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A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation
Published on: February 28, 2012
Implantable cardioverter defibrillator implantation in children in The Netherlands
A Derk Jan Ten Harkel1, Nico A Blom, Annette G Reimer
1Department of Paediatric Cardiology, Erasmus MC-Sophia, Dr. Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands. A.Tenharkel@erasmusmc.nl
Insights
Implantable cardioverter-defibrillators (ICDs) are safe for children, offering good outcomes. However, inappropriate shocks remain a significant concern requiring careful management.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
- Medical Devices
Background:
- Implantable cardioverter-defibrillators (ICDs) are crucial for managing life-threatening arrhythmias in pediatric patients.
- Understanding the safety, efficacy, and complications of ICD implantation in this population is essential for optimizing patient care.
Purpose of the Study:
- To evaluate the indications, underlying cardiac disorders, efficacy, and complications of ICD implantation in pediatric patients.
- To assess the safety and medium-term outcomes of ICDs in children and adolescents.
Main Methods:
- Retrospective review of medical records for pediatric patients (≤18 years) who underwent ICD implantation between January 1995 and September 2002 in The Netherlands.
- Analysis of implantation indications, cardiac conditions, device placement, and patient outcomes, including shock events and mortality.
Main Results:
- 23 pediatric patients received ICDs for aborted sudden cardiac death, syncope, or primary prevention.
- Underlying conditions included electrical diseases, cardiomyopathies, and congenital heart defects.
- No early mortality was observed; median follow-up was 29 months.
- Inappropriate shocks occurred in 7 patients, while appropriate shocks occurred in 5 patients. One patient died due to intractable arrhythmias.
Conclusions:
- Pediatric ICD implantation is a safe procedure with favorable medium-term results.
- A significant number of inappropriate shocks represent the primary complication, necessitating further research and improved device programming.
Unlabelled:
To evaluate the indications, underlying cardiac disorders, efficacy and complications involved with implantable cardioverter-defibrillators (ICDs) in paediatric patients in The Netherlands, the records of all patients aged 18 years or younger who underwent ICD placement were reviewed retrospectively. Between January 1995 and September 2002, 23 patients (11 males, 12 females; median age 12 years, range 6 months to 16 years) underwent ICD implantation. The ICD was implanted for aborted sudden cardiac death ( n = 14), syncope ( n = 5) or for primary prevention of sudden cardiac death ( n = 4). Underlying cardiac disorders were electrical diseases ( n = 16), hypertrophic or dilated cardiomyopathy ( n = 4) and congenital cardiac malformations ( n = 3). Five patients had an epicardially placed ICD, while 18 underwent a transvenous approach. The generator was placed in an abdominal position in eight patients, whereas it was placed in the subpectoral region in 15. There was no early mortality. Median hospital stay was 5 days (range 2-30 days). Median follow-up time was 29 months (range 1 month to 7 years). Seven patients experienced an inappropriate shock after a median period of 7 months; five patients an appropriate shock after a median period of 3 months. The reasons for inappropriate shock were supraventricular tachycardia ( n = 1), sinus tachycardia ( n = 4) or T-wave sensing (n = 2). One patient with malignant long QT syndrome died of intractable arrhythmias and irreversible cardiomyopathy. Generator replacement was necessary in four patients after 28, 44, 51 and 54 months respectively.
Conclusion:
Implantable cardioverter-defibrillator implantation in paediatric patients is a safe procedure with a good medium-term outcome. The most serious problem is the occurrence of a significant number of inappropriate shocks.
