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Controversies in Arrhythmia and Electrophysiology

Should patients with congenital heart disease and a systemic ventricular ejection fraction less than 30% undergo prophylactic implantation of an ICD?

Patients With Congenital Heart Disease and a Systemic Ventricular Ejection Fraction Less Than 30% Should Undergo Prophylactic Implantation of an Implantable Cardioverter Defibrillator

Michael J. Silka, MD and Yaniv Bar-Cohen, MD

From the Division of Cardiology, Department of Pediatrics, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, Calif.

Correspondence to Michael J. Silka, MD, Children’s Hospital Los Angeles, 4650 Sunset Boulevard, Mail Stop 34, Los Angeles, CA 90027. E-mail msilka@chla.usc.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Areduced left ventricular (LV) ejection fraction (EF) is established as one of the strongest risk factors for sudden and total cardiac mortality in adults with ischemic and nonischemic heart disease.^1,2 Based on the Multicenter Automatic Defibrillator Implantation Trial II and Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) clinical trials, patients with an LVEF <30% are at a significantly increased risk for sudden cardiac death (SCD) and thus warrant an implantable cardioverter defibrillator (ICD).^3,4 At the same time, increasing numbers of patients with congenital heart disease (CHD) continue to survive complex repairs or palliations of their heart defects, allowing survival beyond adolescence and into adulthood. However, it is uncertain whether the risks of systemic ventricular dysfunction and the benefits of primary prevention ICDs demonstrated in adult clinical trials extend to patients with CHD. Clarification regarding this issue is important because in the current era, the majority of ICD implantations in patients with CHD are for primary prevention of SCD.⁵

Response by Triedman see p 307

In this article, we argue that patients with CHD and a systemic ventricular EF <30% should undergo prophylactic implantation of an ICD. Although large-scale randomized clinical ICD trials are unlikely to be performed in these patients, data from adult studies with other forms of heart disease as well as observational and registry studies in CHD patients provide consistent support for the proposal that advanced systemic ventricular dysfunction is a significant risk factor for SCD in CHD patients and thus provides a rational basis for prophylactic . . . [Full Text of this Article]

Related Article

Should patients with congenital heart disease and a systemic ventricular ejection fraction less than 30% undergo prophylactic implantation of an ICD?: Implantable Cardioverter Defibrillator Implantation Guidelines Based Solely on Left Ventricular Ejection Fraction Do Not Apply to Adults With Congenital Heart Disease

John K. Triedman
Circ Arrhythm Electrophysiol 2008 1: 307-316. [Extract] [Full Text] [PDF]