Implantable cardioverter defibrillator therapy for life-threatening arrhythmias in young patients

J Interv Card Electrophysiol. 2002 Jul;6(3):235-44. doi: 10.1023/a:1019509803992.


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 [6], repaired congenital heart disease [5];, and idiopathic ventricular tachycardia/fibrillation [4]. Indications comprised resuscitated SCD [15], syncope [9], and life-threatening ventricular arrhythmia [3]. 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.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Cardiovascular Diseases / diagnosis
  • Cardiovascular Diseases / mortality
  • Cardiovascular Diseases / therapy*
  • Child
  • Cohort Studies
  • Critical Illness
  • Death, Sudden, Cardiac / prevention & control*
  • Defibrillators, Implantable*
  • Female
  • Heart Defects, Congenital / diagnosis
  • Heart Defects, Congenital / mortality
  • Heart Defects, Congenital / therapy*
  • Humans
  • Male
  • Prognosis
  • Registries
  • Severity of Illness Index
  • Survival Rate
  • Tachycardia, Ventricular / diagnosis
  • Tachycardia, Ventricular / mortality
  • Tachycardia, Ventricular / therapy*
  • Treatment Outcome