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A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation
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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

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Implantable cardioverter defibrillator therapy in paediatric patients for primary vs. secondary prevention

Jani Thuraiaiyah1, Berit Thornvig Philbert1, Annette Schophuus Jensen1

  • 1Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Inge Lehmanns Vej 7, 2100 Copenhagen, Denmark.

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|September 30, 2024
PubMed

Insights

Pediatric patients receiving implantable cardioverter-defibrillators (ICDs) have high rates of appropriate therapy and complications, regardless of whether the ICD is for primary or secondary prevention. These outcomes were similar between the two prevention groups in this study.

Area of Science:

  • Pediatric Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Implantable cardioverter-defibrillators (ICDs) are crucial for managing life-threatening arrhythmias in children, but decisions regarding their implantation are complex due to longer life expectancy and complication risks.
  • While secondary prevention indications for ICDs are well-established, primary prevention requires careful risk-benefit evaluation considering sudden cardiac death versus device-related complications.
  • Young patients stand to gain the most years of life from ICDs, underscoring the importance of understanding outcomes in this population.

Purpose of the Study:

  • To compare the outcomes of pediatric patients who received an ICD for primary versus secondary prevention of sudden cardiac death.
  • To analyze complication rates, appropriate therapy, and mortality in children with ICDs.

Main Methods:

  • A retrospective nationwide cohort study analyzed data from the Danish ICD registry for patients aged 15 years or younger at ICD implantation between 1982 and 2021.
  • Data on demographics, complications (infections, lead failure, re-operation, arrhythmia-related mortality), and mortality were extracted from medical records.
  • The primary endpoint was the first occurrence of appropriate therapy (shock or anti-tachycardia pacing) for ventricular tachycardia or fibrillation.

Main Results:

  • Of 72 pediatric patients, 23 received ICDs for primary prevention and 49 for secondary prevention, with a median follow-up of 9.0 years.
  • The 10-year cumulative incidence of appropriate therapy was 70%, with complication rates at 41% and inappropriate therapy rates at 15%.
  • No significant differences in appropriate therapy, complications, or mortality were observed between the primary and secondary prevention groups.

Conclusions:

  • In children, ICDs are more commonly implanted for secondary prevention (two-thirds of cases).
  • Pediatric patients experience higher rates of appropriate therapy and complications compared to adults, though inappropriate therapy rates remain low.
  • Outcomes for ICD implantation in children appear similar for both primary and secondary prevention indications.
Abstract

Keywords:
Appropriate therapyCongenital heart diseaseImplantable cardioverter defibrillatorPaediatric cardiologySudden cardiac death

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