Nouvelles techniques de stimulation dans le domaine des cardiopathies congénitales

Abstract

The number of children and adult with congenital heart disease requiring implantation of cardiac pacemaker or cardioverter defibrillator is constantly increasing. The lead between stimulation/defibrillation site and the generator constitutes the main weakpoint of those devices despite the numerous recent technological advances: use of bipolar probes, corticoid elution electrodes, insulation improvement, magnetic resonance imaging (MRI) compatibility. Risk of device failure remains high in this population. Long term adverse events with endovascular devices remain high. That point leads us to review our implantation strategies. We try to favour an extravascular solution whenever possible. Subcutaneous defibrillators may be proposed to patients at high risk for severe ventricular arrhythmia without cardiac pacing indication. Patients should have a rigorous pre-implantation screening procedure to minimize the increased risk of inappropriate shock. New single chamber, VVIR-type, leadless pacemakers can be implanted directly into the right ventricle. Miniaturized implantable loop recorders help in management of palpitations and syncopes: it increases diagnosis yield and helps arrhythmias burden assessment. Development of remote monitoring (implantable loop recorder, pacemaker and defibrillator) helps to reduce the incidence of adverse clinical events by providing an early detection of clinically relevant events such as arrhythmias and device failure.