Implantable Cardioverter Defibrillator Use in Males with Duchenne Muscular Dystrophy and Severe Left Ventricular Dysfunction

Michael A. McCulloch*, Ashwin K. Lal, Kenneth Knecht, Ryan J. Butts, Chet R. Villa, Jonathan N. Johnson, Jennifer Conway, Matthew J. Bock, Kurt R. Schumacher, Sabrina P. Law, Joshua M. Friedland-Little, Shriprasad R. Deshpande, Shawn C. West, Irene D. Lytrivi, Katheryn E. Gambetta, Carol A. Wittlieb-Weber

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Duchenne muscular dystrophy (DMD) is characterized by myocardial fibrosis and left ventricular (LV) dysfunction. Implantable cardioverter defibrillator (ICD) use has not been characterized in this population but is considered for symptomatic patients with severe LV dysfunction (SLVD) receiving guideline-directed medical therapy (GDMT). We evaluated ICD utilization and efficacy in patients with DMD. Retrospective cohort study of DMD patients from 17 centers across North America between January 2, 2005 and December 31, 2015. ICD use and its effect on survival were evaluated in patients with SLVD defined as ejection fraction (EF) < 35% and/ or shortening fraction (SF) < 16% on final echocardiogram. SLVD was present in 57/436 (13.1%) patients, of which 12 (21.1%) died during the study period. Of these 12, (mean EF 20.9 ± 6.2% and SF 13.7 ± 7.2%), 8 received GDMT, 5 received steroids, and none received an ICD. ICDs were placed in 9/57 (15.8%) patients with SLVD (mean EF 31.2 ± 8.5% and SF 10.3 ± 4.9%) at a mean age of 20.4 ± 6.3 years; 8/9 received GDMT, 7 received steroids, and all were alive at study end; mean ICD duration was 36.1 ± 26.2 months. Nine ICDs were implanted at six different institutions, associated with two appropriate shocks for ventricular tachycardia in two patients, no inappropriate shocks, and one lead fracture. ICD use may be associated with improved survival and minimal complications in DMD cardiomyopathy with SLVD. However, inconsistent GDMT utilization may be a significant confounder. Future studies should define optimal indications for ICD implantation in patients with DMD cardiomyopathy.

Original languageEnglish (US)
Pages (from-to)925-931
Number of pages7
JournalPediatric cardiology
Volume41
Issue number5
DOIs
StatePublished - Jun 1 2020

Keywords

  • Duchenne
  • ICD
  • Left ventricular failure
  • Mortality

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Cardiology and Cardiovascular Medicine

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    McCulloch, M. A., Lal, A. K., Knecht, K., Butts, R. J., Villa, C. R., Johnson, J. N., Conway, J., Bock, M. J., Schumacher, K. R., Law, S. P., Friedland-Little, J. M., Deshpande, S. R., West, S. C., Lytrivi, I. D., Gambetta, K. E., & Wittlieb-Weber, C. A. (2020). Implantable Cardioverter Defibrillator Use in Males with Duchenne Muscular Dystrophy and Severe Left Ventricular Dysfunction. Pediatric cardiology, 41(5), 925-931. https://doi.org/10.1007/s00246-020-02336-9