Müller Matthias J, Dieks Jana K, Backhoff David, Schneider Heike E, Ruschewski Wolfgang, Tirilomis Theodor, Paul Thomas, Krause Ulrich
Department of Pediatric Cardiology and Intensive Care, University Medical Center, Georg August University Goettingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
Department of Thoracic, Heart, and Cardiovascular Surgery, University Medical Center, Georg August University Goettingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
J Interv Card Electrophysiol. 2019 Mar;54(2):151-159. doi: 10.1007/s10840-018-0451-y. Epub 2018 Sep 25.
Implantable cardioverter defibrillators (ICD) protect from sudden cardiac death (SCD). In infants and young children, ICD implantation and programming is challenging due to small body size, elevated heart rates, and high physical activity.
We report our experience applying a non-transvenous ICD (NT-ICD) system to infants and children < 12 years of age and < 45-kg body weight.
Between 07/2004 and 07/2016, NT-ICD had been implanted in 36 patients. Nine out of 36 patients (25%) had NT-ICD implantation for primary and 27/36 (75%) for secondary prevention. Underlying diseases included inherited primary electrical arrhythmogenic diseases (n = 26; 72%), cardiomyopathies (n = 8; 22%), and congenital heart defects (n = 2; 6%). The median (interquartile range) age at implantation was 6 (1.9-8.4) years, and the median body weight was 21.7 (11.2-26.8) kg. Three different NT-ICD implantation techniques had been applied over time: (1) abdominal device/subcutaneous shock coil, (2) abdominal device/pleural shock coil, and (3) subcardiac device/pleural shock coil.
During median follow-up of 5.2 (2.7-7.2) years, appropriate ICD discharges were documented in 12 (33.3%) and inappropriate shocks in 4 patients (11.1%). In 12/36 individuals (33.3%), a total of 25 surgical revisions were required due to NT-ICD malfunction. Eighteen out of 25 (72%) surgical revisions were necessary in patients with subcutaneous shock coil/abdominal device position. Surgical revisions (3/25, 12%) were significantly reduced (p < 0.001) after modifying the implantation technique to subcardiac device/pleural shock coil.
NT-ICD was safe and effective in infants and young children. Appropriate ICD discharges occurred in a considerable number of patients. After modifying the implantation technique, the need for surgical revision could significantly be decreased.
植入式心脏复律除颤器（ICD）可预防心源性猝死（SCD）。对于婴幼儿而言，由于体型小、心率快以及体力活动量大，ICD植入和程控颇具挑战性。
我们报告应用非经静脉ICD（NT-ICD）系统治疗12岁以下、体重<45kg婴幼儿和儿童的经验。
2004年7月至2016年7月期间，36例患者植入了NT-ICD。36例患者中9例（25%）因一级预防植入NT-ICD，27例（75%）因二级预防植入。基础疾病包括遗传性原发性心律失常疾病（n = 26；72%）、心肌病（n = 8；22%）和先天性心脏缺陷（n = 2；6%）。植入时的中位（四分位间距）年龄为6（1.9 - 8.4）岁，中位体重为21.7（11.2 - 26.8）kg。随着时间推移应用了三种不同的NT-ICD植入技术：（1）腹部装置/皮下除颤线圈，（2）腹部装置/胸膜除颤线圈，（3）心下装置/胸膜除颤线圈。
在中位随访5.2（2.7 - 7.2）年期间，12例（33.3%）记录到ICD恰当放电，4例患者（11.1%）出现不恰当电击。36例患者中有12例（33.3%）因NT-ICD故障共需要25次手术翻修。25次手术翻修中有18例（72%）是皮下除颤线圈/腹部装置位置的患者所必需的。将植入技术改为心下装置/胸膜除颤线圈后，手术翻修次数（3/25，12%）显著减少（p < 0.001）。
NT-ICD在婴幼儿和儿童中安全有效。相当数量的患者出现了ICD恰当放电。改变植入技术后，手术翻修的需求可显著降低。
