2021 PACES expert consensus statement on the indications and management of cardiovascular implantable electronic devices in pediatric patients

Abstract

In view of the increasing complexity of both cardiovascular implantable electronic devices (CIEDs) and patients in the current era, practice guidelines, by necessity, have become increasingly specific. This document is an expert consensus statement that has been developed to update and further delineate indications and management of CIEDs in pediatric patients, defined as ≤21 years of age, and is intended to focus primarily on the indications for CIEDs in the setting of specific disease categories. The document also highlights variations between previously published adult and pediatric CIED recommendations and provides rationale for underlying important differences. The document addresses some of the deterrents to CIED access in low- and middle-income countries and strategies to circumvent them. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by class of recommendation and level of evidence. Several questions addressed in this document either do not lend themselves to clinical trials or are rare disease entities, and in these instances recommendations are based on consenus expert opinion. Furthermore, specific recommendations, even when supported by substantial data, do not replace the need for clinical judgment and patient-specific decision-making. The recommendations were opened for public comment to Pediatric and Congenital Electrophysiology Society (PACES) members and underwent external review by the scientific and clinical document committee of the Heart Rhythm Society (HRS), the science advisory and coordinating committee of the American Heart Association (AHA), the American College of Cardiology, (ACC) and the Association for European Paediatric and Congenital Cardiology (AEPC). The document received endorsement by all the collaborators and the Asia Pacific Heart Rhythm Society (APHRS), the Indian Heart Rhythm Society (IHRS), and the Latin American Heart Rhythm Society (LAHRS). This document is expected to provide support for clinicians and patients to allow for appropriate CIED use, appropriate CIED management, and appropriate follow-up in pediatric patients.

Resuscitated Sudden Cardiac Arrest of a Neonate with Congenital LQT Syndrome-Associated Torsades de Pointes: A Case Report and Literature Review

“…In addition to medical treatment, cardiac pacing to prevent bradycardia and ICD implantation have been advised in LQT patients who have survived a cardiac arrest or in patients at anticipated high risk for life-threatening cardiac arrhythmias [ 6 , 29 ].…”

Screening, diagnosis and follow-up of Brugada syndrome in children: a Dutch expert consensus statement

“…Medical therapy with quinidine can be considered in highly symptomatic patients, but the evidence in children is limited [ 24 , 25 ]. An implantable cardiac defibrillator should only be implanted according to international guidelines [ 26 ]. Although right ventricular outflow tract epicardial ablation seems promising in symptomatic adults with BrS [ 27 ], its short- and long-term effects in children are unknown.…”

Implantable Loop Recorder with Long Sensing Vector: Safety, Acceptability, and Sensing Performance in Pediatric Patients

“…Unexplained recurrent syncope was the most common indication for ILR implantation (56%) in this study. According to the latest guidelines, ILR is recommended in high-risk patients with unexplained syncope, without indication for pacemaker or ICD, and is reasonable in patients with recurrent syncope of uncertain origin, but without a high risk of SCD [9]. ILR implantation should be considered when arrhythmogenic syncope is suspected but not proven [9,10].…”

“…They are helpful in establishing a symptom-rhythm correlation in patients with recurrent and/ or unexplained syncope, palpitations, cryptogenic stroke, or to record recurrences in patients undergoing catheter ablation for atrial fibrillation [1][2][3][4]. The reduction in device size and the simplification of the insertion procedure have facilitated their use even in the pediatric population; benefits from ILR implantation have been demonstrated in patients with or without congenital heart disease (CHD) or primary cardiac electrical disorders [5][6][7][8][9]. The ILR with long sensing vector is a novel device with a wider electrode spacing thanks to the addition of a long flexible antenna to the rigid case.…”