Combined subcutaneous implantable cardioverter defibrillator and
pacemaker devices in complex congenital heart disease. A single-center
experienced based study.
Background: Subcutaneous implantable cardioverter
defibrillators (S-ICD) are widely accepted therapy in congenital heart
disease (CHD) patients at risk of life-threatening ventricular
arrhythmias or sudden cardiac death (SCD) when pacing is not required.
Occasionally, pacemaker (PM) dependent CHD patients will subsequently
develop an indication for a cardioverter defibrillator. The use of S-ICD
in complex CHD who have had already PM devices implanted implies some
specific considerations, as the safety for these patients in unknown and
recommendations among physicians may vary widely. Methods: We
review the data and studied the indications for S-ICD in complex CHD
with previous PM and discuss its usefulness in clinical practice.
Results: From a large cohort of 345 patients enrolled in the
S-ICD “Monaldi care” registry, that encompass all the patients
implanted in the Monaldi Hospital of Naples, we considered 11
consecutive complex CHD patients (10M/1F aged 40.4±18.4 years) who
underwent S-ICD implant after a previous PM implant, from February 2015
to October 2022. Mean follow-up was 23.7±22.5 months. All the patients
showed a good compliance to the device system with no complications
(infections or skin erosions). Conclusions: In complex CHD with
already implanted PM devices, S-ICD implant appears to be a safe
alternative to PM upgrading to transvenous ICD system, avoiding
abandoned leads or life-threatening lead extraction. However, there are
important issues with regards to testing and programming that need to be
addressed at the time of implantation.