Comparison of defibrillation modalities in the paediatric population: IChildren registry, a French observational and multicentric study

Abstract

The presence of an implantable cardioverter-defibrillator (ICD) in the paediatric population is marked by the occurrence of more frequent complications compared to the adult population, such as lead failure, infections and inappropriate shocks. The objectives of the iChildren study is to carry out an inventory of French practices and to compare the three available defibrillation methods (endovascular, surgical, subcutaneous S-ICD) in terms of effectiveness and safety. We retrospectively included 274 children aged 16 years or younger at the time of the first implantation of an ICD, from most of the major French implanting centres since 2005. Data were collected in an eCRF. The primary composite outcome (PCO) associates the occurrence of lead failure or device infection. We also analyse the rate of appropriate and inappropriate shocks. An endovascular ICD was implanted in 103 patients (38%), a subcutaneous ICD (S-ICD) in 55 patients (20%), a surgical ICD in 116 patients (42%). During a mean follow-up time of 5.7 years, the occurrence of PCO was found in 21% of patients, 5% of the S-ICD patients, 19% of the endovascular patients, 29% of the surgical patients. In univariate analysis, the factors associated with PCO were: young age group, type of ICD. In multivariate analysis, after adjustment, the surgical ICD was associated with the highest risk of PCO (P < 0.05). In the total population, the rate of appropriate shocks was 30%, the rate of inappropriate shocks was 11%, with no statistically significant difference between ICD types at implantation. Surgical implantation of an ICD is associated with more long-term complications, such as lead failure and device infection. There was no statistically significant difference in the occurrence of inappropriate shocks between the 3 defibrillation approaches.