Turner Christian J, Stephenson Elizabeth A
The Heart Centre for Children, The Children's Hospital at Westmead, Westmead, 2145, Sydney, NSW, Australia,
Curr Treat Options Cardiovasc Med. 2012 Oct;14(5):435-42. doi: 10.1007/s11936-012-0202-9.
The vast majority of implantable cardioverter defibrillators (ICDs) continue to be implanted in the adult population. Accordingly, manufacturers develop devices and leads primarily for the adult population. Whilst the number of ICDs implanted in children is small in comparison, the potential benefits are large to this group. It is a common frustration among pediatric cardiologists whom implant devices that impressive technological developments continue to be developed for the adult population; as the population of children with ICDs is small, robust clinical studies often lag behind. By necessity, pediatric cardiologists and cardiothoracic surgeons have developed innovative techniques utilizing adult components in unusual configurations for children with complex congenital heart disease. As in the adult population, inappropriate shocks are one of the most limiting and concerning complications in the use of ICDs. Unfortunately, as will be discussed below, children are at increased risk of inappropriate shocks when compared with adults. The true impact of inappropriate shocks is increasingly being realized, and much of the focus in management of children with ICDs surrounds the prevention of inappropriate shocks.
绝大多数植入式心脏复律除颤器（ICD）仍植入于成年人群体中。因此，制造商主要为成年人群体开发设备和导线。相比之下，植入儿童体内的ICD数量较少，但对这一群体的潜在益处却很大。对于植入设备的儿科心脏病专家来说，一个普遍的困扰是，令人印象深刻的技术发展仍主要是为成年人群体而开发；由于植入ICD的儿童数量较少，有力的临床研究往往滞后。出于必要，儿科心脏病专家和心胸外科医生针对患有复杂先天性心脏病的儿童，开发了利用成人部件以特殊配置的创新技术。与成年人群体一样，不适当电击是使用ICD时最具限制性和令人担忧的并发症之一。不幸的是，如下文将讨论的，与成年人相比，儿童发生不适当电击的风险更高。不适当电击的真正影响越来越受到重视，对植入ICD儿童的管理重点大多围绕预防不适当电击展开。
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