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Stefanelli, Christopher B.; Bradley, David J.; Leroy, Sarah; Dick, Macdonald; Serwer, Gerald A.; Fischbach, Peter S.

doi:10.1023/a:1019509803992

Cited by 94 publications

(4 citation statements)

References 20 publications

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“…During the last two decades, ICD therapy has played an increasing role in the management of a diverse population of cardiac patients, such as ischemic and nonischemic cardiomyopathies and inherited proarrhythmic syndromes [4, 11]. Although ICD implantations in children are only 1% of those in adults, outcome data of ICD therapy in children are comparable with adult clinical trial data [2, 28, 29]. However, complication rate, incidence of infection, and frequency of inappropriate ICD shocks appear to be greater in children [6, 16, 17].…”

Section: Introductionmentioning

confidence: 99%

Psychological Functioning and Disease-Related Quality of Life in Pediatric Patients With an Implantable Cardioverter Defibrillator

et al. 2012

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The objective of this multicenter study was to evaluate psychological functioning and disease-related quality of life (DRQoL) in pediatric patients with an implantable cardioverter defibrillator (ICD) in The Netherlands. Thirty patients were investigated; the mean age was 16.3 years, and the mean duration of implantation was 3.6 years. To assess psychological problems, three domains of the Symptom Checklist (SCL-90-R) were administered to the 25 patients >13 years old. DRQoL was assessed with a disease-specific pediatric questionnaire, the short-form 11-item Worries About (WA)ICDs Scale. Patients ≥13 years old scored significantly higher than the reference group on the domains of anxiety, depression, and sleeping problems of the SCL-90-R (T = 7.5, p < 0.001; T = 5.4, p < 0.001; and T = 7.8, p < 0.001, respectively). Patients who had received an (in)appropriate shock reported more depressive symptoms (T = 2.1, p < 0.03). Patients with >2 years implant duration (N = 19) or who had received an (in)appropriate shock (N = 13) showed lower DRQoL scores on the modified WAICD (T = 2.1, p < 0.04; T = 2.1, p < 0.5, respectively). Age at implantation or underlying disease did not influence psychological problems or DRQoL. Young ICD patients showed more anxiety, depression, and sleeping disorders. Worries were increased among patients with ICD shocks and in those who had their ICD implanted for >2 years. To determine psychological problems and help children to learn to cope with shocks, proper guidance and monitoring of young ICD patients are recommended.

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Section: Introductionmentioning

confidence: 99%

Psychological Functioning and Disease-Related Quality of Life in Pediatric Patients With an Implantable Cardioverter Defibrillator

et al. 2012

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“…The longer defibrillation coil of the subcutaneous lead compared with the shorter electrodes of the transvenous lead is more prone to accidents because of the high physical activity of patients. Although it has been thought that subcutaneous lead and abdominally-inserted active can is sufficient to establish a sufficient electrical field for defibrillation in the small chest of children, the mean defibrillation threshold at implant was higher (15.5 J) despite using various types of defibrillator implantation configurations compared with transvenous systems (11.5 J) (9, 15). A small displacement of the subcutaneous array may lead to an increase in the defibrillation threshold and failure of appropriate therapy.…”

Section: Discussionmentioning

confidence: 99%

Subcutaneous defibrillator implantation in pediatric patients

et al. 2015

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Objective:Although sudden cardiac death is rare in children, an intracardiac defibrillator system is indicated in children with various types of cardiomyopathy, primary electrical diseases, and after surgical repair of congenital heart defects. The use of transvenous defibrillator lead systems is limited in pediatric patients because of a small body size and/or limited vascular access. Subcutaneous array leads combined with an abdominally placed generator can enable implantation.Method:This is a retrospective study of 13 patients who underwent subcutaneous defibrillator implantation between September 2010 and March 2015. The subcutaneous system was preferred because patients were not amenable to transvenous lead placement.Results:The median patient age was 4.1 years, and the median patient weight was 12.1 kg. Diagnoses of patients were long-QT syndrome in 6, aborted cardiac arrest with left ventricular non-compaction in 3, hypertrophic cardiomyopathy with sustained ventricular tachycardia in 3, and arrythmogenic right ventricular cardiomyopathy in 1. Revision of the subcutaneous lead was required in 5 patients 2–26 months after the implantation. Appropriate shocks were observed in three patients. Inappropriate shock and lead fractures were observed in one patient during the follow-up period. The failure of therapy was observed in one patient. There were no perioperative complications and no early or late deaths.Conclusion:Subcutaneous defibrillator systems are safe and effective in pediatric patients when the transvenous method is risky and contraindicated. Because the high growth rate in this population leads to lead failures, a close follow-up of this population is essential. (Anatol J Cardiol 2016; 16: 630-4)

