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Published on: July 18, 2014
Implantable Cardioverter Defibrillator Outcomes in Pediatric and Congenital Heart Disease: Time to System Revision
Brynn E Dechert1, David J Bradley1, Gerald A Serwer1
1Department of Pediatrics and Communicable Diseases, Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Michigan.
Insights
Implantable cardioverter defibrillators (ICDs) require frequent system revisions in pediatric patients with congenital heart disease (CHD). These revisions occur at a rate similar to appropriate ICD therapy, emphasizing the need for careful implantation and longer-lasting devices.
Area of Science:
- Cardiology
- Biomedical Engineering
- Pediatric Electrophysiology
Background:
- Implantable cardioverter defibrillators (ICDs) are crucial for preventing sudden cardiac death.
- However, ICDs carry inherent risks of morbidity, especially in pediatric populations.
- Congenital heart disease (CHD) presents unique challenges for device management.
Purpose of the Study:
- To evaluate the outcomes of ICD implantation in a pediatric and CHD population.
- To determine the rate and reasons for ICD system revisions in this cohort.
- To compare the timing of system revisions with appropriate ICD therapy.
Main Methods:
- Retrospective cohort study of 131 patients (57 with CHD) with 191 ICD systems.
- Follow-up occurred at a single congenital heart center from 2005-2013.
- Primary outcome was ICD system revision, excluding routine battery changes.
Main Results:
- 33% of patients required 60 ICD system revisions over 850 patient-years.
- The revision rate was 70 per 1,000 patient-years, including lead issues and full system revisions.
- Time to system revision was similar to time to appropriate shock and influenced by recalled lead performance.
Conclusions:
- High rates of ICD system revision are observed in pediatric and CHD patients.
- Revision rates are comparable to the incidence of appropriate ICD therapy.
- Judicious implant criteria and enhanced device longevity are critical for this population.
Background:
Implantable cardioverter defibrillators (ICDs) are intended to prevent sudden cardiac death yet also impose a risk of morbidity. This study describes the outcomes of ICDs in a pediatric and congenital heart disease (CHD) population from a single center.
Methods:
Retrospective cohort study of all patients with an ICD followed at the University of Michigan Congenital Heart Center from 2005-2013. The primary outcome was ICD system revision for any reason excluding routine generator change for battery depletion.
Results:
There were 191 ICD systems in 131 patients, including 57 with CHD, 24 with hypertrophic cardiomyopathy, and 45 with structurally normal hearts. Median age was 16 years at initial implant. Total follow-up was 850 patient-years; median 4.9 years/patient. There were 43 (33%) patients who required 60 ICD revisions; 70 revisions/1,000 patient-years of follow-up. Revisions included 25 lead extractions with replacement, 21 lead additions, five lead repositions, and four full system revisions. Kaplan-Meier (K-M) median time to appropriate shock was similar to the median time to system revision. K-M time to system revision was significantly affected by recalled lead performance.
Conclusions:
The need for ICD system revision is high in this pediatric and CHD population and occurs at a rate similar to the rate of receiving appropriate therapy. These results highlight the need for judicious implant criteria and improved device longevity.
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