2021 PACES Expert Consensus Statement on the Indications and Management of Cardiovascular Implantable Electronic Devices in Pediatric Patients: Executive Summary

Abstract

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Children really are not little adults: What we can take away from the 2021 PACES Expert Consensus Statement on the Indications and Management of Cardiovascular Implantable Electronic Devices

“…Owing to this heterogeneity and smaller number of patients, creating and enrolling patients into statistically powered, prospective, randomized trials designed to study outcomes is not tenable. To overcome this limitation, these guidelines 1,5 rely on expert opinion and consensus to present substrate-specific indications for CIEDs.…”

“…These guidelines are the most comprehensive set to date for ICM implantation in pediatric patients and will undoubtedly continue to evolve over time. 1,5 Health care equity Inclusion of comments on CIEDs in low-and middle-income countries is an important contribution from these guidelines. 1,5 Pediatric cardiologists in low-and middle-income countries may deploy more patient-specific strategies in lieu of adherence to guidelines and use explanted devices in resource-limited settings.…”

“…1,5 Health care equity Inclusion of comments on CIEDs in low-and middle-income countries is an important contribution from these guidelines. 1,5 Pediatric cardiologists in low-and middle-income countries may deploy more patient-specific strategies in lieu of adherence to guidelines and use explanted devices in resource-limited settings. While current remote monitoring technology may be prohibitive owing to ancillary equipment and cost, adoption of smartphone applications using Bluetooth technology may expand access.…”

“…There are several noteworthy aspects of pediatric device management discussed in these guidelines. 1,5 Children are not little adults Variation in guidelines for adult vs pediatric patients supports the notion that adult guidelines for CIED implantation do not carry over to pediatrics in a linear fashion. Certainly, select indications are broadly applicable, but others require age-based refinements and changes.…”

“…However, these new guidelines for pediatric implantable cardioverter-defibrillator (ICD) implantation, particularly for secondary prevention in channelopathy patients (specifically long QT syndrome and catecholaminergic polymorphic ventricular tachycardia), are more nuanced and these new guidelines allow for alternate therapies, such as aggressive medical therapy and sympathectomy, to be considered in select patients. 1,5 Another important difference is regarding primary prevention ICD implantation in dilated nonischemic cardiomyopathy patients with an ejection fraction 35%-in pediatric patients, this is now a IIB indication 1,5 in contrast to class I indication in current adult guidelines. 6,7…”