TY - JOUR
T1 - Implantable cardioverter-defibrillator use in catecholaminergic polymorphic ventricular tachycardia
T2 - A systematic review
AU - Roston, Thomas M.
AU - Jones, Karolina
AU - Hawkins, Nathaniel M.
AU - Bos, J. Martijn
AU - Schwartz, Peter J.
AU - Perry, Frances
AU - Ackerman, Michael J.
AU - Laksman, Zachary W.M.
AU - Kaul, Padma
AU - Lieve, Krystien V.V.
AU - Atallah, Joseph
AU - Krahn, Andrew D.
AU - Sanatani, Shubhayan
N1 - Funding Information:
This work was supported by the Rare Disease Foundation and BC Children's Hospital Foundation (to Dr Roston and Dr Sanatani), the Queen Elizabeth II Graduate Scholarship at the University of Alberta (to Dr Roston), Heart and Stroke Foundation of Canada (grant no. G-13-0002775 to Dr Sanatani and grant no. G-14-0005732 to Dr Krahn), Canadian Institutes of Health Research (grant no. 343256 to Dr Krahn), Mayo Clinic Windland Smith Rice Comprehensive Sudden Cardiac Death Program (to Dr Ackerman), and E-Rare Joint Transnational Call for Proposals 2015 “Improving Diagnosis and Treatment of Catecholaminergic Polymorphic Ventricular Tachycardia: Integrating Clinical and Basic Science” (to Dr Sanatani). Dr Laksman is the UBC Dr. Charles Kerr Distinguished Scholar in Cardiovascular Genetics, and Dr Krahn is the Sauder Family and Heart and Stroke Foundation Chair in Cardiology and the Paul Brunes Chair in Heart Rhythm Disorders.
Publisher Copyright:
© 2018 Heart Rhythm Society
PY - 2018/12
Y1 - 2018/12
N2 - Background: The implantable cardioverter-defibrillator (ICD) may be associated with a high risk of complications in patients with catecholaminergic polymorphic ventricular tachycardia (CPVT). However, ICDs in this population have not been systematically evaluated. Objective: The purpose of this study was to characterize the use and outcomes of ICDs in CPVT. Methods: We conducted a systematic review using Embase, MEDLINE, PubMed, and Google Scholar to identify studies that included patients with CPVT who had an ICD. Results: Fifty-three studies describing 1429 patients with CPVT were included. In total, 503 patients (35.2%) had an ICD (median age 15.0 years; interquartile range 11.0–21.0 years). Among ICD recipients with a reported medication status, 96.7% were prescribed β-blockers and 13.2% flecainide. Sympathetic denervation was performed in 23.2%. Nearly half of patients received an ICD for primary prevention (47.3%), and 12.8% were prescribed optimal antiarrhythmic therapy. During follow-up, 40.1% had ≥1 appropriate shock, 20.8% experienced ≥1 inappropriate shock, 19.6% had electrical storm, and 7 patients (1.4%) died. An ICD-associated electrical storm was implicated in 4 deaths. Additional complications such as lead failure, endocarditis, or surgical revisions were observed in 96 of 296 patients (32.4%). A subanalysis of the 10 studies encompassing 330 patients with the most detailed ICD-related data showed similar trends. Conclusion: In this population with CPVT, ICDs were common and associated with a high burden of shocks and complications. The reliance on primary prevention ICDs, and poor uptake of adjuvant antiarrhythmic therapies, suggests that improved adherence to guideline-directed management could reduce ICD use and harm.
AB - Background: The implantable cardioverter-defibrillator (ICD) may be associated with a high risk of complications in patients with catecholaminergic polymorphic ventricular tachycardia (CPVT). However, ICDs in this population have not been systematically evaluated. Objective: The purpose of this study was to characterize the use and outcomes of ICDs in CPVT. Methods: We conducted a systematic review using Embase, MEDLINE, PubMed, and Google Scholar to identify studies that included patients with CPVT who had an ICD. Results: Fifty-three studies describing 1429 patients with CPVT were included. In total, 503 patients (35.2%) had an ICD (median age 15.0 years; interquartile range 11.0–21.0 years). Among ICD recipients with a reported medication status, 96.7% were prescribed β-blockers and 13.2% flecainide. Sympathetic denervation was performed in 23.2%. Nearly half of patients received an ICD for primary prevention (47.3%), and 12.8% were prescribed optimal antiarrhythmic therapy. During follow-up, 40.1% had ≥1 appropriate shock, 20.8% experienced ≥1 inappropriate shock, 19.6% had electrical storm, and 7 patients (1.4%) died. An ICD-associated electrical storm was implicated in 4 deaths. Additional complications such as lead failure, endocarditis, or surgical revisions were observed in 96 of 296 patients (32.4%). A subanalysis of the 10 studies encompassing 330 patients with the most detailed ICD-related data showed similar trends. Conclusion: In this population with CPVT, ICDs were common and associated with a high burden of shocks and complications. The reliance on primary prevention ICDs, and poor uptake of adjuvant antiarrhythmic therapies, suggests that improved adherence to guideline-directed management could reduce ICD use and harm.
KW - Catecholaminergic polymorphic ventricular tachycardia
KW - Flecainide
KW - Implantable cardioverter-defibrillator
KW - Sudden cardiac death
KW - Sympathetic denervation
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U2 - 10.1016/j.hrthm.2018.06.046
DO - 10.1016/j.hrthm.2018.06.046
M3 - Article
C2 - 30063211
AN - SCOPUS:85056610212
SN - 1547-5271
VL - 15
SP - 1791
EP - 1799
JO - Heart rhythm
JF - Heart rhythm
IS - 12
ER -