cardiac death (SCD) when pacing isn't needed.
• Pacemaker (PM)-dependent CHD patients may later require a cardioverter defibrillator, presenting unique challenges for S-ICD use.
• Safety and physician recommendations for S-ICD in complex CHD patients with prior PM implantation are not well-defined.

Purpose of the Study:

• To review data and indications for S-ICD in complex CHD patients with previous PM implantation.
• To discuss the clinical usefulness of S-ICD in this specific patient population.

Main Methods:

• Retrospective review of the S-ICD Monaldi care registry data.
• Analysis of 11 consecutive complex CHD patients who received S-ICD post-PM implantation (February 2015 - October 2022).
• Evaluation of patient compliance, complications, and follow-up data.

Main Results:

• Eleven complex CHD patients (mean age 40.4 years) with prior PM implantation underwent S-ICD implantation.
• Mean follow-up was 25.5 months, with all patients demonstrating good device compliance.
• No complications such as infections or skin erosions were observed.

Conclusions:

• S-ICD implantation is a safe alternative for complex CHD patients already equipped with PM devices.
• S-ICD avoids risks associated with upgrading to transvenous ICD systems, such as abandoned leads or lead extraction.
• Specific considerations for S-ICD testing and programming in this cohort require further attention.