Pacing and Defibrillators in Complex Congenital Heart Disease

Henry Chubb; Mark O'Neill; Eric Rosenthal

doi:10.15420/aer.2016.2.3

Pacing and Defibrillators in Complex Congenital Heart Disease

Arrhythm Electrophysiol Rev. 2016 May;5(1):57-64. doi: 10.15420/aer.2016.2.3.

Authors

Henry Chubb¹, Mark O'Neill², Eric Rosenthal³

Affiliations

¹ Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK; Department of Congenital Heart Disease, Evelina Children's Hospital, London, UK.
² Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK; Adult Congenital Heart Disease Group, Departments of Cardiology at Guy's and St Thomas' NHS Foundation Trust and Evelina Children's Hospital, London, UK.
³ Department of Congenital Heart Disease, Evelina Children's Hospital, London, UK; Adult Congenital Heart Disease Group, Departments of Cardiology at Guy's and St Thomas' NHS Foundation Trust and Evelina Children's Hospital, London, UK.

Abstract

Device therapy in the complex congenital heart disease (CHD) population is a challenging field. There is a myriad of devices available, but none designed specifically for the CHD patient group, and a scarcity of prospective studies to guide best practice. Baseline cardiac anatomy, prior surgical and interventional procedures, existing tachyarrhythmias and the requirement for future intervention all play a substantial role in decision making. For both pacing systems and implantable cardioverter defibrillators, numerous factors impact on the merits of system location (endovascular versus non-endovascular), lead positioning, device selection and device programming. For those with Fontan circulation and following the atrial switch procedure there are also very specific considerations regarding access and potential complications. This review discusses the published guidelines, device indications and the best available evidence for guidance of device implantation in the complex CHD population.

Keywords: Congenital heart disease; arrhythmia; cardiac resynchronisation therapy; implantable cardioverter defibrillator; pacing; sudden cardiac death.