Objectives: This study examined the indications, efficacy and outcomes of implantable cardioverter defibrillator (ICD) use in the pediatric population.
Background: ICDs are first-line therapy for adults resuscitated from sudden cardiac death (SCD) or at high risk for life-threatening ventricular arrhythmias. Use of ICDs in children and young adults is infrequent and there are few data regarding this group.
Methods: We abstracted and analyzed data for all patients in whom ICDs were implanted.
Results: A total of 38 devices were implanted in 27 patients. Age ranged from 6 to 26 years (mean, 14) and weight ranged from 16 to 124 kg (mean, 47). Diagnoses included long QT syndrome (9), hypertrophic cardiomyopathy , repaired congenital heart disease ;, and idiopathic ventricular tachycardia/fibrillation . Indications comprised resuscitated SCD , syncope , and life-threatening ventricular arrhythmia . Initial device placement was infraclavicular in 13, abdominal in 13 and intrathoracic in 1. Epicardial leads were used with 5 systems. A single coil lead was used in 17. Seven patients, all previously resuscitated from SCD, experienced 88 appropriate successful discharges. There were 6 inappropriate discharges in 3 patients. Mean time to device replacement was 3.1 years (n = 11). Complications included 2 infected systems, 2 lead dislodgments, 2 lead fractures, 1 post-pericardiotomy syndrome, 1 adverse event with defibrillation threshold (DFT); testing, and 1 patient with psychiatric sequelae. No deaths occurred with implanted ICDs.
Conclusions: These data demonstrate that ICDs provide safe and effective therapy in young patients. The indications for ICDs as primary preventive therapy remain uncertain.