216-54: S-ICDs in adults with complex congenital heart diseases and absence of venous access to the heart

Abstract

Purpose of the study: Malignant arrhythmias remain the main cause of mortality and morbidity in congenital heart disease (CHD) patients. Because of anatomic variations, surgical interventions, abnormal systemic venous pathway, ICD implantation can be technically challenging. The S-ICD may be an interesting alternative for these patients. Our objective was to assess the feasibility and safety of this new device in congenital heart disease patients. Method used: In 4 French tertiary centers (Montpellier, Lille, Strasbourg and Dijon), CHD patients requiring an ICD, with no transvenous access to the ventricle were prospectively included to receive an S-ICD. Summary of results: From 2012 to 2015, 12 patients were included: 9 (75%) were men and 3 (25%) were women. The median age was 27.5 years old IQ [22.8-44.5]. 5 patients had univentricular heart (4 due to pulmonary atresia and 1 due to tricuspid atresia), 2 had interatrial communication associated with Ebstein's anomaly, 3 Tetralogy of Fallot, 1 transposition of the great arteries and 1 congenitally corrected transposition. 8 patients (66.7%) had secondary prevention and 4 (33.3%) had primary prevention indications. The S-ICD implantation was achieved successfully in all patients. 3 patients had situs inversus requiring right-sided implantation of the lead and the device. At the end of the procedure, induced ventricular fibrillation was successfully detected and treated in all patients (100%). After 15 months of median follow-up IQ [8-30]; there were no device-related serious events. Survival free of inappropriate therapy or system revision was 75%. 1 patient had an impending extrusion requiring reintervention. 2 patients experimented inappropriate shocks: 1 due to T-wave oversensing, 1 due to supraventricular arrhythmia. There were no deaths related with ventricular arrhythmia. Conclusion: The S-ICD is a safe alternative for sudden cardiac death prevention in CHD patients with no central venous access available.