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Outcomes of Pediatric Patients With Defibrillators Following Initial Presentation With Sudden Cardiac Arrest
Jeffrey A Robinson1,2, Martin J LaPage3, Joseph Atallah4
1The Heart Institute (J.A.R., D.S.S., R.J.C.), Cincinnati Children's Hospital Medical Center, OH.
Insights
Pediatric patients receiving an implantable cardioverter defibrillator (ICD) after sudden cardiac arrest (SCA) face a high risk of future device therapy. This risk persists regardless of underlying disease or diagnosis status, underscoring the need for secondary prophylaxis.
Area of Science:
- Cardiology
- Pediatric Electrophysiology
- Sudden Cardiac Arrest Research
Background:
- Implantable cardioverter defibrillators (ICDs) are crucial for secondary prevention in sudden cardiac arrest (SCA) survivors.
- Outcomes and risk factors for appropriate ICD shocks in pediatric SCA patients are not well-defined.
- This study addresses the need for clarity on pediatric ICD recipients post-SCA.
Purpose of the Study:
- To evaluate the outcomes of pediatric patients who received an ICD after SCA.
- To assess the future risk of appropriate shocks and identify associated characteristics.
- To determine factors influencing appropriate ICD therapy during follow-up.
Main Methods:
- A multicenter retrospective analysis was conducted on pediatric patients (age ≤21 years) with no prior cardiac disease who received an ICD post-SCA.
- Data collected included patient/device characteristics, cardiac function, underlying diagnoses, and SCA event details.
- Outcomes, complications, and device therapies were analyzed.
Main Results:
- 106 pediatric patients were analyzed; 19% received appropriate shocks and 15% inappropriate shocks over a median 3-year follow-up.
- Monomorphic ventricular tachycardia and family history of sudden death were associated with freedom from appropriate shock.
- Younger age and positive exercise test predicted appropriate shock in patients >2 years post-implantation.
Conclusions:
- Pediatric patients receiving an ICD after SCA have a high risk of future device therapy, irrespective of underlying disease.
- A lack of definitive diagnosis post-SCA does not reduce the risk of subsequent events.
- Secondary prophylaxis is essential for pediatric SCA survivors receiving an ICD.
Background:
Implantable cardioverter defibrillators (ICD) are recommended for secondary prevention after sudden cardiac arrest (SCA). The outcomes of pediatric patients receiving an ICD after SCA remain unclear. The objective of this study is to evaluate outcomes, future risk for appropriate shocks, and identify characteristics associated with appropriate ICD therapy during follow-up.
Methods:
Multicenter retrospective analysis of patients (age ≤21 years) without prior cardiac disease who received an ICD following SCA. Patient/device characteristics, cardiac function, and underlying diagnoses were collected, along with SCA event characteristics. Patient outcomes including complications and device therapies were analyzed.
Results:
In total, 106 patients were included, median age 14.7 years. Twenty (19%) received appropriate shocks and 16 (15%) received inappropriate shocks (median follow-up 3 years). First-degree relative with SCA was associated with appropriate shocks (P<0.05). In total, 40% patients were considered idiopathic. Channelopathy was the most frequent late diagnosis not made at time of presentation. Neither underlying diagnosis nor idiopathic status was associated with increased incidence of appropriate shock. Monomorphic ventricular tachycardia (hazard ratio, 4.6 [1.2-17.3]) and family history of sudden death (hazard ratio, 6.5 [1.4-29.8]) were associated with freedom from appropriate shock in a multivariable model (area under the receiver operating characteristic curve, 0.8). Time from diagnoses to evaluation demonstrated a nonlinear association with freedom from appropriate shock (P=0.015). In patients >2 years from implantation, younger age (P=0.02) and positive exercise test (P=0.04) were associated with appropriate shock.
Conclusions:
The risk of future device therapy is high in pediatric patients receiving an ICD after SCA, irrelevant of underlying disease. Lack of a definitive diagnosis after SCA was not associated with lower risk of subsequent events and does not obviate the need for secondary prophylaxis.
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