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The Role of Conventional and Right‐Sided ECG Screening for Subcutaneous ICD in a Tetralogy of Fallot Population
Author(s) -
ALONSO PAU,
OSCA JOAQUÍN,
CANO OSCAR,
PIMENTA PEDRO,
ANDRÉS ANA,
YAGÜE JAIME,
MILLET JOSÉ,
RUEDA JOAQUÍN,
SANCHOTELLO MARÍA JOSÉ
Publication year - 2017
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.13017
Subject(s) - medicine , tetralogy of fallot , qrs complex , implantable cardioverter defibrillator , population , cardiology , qt interval , heart disease , environmental health
Background Information regarding suitability for subcutaneous implantable cardioverter‐defibrillator (S‐ICD) implant in tetralogy of Fallot (ToF) population is scarce and needs to be further explored. The aims of our study were: (1) to determine the proportion of patients with ToF eligible for S‐ICD, (2) to identify the optimal sensing vector in ToF patients, (3) to test specifically the eligibility for S‐ICD with right‐sided screening, and (4) to compare with the proportion of eligible patients in a nonselected ICD population. Methods We recruited 60 consecutive patients with ToF and 40 consecutive nonselected patients. Conventional electrocardiographic screening was performed as usual. Right‐sided alternative screening was studied by positioning the left arm and right arm electrodes 1 cm right lateral to the xiphoid midline. The Boston Scientific electrocardiogram (ECG) screening tool was utilized. Results We found a higher proportion of patients with right‐sided positive screening in comparison with standard screening (77 ± 0.4% vs. 67 ± 0.4%; P < 0.0001) and a trend to higher number of appropriate leads in right‐sided screening (1.3 ± 1 vs. 1.1 ± 1 ms; P = 0.07). Patients who failed the screening had a longer QRS duration and longer QT interval. Standard and right‐sided screening showed a higher percent of positive patients in the control group compared to ToF patients (P < 0.001). Conclusion Right‐sided screening was associated with a significant 10% increase in S‐ICD eligibility in ToF patients. When comparing with an acquired cardiomyopathies group, ToF showed a lower eligibility for S‐ICD. The most appropriate ECG vector was the alternate vector in contrast to what is observed in the general population.