ICD Therapy in Children and Young Adults: Low Incidence of Inappropriate Shock Delivery

Botsch, Micha P.; Franzbach, Birgit; Opgen‐Rhein, Bernd; Berger, Felix; Will, Joachim C.

doi:10.1111/j.1540-8159.2010.02695.x

Cited by 18 publications

(7 citation statements)

References 26 publications

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“…127 Because of the lack of sinus node dysfunction in many pediatric ICD recipients, exercise stress testing can be used to determine how high the sinus rate might be to program the detection rate higher than that of sinus tachycardia. Botsch and colleagues 209 reported a relatively low incidence of inappropriate shocks (only 2 of 63 shocks in 11 of 33 pediatric patients) and attributed their success to the use of individual and specific drug therapy, ablation, and patient-specific programming of tachycardia detection and termination algorithms.…”

Section: Icd Eventsmentioning

confidence: 99%

Educational and Psychological Interventions to Improve Outcomes for Recipients of Implantable Cardioverter Defibrillators and Their Families

et al. 2012

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Abstract-Significant mortality benefits have been documented in recipients of implantable cardioverter defibrillators (ICDs); however, the psychosocial distress created by the underlying arrhythmia and its potential treatments in patients and family members may be underappreciated by clinical care teams. The disentanglement of cardiac disease and device-related concerns is difficult. The majority of ICD patients and families successfully adjust to the ICD, but optimal care pathways may require additional psychosocial attention to all ICD patients and particularly those experiencing psychosocial distress. This state-of-the-science report was developed on the basis of an analysis and critique of existing science to (1) describe the psychological and quality-of-life outcomes after receipt of an ICD and describe related factors, such as patient characteristics; (2) describe the concerns and educational/informational needs of ICD patients and their family members; (3) outline the evidence that supports interventions for improving educational and psychological outcomes for ICD patients; (4) provide recommendations for clinical approaches for improving patient outcomes; and (5) identify priorities for future research in this area. The ultimate goal of this statement is to improve the precision of identification and care of psychosocial distress in ICD patients to maximize the derived benefit of the ICD. (Circulation. 2012;126:2146-2172.)Key Words: AHA Scientific Statements Ⅲ anxiety Ⅲ depression Ⅲ implantable cardioverter defibrillator Ⅲ patient education Ⅲ patient outcomes assessment Ⅲ psychological responses Ⅲ quality of life F or patients who receive an implantable cardioverter defibrillator (ICD) for primary or secondary prevention of life-threatening ventricular arrhythmias, the initial experiences related to care for cardiac arrhythmias and ICD therapy are often dramatic. This is especially true if the index event is a sudden cardiac arrest (SCA). Additionally, many patientsThe American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on July 26, 2012. A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By Topic" link or the "By Publication Date" link. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@wolterskluwer.com.The American Heart Association requests that this document be cited as follows: Dunbar SB, Dougherty CM, Sears SF, Carroll DL, Goldstein NE, Mark DB, McDaniel G, Pressler SJ, Schron E, Wang P, Zeigler VL; on behalf of the American Heart As...

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Section: Icd Eventsmentioning

confidence: 99%

Educational and Psychological Interventions to Improve Outcomes for Recipients of Implantable Cardioverter Defibrillators and Their Families

et al. 2012

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“…13 The majority of the present patients had HCM, and the rate of IT was similar to that in a recently published systematic review and meta-analysis. 14 Some reports have noted an extremely low IT rate (3.1%), 15 but the authors advocate a combination of strategies for the prevention of IT: anti-arrhythmic drugs, ablation techniques, individual programming and the use of new-generation devices with supraventricular tachycardia discrimination algorithms.…”

Section: Discussionmentioning

confidence: 99%

“…In other studies the mortality rate was almost exactly the same (2.3%), 16 or higher (5%), 17,18 or even 9%. 15 The causes of death in this very young population can be device failure or lead problem. 20 The present fatal outcomes were caused by ventricular lead dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Fifteen years’ experience of implantable cardioverter defibrillator in children and young adults: Mortality and complications study

Lewandowski

Syska

Kowalik

et al. 2018

Pediatrics International

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“…The two largest reports of pediatric ICD therapy provide a global report of implant experience and clinical outcomes without specific report of systematic DFTs 4,5 . The adult DFT experience has well demonstrated that the testing strategy matters, 13 but the pediatric ICD series that have specifically reported DFTs have not typically specified the method used to assess defibrillation efficacy 11 , 14–19 . The notable exception is the retrospective report by Stefanelli et al, 20 which found a median DFT of 10 J in 27 subjects by use of the step‐down method.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 The adult DFT experience has well demonstrated that the testing strategy matters, 13 but the pediatric ICD series that have specifically reported DFTs have not typically specified the method used to assess defibrillation efficacy. 11,[14][15][16][17][18][19] The notable exception is the retrospective report by Stefanelli et al, 20 which found a median DFT of 10 J in 27 subjects by use of the step-down method. The current prospective trial used a binary search algorithm for measurement of defibrillation efficacy in a pediatric and congenital heart disease cohort.…”

Section: Defibrillation Energy Requirements In Young Icd Recipientsmentioning

confidence: 97%

Prospective Evaluation of Defibrillation Threshold and Postshock Rhythm in Young ICD Recipients

Radbill

Triedman

Berul

et al. 2012

Pacing Clinical Electrophis

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Background: Adaptation of implantable cardioverter defibrillator (ICD) systems to the needs of pediatric and congenital heart patients is problematic due to constraints of vascular and thoracic anatomy. An improved understanding of the defibrillation energy and postshock pacing requirements in such patients may help direct more tailored ICD therapy. We describe the first prospective evaluation of defibrillation threshold (DFT) and postshock rhythm in this population. Methods: We prospectively studied patients ≤60 kg at time of ICD intervention. DFTs were obtained using a binary search protocol with three VF inductions. Postshock pacing was programmed using a stepwise protocol, lowering the rate prior to each VF induction. Results: Twenty patients were enrolled: 11 had channelopathy, five congenital heart disease, and four cardiomyopathy. The median age was 16 years, median weight 48 kg. Twelve patients had a transvenous high‐voltage coil; eight had pericardial +/− subcutaneous coil(s). Median DFT was 7 J (range 3–31 J); 19/20 patients had DFT ≤15 J and all patients <25 kg had DFT ≤9 J (n = 6). There was no difference in DFT between patients with transvenous versus pericardial +/− subcutaneous coils (median 7 J vs 6 J, P = 0.59). No patient with normal atrioventricular conduction prior to defibrillation required postshock pacing (n = 16). There were no adverse events. Conclusions: These data suggest that many pediatric ICD patients have low DFTs and adequate postshock escape rhythm. This may help determine appropriate parameters for future design of pediatric‐specific ICDs. (PACE 2012;35:1487–1493)

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ICD Therapy in Children and Young Adults: Low Incidence of Inappropriate Shock Delivery

Abstract: In children and young adults receiving ICD therapy, the combination of strategies to prevent ventricular arrhythmias using specific drug therapy, ablation procedures, and individual programming with improved devices and leads causes a low incidence of inappropriate shock delivery.

Cited by 18 publications

References 26 publications

Educational and Psychological Interventions to Improve Outcomes for Recipients of Implantable Cardioverter Defibrillators and Their Families

Educational and Psychological Interventions to Improve Outcomes for Recipients of Implantable Cardioverter Defibrillators and Their Families

Fifteen years’ experience of implantable cardioverter defibrillator in children and young adults: Mortality and complications study

Prospective Evaluation of Defibrillation Threshold and Postshock Rhythm in Young ICD Recipients

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