Abstract 14709: Right Sternal Lead Placement Increases Eligibility for Subcutaneous Defibrillator Implantation in Adults With Congenital Heart Disease
Introduction: The subcutaneous implantable cardioverter defibrillator (S-ICD) is an attractive option for patients with congenital heart disease (CHD) in whom a transvenous system is contraindicated. However, more than 10% of adult patients with CHD fail S-ICD screening due to a large T- to R-wave ratio. We hypothesized right-sternal electrodes may permit S-ICD placement in patients who fail left-sternal screen.
Methods: We prospectively screened 40 patients with CHD for S-ICD using the standard proprietary approach. We also screened with right sternal electrodes (with left can electrode position).
Results: The mean age of the cohort was 46+/-15 years; 24 males were enrolled. CHD anomalies consisted of tetralogy of Fallot (n=11), Ebstein’s anomaly (n=7), atrial septal defect (n=6), dextro-looped transposition of the great artery (n=5) and other (n=11). Left side screening ECG failed in 9 patients (23%), five of whom passed with right sternal electrodes, increasing the pass rate from 77% to 90%. Figure shows the screening ECG and chest x-ray of a patient who failed in all three vectors on the left side but passed in the alternative vector on the right side and underwent right sided implantation.
Conclusions: The addition of right sternal electrodes during screening increases S-ICD eligibility and may avoid thoracotomy for high risk patients with CHD.
Author Disclosures: H. Okamura: Other Research Support; Significant; 2014 Fellowship for Young Japanese Investigator conducted by Japanese Heart Rhythm Society, sponsored by Medtronic Japan. C.J. McLeod: None. M.U. Bashir: None. T.L. Webster: None. C.R. Bonnichsen: None. M. Grogan: None. S.D. Phillips: None. C.A. Warnes: None. N.M. Ammash: None. H.M. Connolly: None. P.A. Friedman: Speakers Bureau; Modest; Boston Scientific.
- © 2015 by American Heart Association, Inc.