Adult Congenital Heart Disease Unit, Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, Italy.
Paediatric Cardiology Unit, "L.Vanvitelli" University-Monaldi Hospital, Naples, Italy.
J Interv Card Electrophysiol. 2022 Mar;63(2):283-293. doi: 10.1007/s10840-021-00966-4. Epub 2021 Mar 11.
Implantable cardioverter defibrillators (ICD) are widely accepted therapy in children and adolescents who are survivors of cardiac arrest or for high-risk patients with inheritable channelopathies, cardiomyopathies, or congenital heart disease. Initial experience with subcutaneous ICD (S-ICD) systems has shown a high efficacy in adults. However, the use of S-ICD in children and adolescents implies some specific considerations, as the safety for these patients is unknown and recommendations among physicians may vary widely.
We reviewed the data and studied the indications for S-ICD in children and adolescents and discuss the preliminary clinical experience.
From a cohort of 297 patients enrolled in the S-ICD "Monaldi care" registry that encompass all the patients implanted in the Monaldi Hospital of Naples, we considered 21 consecutive children and adolescents (mean age 13.9 years, range 8-18 years, mean body weight 59.3 kg, range 38-100 kg) who underwent S-ICD implant from April 2014 to June 2020. Mean follow-up was 41.9±21.9 months. Only one patient presented, 6 weeks after implantation, skin erosion at the inferior parasternal incision that resolved after antibiotic therapy, without the necessity of any system revision. Two patients experienced appropriate shocks and four inappropriate shocks, due to T wave oversensing or atrial arrhythmia. Only one patient, with arrhythmogenic right ventricular dysplasia, required a system revision after 36 months of the first implantation and then a reintervention with a replacement of the S-ICD by a conventional ICD system.
Our experience suggests that the S-ICD device can be used in some children over the age of 8 as well as adults, with a similar rate of unwanted side effects, and early evidence of apparent efficacy.
植入式心律转复除颤器（ICD）已被广泛应用于心脏骤停幸存者和遗传性通道病、心肌病或先天性心脏病高危患者。皮下 ICD（S-ICD）系统的初步应用经验显示其在成人中具有较高的疗效。然而，S-ICD 在儿童和青少年中的应用需要考虑一些特殊因素，因为这些患者的安全性尚不清楚，医生的建议也可能存在较大差异。
我们回顾了相关数据，研究了 S-ICD 在儿童和青少年中的适应证，并讨论了初步的临床经验。
在纳入那不勒斯莫纳迪医院的 S-ICD“Monaldi care”注册研究的 297 例患者队列中，我们纳入了 21 例连续的儿童和青少年患者（平均年龄 13.9 岁，范围 8-18 岁；平均体重 59.3kg，范围 38-100kg），他们于 2014 年 4 月至 2020 年 6 月期间接受了 S-ICD 植入术。平均随访时间为 41.9±21.9 个月。仅 1 例患者在植入后 6 周出现下胸骨旁切口处皮肤侵蚀，经抗生素治疗后痊愈，无需系统修改。2 例患者发生了 1 次和 3 次适当电击，原因分别为 T 波过感知和房性心律失常。只有 1 例患有致心律失常性右室发育不良的患者在首次植入后 36 个月时需要系统修改，随后进行了再次干预，将 S-ICD 更换为传统 ICD 系统。
我们的经验表明，S-ICD 装置可用于年龄大于 8 岁的部分儿童和成人，其不良事件发生率和早期疗效与成人相似。
