Botsch Micha P, Franzbach Birgit, Opgen-Rhein Bernd, Berger Felix, Will Joachim C
Department of Pediatric Cardiology and Congenital Heart Disease, Charité Universitaetsmedizin, Berlin, Germany.
Pacing Clin Electrophysiol. 2010 Jun 1;33(6):734-41. doi: 10.1111/j.1540-8159.2010.02695.x. Epub 2010 Feb 8.
Implantable cardioverter defibrillator (ICD) therapy of life-threatening arrhythmias in pediatric patients is feasible; however, recent studies report a high incidence of inappropriate shock deliveries.
The data of all recipients of an ICD at the Charité, Department of Pediatric Cardiology, between January 2001 and November 2007 were retrospectively analyzed regarding underlying cardiac disorders, arrhythmias, medication, ablation procedures, leads and devices, programming, and ICD therapies.
A total of 33 patients underwent ICD implantation, with a median age of 16.5 years (range 8-36 years) and a mean weight of 61 +/- 20.9 kg. Underlying cardiac disorders were electrical heart disease (27%), cardiomyopathy (30%), congenital heart disease (33%), and others (9%). Eighty-five percent received antiarrhythmic drugs, and 12 ablation procedures were performed in nine patients (27%). The devices were programmed individually according to the underlying diseases and arrhythmias. During follow-up, a total of 63 shock therapies were delivered in 11 patients, while a majority of 34 shocks occurred in one patient (no therapies in 22 of 33 patients). Only two such therapies were inappropriate, both delivered for atrial flutter.
In children and young adults receiving ICD therapy, the combination of strategies to prevent ventricular arrhythmias using specific drug therapy, ablation procedures, and individual programming with improved devices and leads causes a low incidence of inappropriate shock delivery.
对小儿患者危及生命的心律失常进行植入式心脏复律除颤器（ICD）治疗是可行的；然而，最近的研究报告显示不适当电击治疗的发生率很高。
回顾性分析了2001年1月至2007年11月在柏林夏里特大学儿科心脏病学部接受ICD治疗的所有患者的数据，内容包括潜在的心脏疾病、心律失常、药物治疗、消融手术、电极导线和设备、程控以及ICD治疗情况。
共有33例患者接受了ICD植入，中位年龄为16.5岁（范围8 - 36岁），平均体重为61±20.9 kg。潜在的心脏疾病包括心电疾病（27%）、心肌病（30%）、先天性心脏病（33%）以及其他（9%）。85%的患者接受了抗心律失常药物治疗，9例患者（27%）进行了12次消融手术。根据潜在疾病和心律失常对设备进行个体化程控。在随访期间，11例患者共接受了63次电击治疗，其中大部分34次电击发生在1例患者身上（33例患者中有22例未接受治疗）。只有2次这样的治疗是不适当的，均针对心房扑动。
在接受ICD治疗的儿童和青年中，采用特定药物治疗、消融手术以及使用改进的设备和电极导线进行个体化程控等预防室性心律失常的策略相结合，导致不适当电击治疗的发生率较低。
