The Heart Institute, Cincinnati Children's Hospital Medical Center, OH (S.B., D.S.S., R.J.C.).
Center for Outcomes Research and Evaluation, Yale-New Haven Health Services Corporation, CT (H.B., K.E.M.).
Circ Arrhythm Electrophysiol. 2018 Sep;11(9):e006542. doi: 10.1161/CIRCEP.118.006542.
Background Implantable cardioverter defibrillators (ICDs) are an important part of therapy for many patients, yet there is little data on population characteristics, complications, or system survival in pediatric patients. Methods A retrospective review of ICD recipients in the National Cardiovascular Data Registry ICD Registry was performed from 2010 to 2016. Patient characteristics and complications between pediatric (≤21 years) and adult populations (>21 years) were compared. Variables associated with complications and early device interventions within the pediatric cohort were evaluated using multivariate modeling. Results There were 562 209 total ICD implants, of which 3461 occurred in the pediatric cohort. Among the pediatric patients, 60% of implants were for primary prevention, and nonischemic cardiomyopathy was the most common underlying disease (60%). Over time, there was an increasing trend of both primary and secondary prevention ICD implantations ( P<0.05). Compared with adults, pediatric patients were more likely to have structural heart disease, hypertrophic cardiomyopathy, and channelopathy, and to receive a single-chamber device (all P<0.001). There was no difference in inhospital complications between the adult and pediatric cohorts (2.4% versus 2.6%, P=0.3). However, among the pediatric patients, lower weight, Ebstein anomaly, worse New York Heart Association class, dual chamber, and cardiac resynchronization therapy-defibrillator were associated with greater risk of complications. Although reintervention for generator replacement or upgrade was more common in adults, the time to reintervention was shorter in the pediatric cohort. Conclusions We observed an increasing trend in ICD device implantation among pediatric patients. The pediatric cohort had similar inhospital complication rates compared with adults but had a shorter time to reintervention.
植入式心脏复律除颤器（ICD）是许多患者治疗的重要组成部分，但对于儿科患者的人群特征、并发症或系统存活率的数据很少。
对 2010 年至 2016 年国家心血管数据登记 ICD 登记处的 ICD 接受者进行了回顾性分析。比较了儿科（≤21 岁）和成年人群（>21 岁）患者的特征和并发症。使用多变量建模评估了儿科队列中与并发症和早期设备干预相关的变量。
共植入 562209 个 ICD，其中 3461 个发生在儿科队列。在儿科患者中，60%的植入是为了预防原发性疾病，最常见的潜在疾病是非缺血性心肌病（60%）。随着时间的推移，原发性和继发性预防 ICD 植入的趋势都在增加（P<0.05）。与成人相比，儿科患者更有可能患有结构性心脏病、肥厚型心肌病和通道病，并接受单腔设备（均 P<0.001）。成人和儿科队列之间的住院并发症无差异（2.4%对 2.6%，P=0.3）。然而，在儿科患者中，体重较低、Ebstein 异常、纽约心脏协会（NYHA）心功能分级较差、双腔和心脏再同步治疗除颤器与并发症风险增加相关。虽然成人中因更换或升级发生器而再次干预更为常见，但儿科患者的再次干预时间更短。
我们观察到儿科患者 ICD 设备植入的趋势在增加。儿科队列与成人相比，住院并发症发生率相似，但再次干预的时间更短。
