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Analysis of Screening Electrocardiogram for the Subcutaneous Defibrillator in Adults with Congenital Heart Disease

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Abstract

Candidates for the subcutaneous implantable cardioverter-defibrillator (S-ICD) are screened using an electrocardiogram (S-ECG) tool to measure appropriate detection. We sought to define the S-ICD candidacy of congenital heart disease patients using the S-ECG tool. We also analyzed the reliability of the (S-ECG) tool between measurers in this population. Patients above the age of 12 and with a diagnosis associated with either a higher incidence of cardiac arrest or vascular access challenges were asked to undergo screening. S-ECGs were then analyzed by a pediatric electrophysiologist, an S-ICD device engineer, and an S-ICD clinical representative for candidacy. Results were compared for interobserver variability and S-ECGs were analyzed by t test to determine variables that differ among passing and failing leads. Thirty-one patients underwent screening. Two of the 31 (6.5%) patients failed S-ICD screening. Analysis of the screening leads demonstrated the highest passing rates using lead III at a 5 mm/mV amplitude setting with 71 and 62% pass rate in the supine and standing positions, respectively. Interobserver analysis correlated well among the three measurers. There was a higher amplitude difference between QRS and T waves among passing versus failing S-ECG. Congenital heart disease patients have acceptable passage rates utilizing the S-ECG algorithm. Interobserver measurements were well correlated and these data suggest that the proximal coil to device (lead III) vector would be best utilized in this patient population. A larger difference between QRS and T wave amplitudes was associated with a higher S-ECG passing rate.

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(Courtesy of Boston Scientific)

Fig. 2

(Courtesy of Cameron Health/Boston Scientific)

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Acknowledgements

Special thanks to Shelby Kutty, MD, Ling Li, MD, and Valerie K. Shostrom, M.S. for statistical work and assistance.

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Authors and Affiliations

  1. University of Nebraska Medical Center, Children’s Hospital and Medical Center, 8200 Dodge Street, Omaha, NE, 68164, USA

    Vincent C. Thomas

  2. Boston Scientific, Marlborough, MA, USA

    Mark Peterson & Martin McDaniel

  3. Children’s Heart Center Nevada, Las Vegas, NV, USA

    Humberto Restrepo & Abraham Rothman

  4. University of Nevada School of Medicine, Reno, NV, USA

    Abraham Rothman & Amit Jain

Authors
  1. Vincent C. Thomas
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  2. Mark Peterson
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  3. Martin McDaniel
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  4. Humberto Restrepo
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  5. Abraham Rothman
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Contributions

Concept/design: VCT, HR, AJ. Data collection, analysis/interpretation: VCT, MP, MM, AJ, HR, AR. Drafting article: VCT, AJ. Critical revision of article: VCT, AR, AJ, MM.

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Correspondence to Vincent C. Thomas.

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Mark Peterson and Martin McDaniel are contracted employees of Boston Scientific. All other authors have no disclosures.

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Thomas, V.C., Peterson, M., McDaniel, M. et al. Analysis of Screening Electrocardiogram for the Subcutaneous Defibrillator in Adults with Congenital Heart Disease. Pediatr Cardiol 38, 1162–1168 (2017). https://doi.org/10.1007/s00246-017-1635-4

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  • DOI: https://doi.org/10.1007/s00246-017-1635-4

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