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Use of implantable cardioverter-defibrillators in pediatric patients
1Mattel Children's Hospital at University of California-Los Angeles, Los Angeles, California, USA. kshannon@mednet.ucla.edu
Insights
Automatic implantable cardioverter-defibrillators (ICDs) show promise for preventing sudden cardiac death in children, similar to adults. However, more research is needed to confirm safety and efficacy in pediatric populations.
Area of Science:
- Cardiology
- Pediatric Electrophysiology
- Medical Device Technology
Background:
- Automatic implantable cardioverter-defibrillators (ICDs) are widely used for sudden cardiac death prevention in adults.
- Increasing use in pediatric patients is based on adult data, with limited pediatric-specific evidence.
- Retrospective studies suggest similar mortality reduction in children but a higher complication rate.
Purpose of the Study:
- To review the current evidence on ICD use in pediatric patients.
- To identify gaps in knowledge regarding safety, efficacy, and optimal programming in children.
- To highlight the need for prospective trials in pediatric populations.
Main Methods:
- Review of existing retrospective studies and literature on pediatric ICD implantation.
- Analysis of data regarding indications, outcomes, and complications in children.
- Synthesis of findings to assess the current state of evidence.
Main Results:
- Pediatric ICD use is growing, with retrospective data indicating potential for mortality reduction comparable to adults.
- Complication rates appear slightly higher in pediatric patients compared to adults.
- Existing data are limited by small sample sizes and short follow-up periods.
Conclusions:
- While retrospective data are encouraging, prospective trials are essential to establish definitive safety and efficacy of ICDs in children.
- Further research should investigate the impact of implant technique, patient growth, and device programming on pediatric outcomes.
- Evidence-based guidelines for pediatric ICD implantation and management are needed.
Abstract:
Automatic implantable cardioverter-defibrillator use has become widespread in the prevention of sudden death in at-risk populations. The compelling safety and efficacy data in numerous large, blinded trials on adult patients have led to increasing use of these devices in pediatric patients. Although there are no prospective data to support device therapy in pediatric patients, several large, retrospective studies suggest that pediatric patients are likely to enjoy the same reduction in mortality as adult patients, with a slightly higher rate of complications from the device implant. Data on the use of these devices in pediatric patients for several different indications exist but are limited to retrospective reviews with small numbers and short follow-up. Large prospective trials are needed to assess the safety and efficacy of these devices in children and the influence of implant technique, patient growth, and programmed parameters on overall outcome.