Potential eligibility of congenital heart disease patients for subcutaneous implantable cardioverter-defibrillator based on surface electrocardiogram mapping.

Abstract

The eligibility of complex congenital heart disease (C-CHD) patients for subcutaneous implantable cardioverter-defibrillator (S-ICD) has yet to be determined. The aim of this study was to determine in C-CHD patients: (i) the S-ICD eligibility, (ii) the most effective sensing vector, (iii) the impact of posture change on screening eligibility, and (iv) the impact of using two vs. six postures for screening. Adults with structurally normal hearts were used as controls. The Boston Scientific ECG screening tool was used to determine eligibility for S-ICD in two and six different postures in 30 patients with C-CHD and 10 controls. Statistical significance was determined using Fisher's exact test. In total, 1440 bipolar vectors were collected. The mean age was 36.3 years, 57% subjects were men. Over all 86.7% of C-CHD patients and 100% controls (P > 0.05) met S-ICD eligibility. In controls, the primary vector (PV) was the most effective, and the alternate vector (AV) was least effective. In C-CHD patients, the AV was comparable to the PV. Posture change did not significantly affect S-ICD eligibility in C-CHD patients and controls (P > 0.05). Screening with six postures vs. two did not significantly affect S-ICD eligibility of C-CHD patients (83% vs. 87%, P > 0.05) or controls (90% vs. 100% P = >0.05). No significant differences were observed between S-ICD eligibility in C-CHD patients and controls. The AV and PV are most suitable in C-CHD patients. No significant impact of postural change was observed for S-ICD eligibility between the two groups. No significant difference was observed in S-ICD eligibility when screening using two or six postures in both groups.