Heersche Jogien H M, Blom Nico A, van de Heuvel Freek, Blank Christiaan, Reimer Annette G, Clur Sally-Ann, Witsenburg Maarten, ten Harkel A Derk Jan
Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Pacing Clin Electrophysiol. 2010 Feb;33(2):179-85. doi: 10.1111/j.1540-8159.2009.02603.x. Epub 2009 Dec 15.
Implantable cardioverter defibrillator (ICD) therapy is increasingly used in children. The purpose of this multicenter study is to evaluate mid-term clinical outcome and to identify predictors for device discharge in pediatric ICD recipients.
From 1995 to 2006, 45 patients in The Netherlands under the age of 18 years received an ICD. Mean age at implantation was 10.8 +/- 5.2 years. Primary prevention (N = 22) and secondary prevention (N = 23) were equally distributed. Underlying cardiac disorders were primary electrical disease (55%), cardiomyopathy (20%), and congenital heart disease (17%). The follow-up was 44 +/- 32.9 months. Three patients (7%) died and one patient (2%) underwent heart transplantation. ICD-related complications occurred in eight patients (17%), seven of whom had lead-related complications. Fourteen patients (31%) received appropriate ICD shocks; 12 patients (27%) received inappropriate ICD shocks. Fifty-five percent of 22 ICD recipients under the age of 12 years received appropriate shocks, which was higher as compared with 9% of 23 older ICD recipients (P = 0.003). Although the incidence of appropriate shocks in the present study was larger in secondary prevention (9/23; 39%) as compared with primary prevention (5/22; 23%), this difference did not reach significance.
In our population of patients, children <12 years of age had more appropriate shocks than patients 13-18 years. The complication rate is low, and is mainly lead related.
植入式心脏复律除颤器（ICD）治疗在儿童中的应用越来越广泛。这项多中心研究的目的是评估中期临床结果，并确定小儿ICD植入患者装置放电的预测因素。
1995年至2006年，荷兰45名18岁以下患者接受了ICD植入。植入时的平均年龄为10.8±5.2岁。一级预防（N = 22）和二级预防（N = 23）分布均衡。潜在的心脏疾病包括原发性心电疾病（55%）、心肌病（20%）和先天性心脏病（17%）。随访时间为44±32.9个月。3名患者（7%）死亡，1名患者（2%）接受了心脏移植。8名患者（17%）发生了与ICD相关的并发症，其中7名有导线相关并发症。14名患者（31%）接受了适当的ICD电击；12名患者（27%）接受了不适当的ICD电击。22名12岁以下的ICD植入患者中有55%接受了适当的电击，这一比例高于23名年龄较大的ICD植入患者中的9%（P = 0.003）。尽管本研究中二级预防（9/23；39%）中适当电击的发生率高于一级预防（5/22；23%），但这一差异无统计学意义。
在我们的患者群体中，12岁以下儿童比13 - 18岁患者接受了更多适当的电击。并发症发生率较低，且主要与导线相关。
