Abstract 3223: Outcome of Implantable Cardioverter Defibrillators in Adults with Congenital Heart Disease: a multicentre study
Background: Information on the outcome of implantable cardioverter defibrillator (ICD) therapy in adults with congenital heart disease (CHD) is lacking.
Aims: To investigate the outcome and complications of ICD therapy in adults with CHD and to identify predictors of (in-) appropriate shocks.
Methods: All CHD patients ≥18 years at first ICD implantation were identified using the nation-wide adult CHD registry in the Netherlands and a tertiary care centre database in Belgium.
Results: Sixty-four patients (63% tetralogy of Fallot, age at implantation 37±13 years) were identified. Early complications included pocket haematoma (n=3), lead failure (n=2) and pneumothorax (n=2). Late complications (except inappropriate shocks) occurred in 11 (17%) patients, including lead failure (n=6), thrombo-embolic events (n=4), and ICD storm (n=3). Overall, 30 ICD re-intervention procedures were performed in 20 (31%) patients during the median follow-up of 3.7 years. Half of the patients had at least 1 shock episode (overall 88 episodes, 206 shocks), 46 shocks in 15 (23%) different patients were classified as appropriate, with a median duration to first shock of 2.3 years. The majority of shocks, 160 (78%) in 26 (41%) patients, were inappropriate with a median duration to first shock of 0.6 years. No predictors of (in-) appropriate shocks were identified, except tetralogy of Fallot being associated with less appropriate shocks than patients with other CHD (hazard ratio 0.29, 0.10 – 0.84, p=0.02). During follow-up, one patient died who had received the ICD as a bridge to transplantation.
Conclusions: The ICD provided effective therapy in a quarter of adults with CHD at a median follow-up of 3.7 years, with acceptable implantation related and long-term complication rates. The incidence of inappropriate shocks, however, appeared to be excessive.