Implantable Cardioverter-Defibrillators in Children: A 14-Year Population-Based Study

Area of Science:

• Pediatric Cardiology
• Medical Device Technology
• Electrophysiology

Background:

• Implantable cardioverter-defibrillator (ICD) therapy in children, particularly for primary prevention, has limited data, especially from less affluent regions.
• The increasing adoption of fully subcutaneous (S-ICD) and extravascular (EV-ICD) systems necessitates analysis of their use in pediatric populations.

Purpose of the Study:

• To analyze the epidemiology, indications, complications, and outcomes of pediatric ICD recipients at a tertiary center.
• To evaluate the safety and efficacy of different ICD system types in children.
• To assess the challenges in primary prevention risk stratification for pediatric ICD implantation.

Main Methods:

• A retrospective, population-based, nationwide, single-center study analyzing medical records from 2012 to 2025.
• Inclusion of patients aged 0-18 years who underwent ICD implantation.
• Kaplan-Meier analyses for shock-free and mortality endpoints.

Main Results:

• Forty-nine pediatric patients were included, with an estimated national incidence of 1 ICD implantation per 22,000 live births.
• ICDs were primarily for secondary prevention (80%), with Long QT syndrome and hypertrophic cardiomyopathy as common diagnoses.
• Appropriate shocks occurred in 27% of secondary prevention patients; no appropriate therapies were seen in primary prevention despite higher mortality. Inappropriate shocks affected 22%, and major device complications occurred in 17%.

Conclusions:

• Pediatric ICD therapy is associated with significant device-related morbidity and challenges in primary prevention risk stratification.
• Emerging S-ICD and EV-ICD systems show promise as less invasive alternatives for selected pediatric patients.
• Further research is needed to optimize ICD therapy and risk stratification in pediatric populations.