Eicken Andreas, Kolb Christof, Lange Sylvia, Brodherr-Heberlein Silke, Zrenner Bernhard, Schreiber Christian, Hess John
Department of Pediatric Cardiology and Congenital Heart Disease, Deutsches Herzzentrum München, Lazarettstr. 36, D-80636 München, Germany.
Int J Cardiol. 2006 Feb 8;107(1):30-5. doi: 10.1016/j.ijcard.2005.02.048.
Implantable cardioverter defibrillators (ICD) proved to be effective in the prevention of sudden cardiac death in adults. In children, the experience of ICD therapy is limited. This retrospective study was undertaken to review our experience with ICD implantation in children with special consideration of psychosocial impact of this therapy.
Sixteen children (f:5, m:11, median age 12.2 years, range 4-15.9 years) received an ICD. Eleven patients had survived sudden cardiac death with documented ventricular fibrillation (VF) and five patients had sustained ventricular tachycardia (VT) with hemodynamic significance. The underlying heart disease was congenital in 5, hypertrophic cardiomyopathy in 2, myocarditis in 2 and primary electrical in 7 patients. All leads were implanted transvenously. Mean follow up was 43.1 months (range 1-105 months). All patients are alive. In 7 patients, a total of 387 sustained VT episodes were detected by the ICD. At follow-up, 10 inappropriate shocks were delivered in four patients. One early and six late lead revisions were done in seven patients. 12/16 (75%) patients had concomitant antiarrhythmic drug therapy. About half of the adolescents showed signs of depression and/or anxiety.
ICD therapy via transvenous access for prevention of sudden cardiac death is feasible and effective even in small children. However, the occurrence of lead complications is significant. Since about half of the adolescents showed signs of depression and/or anxiety, professional psychological surveillance should be considered in these patients.
植入式心脏复律除颤器（ICD）已被证明在预防成人心脏性猝死方面有效。在儿童中，ICD治疗的经验有限。本回顾性研究旨在回顾我们在儿童中植入ICD的经验，并特别考虑这种治疗的社会心理影响。
16名儿童（女5名，男11名，中位年龄12.2岁，范围4 - 15.9岁）接受了ICD植入。11例患者心脏性猝死存活，记录有室颤（VF），5例患者有具有血流动力学意义的持续性室性心动过速（VT）。潜在心脏病为先天性5例，肥厚型心肌病2例，心肌炎2例，原发性心电疾病7例。所有导线均经静脉植入。平均随访43.1个月（范围1 - 105个月）。所有患者均存活。7例患者中，ICD共检测到387次持续性VT发作。随访时，4例患者发生了10次不适当电击。7例患者进行了1次早期和6次晚期导线修正。16例患者中有12例（75%）同时接受抗心律失常药物治疗。约一半的青少年表现出抑郁和/或焦虑迹象。
即使在小儿中，经静脉途径进行ICD治疗预防心脏性猝死也是可行且有效的。然而，导线并发症的发生率较高。由于约一半的青少年表现出抑郁和/或焦虑迹象，这些患者应考虑进行专业的心理监测。