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“…The patients were mostly female (12 patients; 80%), and the median age at implant was 14.9 months (IQR, 1.7-28.5). The majority received an ICD for secondary prevention (12 affecting a majority of the study group (8 patients; 53%). Three patients received an ICD for primary prevention (20%).…”

Section: Patient Characteristics and Indicationsmentioning

confidence: 99%

“…Multiple studies, however, have demonstrated the challenges associated with ICD use in children, including increased rates of inappropriate shocks, system malfunction, need for epicardial placement, and complications in younger patients. [7][8][9][10][11][12][13][14][15][16][17] The issues hampering ICD performance in children are even more pronounced in the smallest of pediatric patients: infants and toddlers (age, 0-3 years). This unique population has the added challenges of procedural complexity associated with device implantation, rapid growth in the first several years of life, markedly higher baseline and peak heart rates, and long-term ICD programming and management.…”

mentioning

confidence: 99%

Implantable Cardioverter Defibrillators in Infants and Toddlers: Indications, Placement, Programming, and Outcomes

Zahedivash

Hanisch

Dubin

et al. 2022

Circ: Arrhythmia and Electrophysiology

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Background: Limited data exist regarding implantable cardioverter defibrillator (ICD) usage in infants and toddlers. This study evaluates ICD placement indications, procedural techniques, programming strategies, and outcomes of ICDs in infants and toddlers. Methods: This is a single-center retrospective review of all patients ≤3 years old who received an ICD from 2009 to 2021. Results: Fifteen patients received an ICD at an age of 1.2 years (interquartile range [IQR], 0.1–2.4; 12 [80%] women; weight, 8.2 kg [IQR, 4.2–12.6]) and were followed for a median of 4.28 years (IQR, 1.40–5.53) or 64.2 patient-years. ICDs were placed for secondary prevention in 12 patients (80%). Diagnoses included 8 long-QT syndromes (53%), 4 idiopathic ventricular tachycardias/ventricular fibrillations (VFs; 27%), 1 recurrent ventricular tachycardia with cardiomyopathy (7%), 1 VF with left ventricular noncompaction (7%), and 1 catecholaminergic polymorphic ventricular tachycardia (7%). All implants were epicardial, with a coil in the pericardial space. Intraoperative defibrillation safety testing was attempted in 11 patients (73%), with VF induced in 8 (53%). Successful restoration of sinus rhythm was achieved in all tested patients with a median of 9 (IQR, 7.3–11.3) J or 0.90 (IQR, 0.68–1.04) J/kg. Complications consisted of 1 postoperative chylothorax and 3 episodes of feeding intolerance. VF detection was programmed to 250 (IQR, 240–250) ms with first shock delivering 10 (IQR, 5–15) J or 1.1 (IQR, 0.8–1.4) J/kg. Three patients (20%) received appropriate shocks for ventricular tachycardia/VF. No patient received an inappropriate shock. There were 2 (13%) ventricular lead fractures (at 2.6 and 4.2 years post-implant), 1 (7%) pocket-site infection, and 2 (13%) generator exchanges. All patients were alive, and 1 patient (7%) received a heart transplant. Conclusions: ICDs can be safely and effectively placed for sudden death prevention in infants and toddlers with good midterm outcomes.

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Abstract: These data demonstrate that ICDs provide safe and effective therapy in young patients. The indications for ICDs as primary preventive therapy remain uncertain.

Cited by 94 publications

References 20 publications

Psychological Functioning and Disease-Related Quality of Life in Pediatric Patients With an Implantable Cardioverter Defibrillator

Psychological Functioning and Disease-Related Quality of Life in Pediatric Patients With an Implantable Cardioverter Defibrillator

Subcutaneous defibrillator implantation in pediatric patients

Implantable Cardioverter Defibrillators in Infants and Toddlers: Indications, Placement, Programming, and Outcomes

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