Long-term follow-up of patients with tetralogy of fallot and implantable cardioverter defibrillator–The DAI-T4F nationwide registry - 14/08/21
, Abdeslam Bouzeman, MD 4, Guillaume Duthoit, MD 5, Linda Koutbi, MD 6, Francis Bessiere, MD, PhD 7, Fabien Labombarda, MD 8, Christelle Marquié, MD 9, Jean Baptiste Gourraud, MD, PhD 10, Pierre Mondoly, MD 11, Jean-Marc Sellal, MD 12, Pierre Bordachar, MD, PhD 13, Alexis Hermida, MD 14, Frédéric Anselme, MD, PhD 15, Anouk Asselin, MSc 1, Caroline Audinet, MD 16, Yvette Bernard, MD 17, Paul Bru, MD 18, Sok Sithikun Bun, MD 19, Gael Clerici, MD 20, Antoine Da Costa, MD, PhD 21, Maxime de Guillebon, MD 22, Pascal Defaye, MD 23, Nathalie Elbaz, MD 24, Romain Eschalier, MD, PhD 25, Rodrigue Garcia, MD 26, Charles Guenancia, MD 27, Benoit Guy-Moyat, MD 28, Franck Halimi, MD 4, Didier Irles, MD 29, Laurence Iserin, MD 2, François Jourda, MD 30, Magalie Ladouceur, MD, PhD 1, 2, Philippe Lagrange, MD 31, Mikael Laredo, MD 5, Jacques Mansourati, MD, PhD 32, Grégoire Massoulié, MD 25, Amel Mathiron, MD 14, Philippe Maury, MD 11, Anne Messali, MD 33, Kumar Narayanan, MD 1, Cédric Nguyen, MD 34, Sandro Ninni, MD 9, Marie-Cécile Perier, MSc 1, Bertrand Pierre, MD 35, Penelope Pujadas, MD 36, Frédéric Sacher, MD, PhD 13, Pascal Sagnol, MD 34, Ardalan Sharifzadehgan, MD, MPH 1, 3, Camille Walton, MD 7, Pierre Winum, MD 37, Cyril Zakine, MD 38, Laurent Fauchier, MD, PhD 35, Raphael Martins, MD, PhD 39, Jean-Luc Pasquié, MD, PhD 40, Jean-Benoit Thambo, MD, PhD 13, Xavier Jouven, MD, PhD 1, 3, Nicolas Combes, MD 41, Eloi Marijon, MD, PhD 1, 3on behalf of
DAI-T4F investigators
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Résumé |
Introduction |
Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease, and sudden cardiac death represents an important mode of death in these patients. Data evaluating the implantable cardioverter defibrillator (ICD) in this patient population remain scarce.
Objective |
We aimed to describe long-term follow-up of TOF patients implanted with ICD through a nationwide French registry.
Methods |
Nationwide French Registry including all TOF patients with an ICD initiated in 2010 by the French Institute of Health and Medical Research. The primary time to event endpoint was the time from ICD implantation to first appropriate ICD therapy. Clinical events were centrally adjudicated by a blinded committee.
Results |
A total of 165 patients (mean age 42.2±13.3 years, 70.1% males) were included from 40 centers, including 104 (63.0%) in secondary prevention. During a median (IQR) follow-up of 6.8 (2.5–11.4) years, 78 (47.3%) patients received at least one appropriate ICD therapy. The annual incidence of the primary outcome was 10.5% (7.1% and 12.5% in primary and secondary prevention, respectively, P=0.03). Overall, 71 (43.0%) patients presented with at least one ICD complication, including inappropriate shocks in 42 (25.5%) patients and lead dysfunction in 36 (21.8%) patients. Among 61 (37.0%) primary prevention patients, the annual rate of appropriate ICD therapies was 4.1%, 5.3%, 9.5%, and 13.3% in patients with respectively no, one, two, or ≥three guideline-recommended risk factors. QRS fragmentation was the only independent predictor of appropriate ICD therapies (HR 3.47, 95% CI 1.19–10.11), and its integration in a model with current criteria increased the 5-year time-dependent area under the curve from 0.68 to 0.81 (P=0.006) (Fig. 1).
Conclusions |
Patients with TOF and an ICD experience high rates of appropriate therapies, including those implanted in primary prevention. The considerable long-term burden of ICD-related complications, however, underlines the need for careful candidate selection. A combination of easy-to-use criteria including QRS fragmentation might improve risk stratification.
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| ☆ | Due to the pandemic, this abstract was already published in Circulation, https://doi.org/10.1161/CIRCULATIONAHA.120.046745. |
Vol 13 - N° 4
P. 271-272 - septembre 2021 Retour au numéro
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