“Primum non nocere…” Explanting implantable
cardioverter-defibrillators in patients with inherited arrhythmia
syndromes - Case series
Abstract
Introduction: Patients with Inherited arrhythmia syndromes
(IAS) are at risk for life-threatening arrhythmias that may present as a
sudden cardiac arrest (SCA) or a cardiac syncope. The benefit
of Implantable cardioverter-defibrillators (ICD) in patients with IAS
should be weighted against the risk for adverse events. This case-series
describes patients diagnosed with an IAS, who were eventually
reclassified in a low risk category and subsequently got their ICD
explanted. Methods: We selected patients who, 1) were
diagnosed with an IAS, 2) presented with either a documented arrhythmic
event or syncope presumed to be arrhythmic syncope, 3) followed by an
ICD implant, and 4) in whom we decided to explant the pulse generator.
Results: Overall, eight patients fulfilled the inclusion
criteria. Mean age at ICD implantation was 35±11.6 years. Mean length of
ICD in situ was 4.9±3.6 years. None of the patients experienced a
cardiac event. 2 patients presented with a presumed cardiac syncope,
this diagnosis was rejected after guideline guided syncope evaluation
including Tilt table testing. Alternative (pharmacological) therapy was
started in six patients. Conclusion: These cases illustrate
the importance of re-evaluating ICD therapy in patients with IAS. This
should be integrated in standard clinical care, even in patients with
IAS who survived a SCA and long term critical follow up is available. In
patients with IAS presenting with an presumed cardiac syncope, extensive
guideline guided syncope evaluation, can be of additional value when
syncope event remains unknown