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Sudden death prior to pediatric heart transplantation: would implantable defibrillators improve outcome?

Edward K Rhee1, Charles E Canter, Susan Basile

  • 1Division of Pediatric Cardiology, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri 63110, USA. rhee_e@kids.wustl.edu

The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation
|April 24, 2007
PubMed

Insights

Sudden cardiac death is uncommon in children awaiting heart transplants. However, those with ischemic cardiomyopathy face a higher risk, suggesting potential benefit from implantable cardioverter-defibrillators (ICDs).

Area of Science:

  • Pediatric Cardiology
  • Cardiovascular Research
  • Transplantation Medicine

Background:

  • Implantable cardioverter-defibrillator (ICD) therapy has demonstrated survival benefits in adults with cardiomyopathy.
  • The incidence of sudden death in pediatric cardiomyopathy patients is not well-established.
  • Understanding sudden death risk is crucial for evaluating ICD efficacy in children.

Purpose of the Study:

  • To determine the incidence of sudden cardiac death (SCD) in children with cardiomyopathy before heart transplantation.
  • To identify risk factors associated with SCD in this pediatric population.
  • To inform decisions regarding primary prevention strategies for SCD in pediatric heart transplant candidates.

Main Methods:

  • Retrospective analysis of the Pediatric Heart Transplant Study (PHTS) database.
  • Inclusion of patients aged 18 years or younger who died after listing for heart transplantation but before the procedure.
  • Focus on patients experiencing sudden or arrhythmic death, with examination of clinical and demographic variables.

Main Results:

  • Out of 2,392 patients, 420 (17.6%) died pre-transplant; only 32 (1.3%) deaths were sudden or arrhythmic.
  • Patients with ischemic cardiomyopathy exhibited a significantly increased risk of sudden death (relative risk = 6.92).
  • Congenital heart disease and UNOS status at listing were not linked to increased sudden death risk.

Conclusions:

  • The overall incidence of sudden death in children awaiting heart transplantation is low.
  • Widespread ICD implantation for primary prevention is unlikely to improve survival in the general pediatric population.
  • Children with ischemic cardiomyopathy represent a subgroup with higher sudden death risk who may benefit from ICD therapy.
Abstract

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