Abstract
Validation data of the use of implantable cardioverter-defibrillators (ICD) in the pediatric population is insufficient, with limited follow-up periods. The aim of the study was to report on 17 years of experience with implantable cardioverter-defibrillator (ICD) therapy in children and young adults. This retrospective review included patients below the age of 18 years at the time of ICD implantation between May 2000 and December 2017. For the statistical analysis, the sample was divided into groups by gender and the type of indications for ICD implantation (primary vs secondary prevention). The study group included 20 children (8 female, 12 male) who underwent ICD implantation for primary or secondary prevention of sudden cardiac death (SCD). The average age at the time of the initial procedure was 15.6 years (range: 3.8-17.7 years). Primary electrical disease (PED) was present in 9 patients, cardiomyopathy (CMP) in 9 and 2 others had congenital heart defects (CHDs). The median follow-up time was 6.7 years (range: 0.4-12.5 years). The outcomes of ICD therapy were analyzed. No differences between the sexes were found in terms of treatment strategy effectiveness (p > 0.05). The girls were more often treated as primary prevention (p = 0.009). After implantation, all the patients were on optimal pharmacotherapy. Alltogether there were 126 ICD interventions in 11 patients, including 23 inadequate interventions (IA) in 2 children (18.2%).Three children (15%) died due to electrical storms. In the per-procedure analysis, the overall freedom rate from ICD lead replacement was 90%, 80% and 57% at 1, 5 and 10 years of observation, respectively. Implantable cardioverter-defibrillator implantation indications in children are more heterogeneous in comparison to adult population. In the pediatric population undergoing ICD implantation, the treatment strategy is influenced by gender. The rate of inappropriate ICD discharges (IA) in our group of pediatric patients was low. Rigorous pharmacotherapy and individual ICD programming seemed of paramount importance. Lead malfunctions LF constituted the most prevalent complication observed.
Highlights
The authors present their own experience in the of use of implantable cardioverter-defibrillator (ICD) therapy in children, with one of the longest follow-up periods conducted in a single center from pediatrics to adulthood
In the pediatric population undergoing implantable cardioverter-defibrillators (ICD) implantation, the treatment strategy is influenced by gender
Validation data for ICD use in pediatric populations is insufficient, with limited follow-up periods, and is primarily based on isolated clinical cases, single-center studies, registries, and a few comparison studies with ICD use in adults
Summary
The authors present their own experience in the of use of implantable cardioverter-defibrillator (ICD) therapy in children, with one of the longest follow-up periods conducted in a single center from pediatrics to adulthood. Validation data for ICD use in pediatric populations is insufficient, with limited follow-up periods, and is primarily based on isolated clinical cases, single-center studies, registries, and a few comparison studies with ICD use in adults. The implementation of ICD therapy has significantly decreased the number of sudden cardiac deaths (SCD) in the adult population.[1,2,3] According to the American Heart Association (AHA) and American College of Cardiology (ACC) recommendations, the secondary prevention indications for ICD therapy are the same in children as in adults. Validation data of the use of implantable cardioverter-defibrillators (ICD) in the pediatric population is insufficient, with limited follow-up periods
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