Department of Pediatric Cardiology, Schneider's Children Medical Center, Petach-Tikva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Pediatr Cardiol. 2024 Dec;45(8):1776-1783. doi: 10.1007/s00246-023-03280-0. Epub 2023 Sep 5.
Implantable cardioverter-defibrillators (ICD) are increasingly being used among the pediatric population for indications of both primary and secondary prevention. There is limited long-term data on the outcomes of pediatric patients following ICD implantation. The aim of this study was to investigate the characteristics of this population, burden of appropriate and inappropriate shock and complication rate in a large tertiary pediatric medical center. Included were children under the age of 18 years who underwent ICD implantation and had clinical follow up at our center. Data were retrospectively collected between study period 2005-2020. Primary outcome was the incidence of ICD shock appropriate and inappropriate. Secondary outcome was defining our patient population characteristics. Our cohort included 51 patients who underwent ICD implantation. Mean age at implantation was 10.9 ± 4.7 years and average follow-up time was 67 months. Diagnoses of implanted patients were: 28 (55%) patients with syndromes with risk for sudden death, cardiomyopathy in 14 patients (27%) and congenital heart disease (CHD) in 9 patients (18%). Forty-two (82%) patients had an ICD implanted for secondary prevention after experiencing a life-threatening arrhythmia and 9 (18%) for primary prevention. An endocardial system was implanted in 39 (76%) patients and an epicardial systems in 12 (24%) patients. A total of 20 (39%) patients received appropriate shocks for ventricular fibrillation(VF). 5 patients received inappropriate shocks, 4 due to sinus tachycardia and 1 due to rapidly conducted atrial fibrillation. Those who received an inappropriate shock had a significantly shorter ICD-programmed VF detection cycle length compared to those who did not receive an inappropriate shock (320 ms versus 270 ms, p = 0.062). This single center study demonstrates a high rate of appropriate ICD shocks (39%) and a low rate of inappropriate ICD shocks. Accurate programming of ICD devices in the pediatric population is paramount to avoid inappropriate ICD shocks.
植入式心律转复除颤器（ICD）在儿科人群中的应用越来越广泛，用于一级和二级预防。关于儿科患者植入 ICD 后的长期结果数据有限。本研究旨在调查该人群的特征、适当和不适当电击的负担以及大型三级儿科医疗中心的并发症发生率。研究对象为在我们中心接受 ICD 植入并进行临床随访的年龄在 18 岁以下的儿童。数据是在 2005 年至 2020 年的研究期间回顾性收集的。主要结果是 ICD 电击的适当和不适当发生率。次要结果是确定我们的患者人群特征。我们的队列包括 51 名接受 ICD 植入的患者。植入时的平均年龄为 10.9±4.7 岁，平均随访时间为 67 个月。植入患者的诊断为：28 名（55%）患者患有有猝死风险的综合征，14 名（27%）患者患有心肌病，9 名（18%）患者患有先天性心脏病（CHD）。42 名（82%）患者因发生危及生命的心律失常而植入 ICD 进行二级预防，9 名（18%）患者因一级预防而植入 ICD。39 名（76%）患者植入心内膜系统，12 名（24%）患者植入心外膜系统。共有 20 名（39%）患者因室颤（VF）接受了适当的电击。5 名患者接受了不适当的电击，其中 4 名是由于窦性心动过速，1 名是由于快速传导的心房颤动。与未接受不适当电击的患者相比，接受不适当电击的患者 ICD 程控的 VF 检测周期长度明显更短（320ms 比 270ms，p=0.062）。这项单中心研究表明，适当的 ICD 电击率较高（39%），不适当的 ICD 电击率较低。在儿科人群中准确编程 ICD 设备对于避免不适当的 ICD 电击至关重要。
