Berul Charles I, Van Hare George F, Kertesz Naomi J, Dubin Anne M, Cecchin Frank, Collins Kathryn K, Cannon Bryan C, Alexander Mark E, Triedman John K, Walsh Edward P, Friedman Richard A
Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA.
J Am Coll Cardiol. 2008 Apr 29;51(17):1685-91. doi: 10.1016/j.jacc.2008.01.033.
We sought to determine the implications of implantable cardioverter-defibrillator (ICD) placement in children and patients with congenital heart disease (CHD).
There is increasing frequency of ICD use in pediatric and CHD patients. Until recently, prospective registry enrollment of ICD patients was not available, and children and CHD patients account for only a small percentage of ICD recipients. Therefore, we retrospectively obtained collaborative data from 4 pediatric centers, aiming to identify implant characteristics, shock frequency, and complications in this unique population.
Databases from 4 centers were collated in a blinded fashion. Demographic information, implant electrical parameters, appropriate and inappropriate shock data, and complications were recorded for all implants from 1992 to 2004.
A total of 443 patients were included, with a median age of 16 years (range 0 to 54 years) and median weight of 61 kg (range 2 to 130 kg), with 69% having structural heart disease. The most common diagnoses were tetralogy of Fallot (19%) and hypertrophic cardiomyopathy (14%). Implant indication was primary prevention in 52%. Shock data were available on 409 patients, of whom 105 (26%) received appropriate shocks (mean 4 shocks/patient, range 1 to 29 shocks/patient). Inappropriate shocks occurred in 87 of 409 patients (21%), with a mean of 6 per patient (range 1 to 60), mainly attributable to lead failure (14%), sinus or atrial tachycardias (9%), and/or oversensing (4%).
Children and CHD ICD recipients have significant appropriate and inappropriate shock frequencies. Optimizing programming, medical management, and compliance may diminish inappropriate shocks. Despite concerns regarding generator recalls, lead failure remains the major cause of inappropriate shocks, complications, and system malfunction in children. Prospective assessment of ICD usage in this population may identify additional important factors in pediatric and CHD patients.
我们试图确定植入式心脏复律除颤器（ICD）在儿童及先天性心脏病（CHD）患者中的应用情况。
ICD在儿科及CHD患者中的使用频率日益增加。直到最近，ICD患者的前瞻性登记入组才得以实现，而儿童和CHD患者在ICD接受者中仅占一小部分。因此，我们回顾性地从4个儿科中心获取了协作数据，旨在确定这一特殊人群的植入特征、电击频率及并发症情况。
对4个中心的数据库进行盲态整理。记录了1992年至2004年所有植入患者的人口统计学信息、植入电参数、恰当和不恰当电击数据以及并发症情况。
共纳入443例患者，中位年龄16岁（范围0至54岁），中位体重61 kg（范围2至130 kg），69%患有结构性心脏病。最常见的诊断为法洛四联症（19%）和肥厚型心肌病（14%）。植入指征为一级预防的占52%。409例患者有电击数据，其中105例（26%）接受了恰当电击（平均每位患者4次电击，范围1至29次电击/患者）。409例患者中有87例（21%）发生了不恰当电击，平均每位患者6次（范围1至60次），主要归因于导线故障（14%）、窦性或房性心动过速（9%）和/或感知过度（4%）。
儿童及CHD患者接受ICD治疗时，恰当和不恰当电击频率均较高。优化程控、药物治疗及依从性可能会减少不恰当电击。尽管对发生器召回存在担忧，但导线故障仍是儿童不恰当电击、并发症及系统故障的主要原因。对该人群ICD使用情况的前瞻性评估可能会发现儿科及CHD患者中的其他重要因素。
