Advances in cardiac care of the young have given rise to a growing and aging population
of patients with congenital heart disease. Despite remarkable improvements in overall
survival, sudden cardiac death remains the most common cause of late mortality. As
a result, implantable cardioverter-defibrillators (ICDs) are increasingly used in
this heterogeneous patient population. Tetralogy of Fallot and transposition of the
great arteries are the most prevalent subtypes of congenital heart disease in ICD
recipients.
1
,
2
,
3
Common to this young population is the high rate of lead-related complications and
inappropriate shocks.
1
,
2
,
3
In a multicenter study of patients with tetralogy of Fallot, 25% received inappropriate
shocks, predominantly due to sinus or supraventricular tachycardia.
1
Although a similar proportion of patients with transposition received inappropriate
shocks (24%), 62% were due to oversensing or lead dysfunction.
3
Herein, we offer 10 practical tips for optimizing ICD programming in patients with
congenital heart disease (Table 1) in view of reducing inappropriate and potentially avoidable shocks.
Table 1ICD programming tips for patients with congenital heart disease
| Programming tip | Comment |
|---|---|
| Program faster VT detection rate | For example, 200 bpm for primary prevention; 30–60 ms slower than clinical or induced VT for secondary prevention |
| Program monitoring zone | Should not interact with active zones in modern ICDs |
| Program longer detection times | For example, 24 of 32 or 30 of 40 intervals |
| Program fast VT zone | Allows use of ATP |
| Program discriminators | For rates up to 200 bpm; “off” if complete AV block |
| Deactivate rate smoothing | Except for VT triggered by short–long–short sequences |
| Deactivate “safety” timers | “High rate time out” and “sustained rate duration” |
| Program ATP in VF zone | If programmable, two sequences are superior to one |
| Optimize number of ATP sequences | For example, at least 2 in faster VT zone, 4–6 in slower VT zone; burst not ramp |
| Program maximum shock output | Recommended pending further data |
ATP = antitachycardia pacing; ICD = implantable cardioverter-defibrillator; VF = ventricular
fibrillation; VT = ventricular tachycardia.
Keywords
Abbreviations:
ATP (antitachycardia pacing), ICD (implantable cardioverter-defibrillator), SVT (supraventricular tachycardia), VF (ventricular fibrillation), VT (ventricular tachycardia)To read this article in full you will need to make a payment
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References
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Article info
Publication history
Published online: November 08, 2010
Accepted:
October 30,
2010
Received:
September 6,
2010
Footnotes
This work was supported in part by the Canada Research Chair in Electrophysiology and Adult Congenital Heart Disease (PK). Dr. Mansour has served as a consultant for Biotronik.
Identification
Copyright
© 2011 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
