Oliver et al reported risk factors for sudden cardiac death for an adult with congenital heart disease. These can help to identify a patient who may benefit from more aggressive management. The authors are from the Spanish ACHD Network.
Patient selection: adult with congenital heart disease
Risk factors for sudden cardiac death:
(1) male sex (OR 1.8)
(2) unexplained syncope (OR 4.1)
(3) symptomatic ischemic heart disease (OR 8)
(4) non-life-threatening ventricular tachycardia (OR 5.3)
(5) prolonged QRS duration (OR 1.02)
(6) ventricular systolic dysfunction (OR 3.7)
(7) moderate or severe hypertrophy of the systemic ventricle (OR 3.8)
(8) moderate or severe sub-pulmonary ventricular hypertrophy (OR 2.7)
(9) young age (OR 0.98)
(10) risk category (OR 9.8 for high risk and 3.9 for moderate risk)
High risk category:
(1) Rastelli procedure
(2) coronary anomaly
(3) non-repaired cyanotic heart disease
(4) complex tetralogy or Fallot
(5) Eisenmenger physiology
Moderate risk category:
(1) non-complex tetralogy of Fallot
(2) Fontan procedure with single ventricle physiology
(3) atrial switch
(4) Ebstein anomaly
(5) congenitally corrected transposition
A patient at risk who does not have contraindications should have an ICD placed.
