Implantable cardioverter defibrillator therapy for prevention of sudden cardiac death in children in the Netherlands.

INTRODUCTION

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.

METHODS AND RESULTS

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.

CONCLUSIONS

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.