Midterm Results of Implantable Cardioverter Defibrillators in Children and Young Adults from a Single Center in Turkey

Aykan, Hayrettin Hakan; Karagöz, Tevfik; Güleç, Mustafa; Ertuğrul, İlker; Aypar, Ebru; Özer, Sema; Alehan, Dursun; Çeliker, Alpay; Özkutlu, Süheyla

doi:10.1111/pace.12954

Cited by 8 publications

(4 citation statements)

References 44 publications

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“…Similarly, complications (17–39%) and IASs (20–30%) in children with transvenous-ICD are much more frequent than in adults. 1 , 19 , 20 Procedural complications and IASs seem to be less with the S-ICD, but a direct comparison with transvenous-ICD has not been made. In addition, the follow-up period of most patients with S-ICD is shorter than with transvenous-ICD.…”

Section: Discussionmentioning

confidence: 99%

The SIDECAR project: S-IcD registry in European paediatriC and young Adult patients with congenital heaRt defects

et al. 2022

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Aims Subcutaneous-implantable cardiac defibrillators (S-ICDs) are used increasingly to prevent sudden cardiac death in young patients. This study was set up to gain insight in the indications for S-ICD, possible complications, and their predictors and follow-up results. Methods and results A multicentre, observational, retrospective, non-randomized, standard-of-care registry on S-ICD outcome in young patients with congenital heart diseases (CHDs), inherited arrhythmias (IAs), idiopathic ventricular fibrillation (IVF), and cardiomyopathies (CMPs). Anthropometry was registered as well as implantation technique, mid-term device-related complications, and incidence of appropriate/inappropriate shocks (IASs). Data are reported as median (interquartile range) or mean ± standard deviation. Eighty-one patients (47% CMPs, 20% CHD, 21% IVF, and 12% IA), aged 15 (14–17) years, with body mass index (BMI) 21.8 ± 3.8 kg/m2, underwent S-ICD implantation (primary prevention in 59%). This was performed with two-incision technique in 81% and with a subcutaneous pocket in 59%. Shock and conditional zones were programmed at 250 (200–250) and 210 (180–240) b.p.m., respectively. No intraoperative complications occurred. Follow up was 19 (6–35) months: no defibrillation failure occurred, 17% of patients received appropriate shocks, 13% of patients received IAS (supraventricular tachycardias 40%, T-wave oversensing 40%, and non-cardiac oversensing 20%). Reprogramming, proper drug therapy, and surgical revision avoided further IAS. Complications requiring surgical revision occurred in 9% of patients, with higher risks in patients with three-incision procedures [hazard ratio (HR) 4.3, 95% confidence interval (95% CI) 0.5–34, P = 0.038] and BMI < 20 (HR 5.1, 95% CI 1–24, P = 0.031). Conclusion This multicentre European paediatric registry showed good S-ICD efficacy and safety in young patients. Newer implantation techniques and BMI > 20 showed better outcome.

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Section: Discussionmentioning

confidence: 99%

The SIDECAR project: S-IcD registry in European paediatriC and young Adult patients with congenital heaRt defects

et al. 2022

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“…The ICDs implanted were transvenous systems (42%), epicardial + subcutaneous coil systems (23%), and S-ICDs (35%). The overall results showed that 28% experienced appropriate shocks, 20% experienced inappropriate shocks, and 23% experienced complications (including 5% with infections) after a follow-up period of 4-5 years [8,10,[12][13][14][24][25][26][27][28].…”

Section: Discussionmentioning

confidence: 99%

ICD Outcome in Pediatric Cardiomyopathies

Silvetti

Tamburri

Campisi

et al. 2022

JCDD

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Background: Pediatric patients with cardiomyopathies are at risk of malignant arrhythmias and sudden cardiac death (SCD). An ICD may prevent SCD. The aim of this study was to evaluate ICD implantation outcomes, and to compare transvenous and subcutaneous ICDs (S-ICDs) implanted in pediatric patients with cardiomyopathies. Methods: The study is single center and retrospective, and includes pediatric patients with cardiomyopathies who required ICD implantation (2010–2021). Outcomes were recorded for appropriate/inappropriate ICD therapy and surgical complications. Transvenous ICD and S-ICD were compared. Data are presented as median values (25th–75th centiles). Results: Forty-four patients with cardiomyopathies (hypertrophic 39%, arrhythmogenic 32%, dilated 27%, and restrictive 2%) underwent transvenous (52%) and S-ICD (48%) implantation at 14 (12–17) years of age, mostly for primary prevention (73%). The follow-up period was 29 (14–60) months. Appropriate ICD therapies were delivered in 25% of patients, without defibrillation failures. Lower age at implantation and secondary prevention were significant risk factors for malignant ventricular arrhythmias that required appropriate ICD therapies. ICD-related complications were surgical complications (18%) and inappropriate shocks (7%). No significant differences in outcomes were recorded, either when comparing transvenous and S-ICD or comparing the different cardiomyopathies. Conclusions: In pediatric patients with cardiomyopathy, ICD therapy is effective, with a low rate of inappropriate shocks. Neither ICD type (transvenous and S-ICDs) nor the cardiomyopathies subgroup revealed divergent outcomes.

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“…In larger adult studies, the rate of IS has been reported to range from 10% to 15%. 16,25,27 However, most studies of ICD use in pediatric and CHD patients have found rates of IS to be between 20% and 30% in these patient populations, 10,11,13,14,[34][35][36][37][38][39][40] with some studies observing IS in up to 40% to 50% of patients and, in some instances, with inappropriate shocks being more frequent than appropriate shocks. 12,19,41,42 This is likely a result of a more active lifestyle, faster rates of sinus tachycardia, longer duration of implantation, smaller patient size, and a higher rate of device and lead complications relative to adult patients.…”

Section: Device Therapymentioning

confidence: 99%

“…Most studies have found that at least 40%, and up to 100%, of patients are on antiarrhythmic medications, primarily b-blockers. 10,13,[39][40][41][47][48][49] This may be a reflection of the different substrates present in the pediatric and CHD population, particularly channelopathy patients, in whom b-blockers are a mainstay of treatment. The use of antiarrhythmic medication has not been conclusively demonstrated to reduce the level of shock burden in this population, despite the common practice of altering medical management in patients who receive shocks.…”

Section: Non-device-based Interventionsmentioning

confidence: 99%

Inappropriate ICD Shocks in Pediatric and Congenital Heart Disease Patients

Garnreiter

2017

J Innov Cardiac Rhythm Manage

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ABSTRACT. Although implantable cardioverter-defibrillators (ICDs) have proven to be life-saving devices, there are frequent complications associated with their use, especially in the pediatric and congenital heart disease populations. Inappropriate shocks are a particularly frequent complication in these groups. This review discusses the causes and implications of inappropriate ICD shocks, and presents potential interventions that may assist in safely reducing the rates of inappropriate shocks in pediatric and congenital heart disease patients with ICDs.

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Midterm Results of Implantable Cardioverter Defibrillators in Children and Young Adults from a Single Center in Turkey

Abstract: Although lead integrity problems, inappropriate shocks, and infections are significant issues, ICD therapy appears to be a safe, effective, and necessary option for the prevention of SCD in both children and young adults.

Cited by 8 publications

References 44 publications

The SIDECAR project: S-IcD registry in European paediatriC and young Adult patients with congenital heaRt defects

The SIDECAR project: S-IcD registry in European paediatriC and young Adult patients with congenital heaRt defects

ICD Outcome in Pediatric Cardiomyopathies

Inappropriate ICD Shocks in Pediatric and Congenital Heart Disease Patients

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