Defibrillators in adult congenital heart disease: Long‐term risk of appropriate shocks, inappropriate shocks, and complications

2020 ◽  
Vol 43 (7) ◽  
pp. 746-753 ◽  
Author(s):  
Benjamin M. Moore ◽  
Jacob Cao ◽  
Rachael L. Cordina ◽  
Mark A. McGuire ◽  
David S. Celermajer
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Adult Congenital Heart Disease ◽  
Inappropriate Shocks ◽  
Appropriate Shocks ◽  
Adult Congenital

7 Long-Term Follow-Up of ICD in Adult Congenital Heart Disease Patients: A Large Single Centre Experience

Heart ◽  
2014 ◽  
Vol 100 (Suppl 3) ◽  
pp. A3.2-A4 ◽  
Author(s):  
Sandhya Santharam ◽  
Maria Theodosiou ◽  
Sara Thorne ◽  
Paul Clift ◽  
Lucy Hudsmith ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Adult Congenital Heart Disease ◽  
Single Centre ◽  
Single Centre Experience ◽  
Long Term Follow Up ◽  
Adult Congenital

scholarly journals Current use and safety of novel oral anticoagulants in adults with congenital heart disease: results of a nationwide analysis including more than 44 000 patients

2020 ◽  
Vol 41 (43) ◽  
pp. 4168-4177 ◽  
Author(s):  
Eva Freisinger ◽  
Joachim Gerß ◽  
Lena Makowski ◽  
Ursula Marschall ◽  
Holger Reinecke ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Prospective Studies ◽  
Congenital Heart ◽  
Adult Congenital Heart Disease ◽  
Oral Anticoagulants ◽  
Novel Oral Anticoagulants ◽  
All Cause Mortality ◽  
Adult Congenital

Abstract Aims  To evaluate the use of novel oral anticoagulants (NOACs) compared with vitamin K antagonists (VKAs) in adult congenital heart disease (ACHD) and assess outcome in a nationwide analysis. Methods and results  Using data from one of Germany’s largest Health Insurers, all ACHD patients treated with VKAs or NOACs were identified and changes in prescription patterns were assessed. Furthermore, the association between anticoagulation regimen and complications including mortality was studied. Between 2005 and 2018, the use of oral anticoagulants in ACHD increased from 6.3% to 12.4%. Since NOACs became available their utilization increased constantly, accounting for 45% of prescribed anticoagulants in ACHD in 2018. Adult congenital heart disease patients on NOACs had higher thromboembolic (3.8% vs. 2.8%), MACE (7.8% vs. 6.0%), bleeding rates (11.7% vs. 9.0%), and all-cause mortality (4.0% vs. 2.8%; all P < 0.05) after 1 year of therapy compared with VKAs. After comprehensive adjustment for patient characteristics, NOACs were still associated with increased risk of MACE (hazard rate—HR 1.22; 95% CI 1.09–1.36) and increased all-cause mortality (HR 1.43; 95% CI 1.24–1.65; both P < 0.001), but also bleeding (HR 1.16; 95% CI 1.04–1.29; P = 0.007) during long-term follow-up. Conclusion  Despite the lack of prospective studies in ACHD, NOACs are increasingly replacing VKAs and now account for almost half of all oral anticoagulant prescriptions. Particularly, NOACs were associated with excess long-term risk of MACE, and mortality in this nationwide analysis, emphasizing the need for prospective studies before solid recommendations for their use in ACHD can be provided.

scholarly journals Pacing-associated cardiomyopathy in adult congenital heart disease

Open Heart ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. e001374
Author(s):  
Benjamin M Moore ◽  
Caroline Medi ◽  
Mark A McGuire ◽  
David S Celermajer ◽  
Rachael L Cordina
Keyword(s):  
Heart Failure ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Ventricular Function ◽  
Congenital Heart ◽  
Adult Congenital Heart Disease ◽  
Pacemaker Implantation ◽  
Ventricular Pacing ◽  
Adult Congenital

ObjectivesLong-term single-site ventricular pacing may adversely affect ventricular function, due to dyssynchronous systemic ventricular contraction. We sought to determine the incidence, predictors and outcomes of pacing-associated cardiomyopathy (PACM) in an adult congenital heart disease (ACHD) cohort.MethodsWe retrospectively identified all patients in our database with a permanent pacemaker from 2000 to 2019. Patients were followed for the primary endpoint of unexplained decline in systemic ventricular function (PACM) and the secondary endpoint of heart failure admission.ResultsOf 2073 patients in our database, 106 had undergone pacemaker implantation. Over a median follow-up of 9.4 years, 25 patients (24%) developed PACM, but only in those with ventricular pacing percentage (VP%) ≥70%; PACM occurred in 0% of those with VP <70% and 47% of those with VP ≥70% (p<0.001). High-burden ventricular pacing (≥70%) remained predictive of PACM in transposition of the great arteries, tetralogy of Fallot and complex biventricular repair subgroups, but not in Fontan patients. Those with PACM were more likely to be admitted with heart failure (44% vs 15%, p=0.002). Cardiac resynchronisation therapy (CRT) upgrade was performed in 11 patients, with 9 responders (82%).ConclusionsIn a cohort of patients with ACHD followed long-term post-pacing, 24% developed cardiomyopathy that was significantly associated with a higher burden of ventricular pacing (VP ≥70%). Given promising response rates to CRT, patients with ACHD expected to pace in the ventricle should be closely monitored for systemic ventricular decline.

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