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Implantable cardioverter-defibrillators in children: a single-institutional experience
W R Wilson1, G E Greer, B P Grubb
1Division of Pediatric Cardiac Surgery, Medical College of Ohio, Toledo, USA. william_wilson@surgery.missouri.edu
Insights
Implantable cardioverter-defibrillators (ICDs) are safe for children experiencing sudden cardiac arrest or syncope from ventricular arrhythmias. Transvenous lead placement is associated with fewer complications and shorter hospital stays.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
- Medical Devices
Background:
- Implantable cardioverter-defibrillators (ICDs) are rarely used in pediatric patients for ventricular arrhythmias.
- Sudden death and syncope due to refractory ventricular arrhythmias are indications for ICD implantation.
Purpose of the Study:
- To evaluate the safety and efficacy of ICDs in pediatric patients.
- To compare outcomes between epicardial and transvenous lead placement in children.
Main Methods:
- Retrospective review of 5 pediatric patients who received ICDs.
- Analysis of underlying cardiac conditions, implantation techniques, and clinical outcomes.
- Follow-up at a mean of 34 months.
Main Results:
- No mortality was observed in the 5 pediatric patients.
- Four out of five patients (80%) received appropriate shocks during follow-up.
- Open thoracotomy for epicardial lead placement was associated with higher complication rates.
Conclusions:
- ICDs are a safe and effective therapy for pediatric patients with life-threatening ventricular arrhythmias.
- Transvenous lead placement in pediatric ICD recipients is linked to reduced morbidity and shorter hospital stays.
Background:
Implantable cardioverter-defibrillators have been infrequently used in children as therapy for resuscitated sudden death and syncope due to ventricular arrhythmias unresponsive to antiarrhythmics.
Methods:
The medical records of 5 children with implantable cardioverter-defibrillators were retrospectively reviewed. All patients had experienced syncope and 3 (60%) an out-of-hospital cardiac arrest. Underlying pathology included hypertrophic cardiomyopathy in 2, long QT syndrome in 2, and ventricular arrhythmia after remote repair of congenital heart disease in 1. Open thoracotomy with epicardial lead placement and transvenous endocardial approaches were used.
Results:
There was no early or late mortality in the 5 pediatric patients undergoing implantable cardioverter-defibrillator placement. Postoperative complications occurred more frequently when open thoracotomy was used for placement. At mean follow-up of 34 months, 4 of the 5 (80%) have received shocks.
Conclusions:
Implantable cardioverter-defibrillator is a safe and reliable therapy for children with resuscitated sudden death and syncope due to ventricular tachycardia unresponsive to antiarrhythmics. Transvenous lead placement lowers morbidity and hospital length of stay.