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Low Risk of Inappropriate Shock Among Pediatric Patients With an Implantable Cardioverter Defibrillator: A Single Center Experience

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Abstract

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.

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Abbreviations

ICD:

Cardioverter-defibrillators

SVT:

Supraventricular tachycardia

VT:

Ventricular tachycardia

VF:

Ventricular fibrillation

ATP:

Antitachycardia pacing

LQTS:

Long QT syndrome

CPVT:

Catecholaminergic ventricular tachycardia

BrS:

Brugada syndrome

SQTS:

Short QT syndrome

HOCM:

Hypertrophic obstructive cardiomyopathy

LV:

Left ventricular

LVNC:

Left ventricular non compaction

DICM:

Dilated cardiomyopathy

ARVD:

Arrhythmogenic right ventricular dysplasia

CHD:

Congenital heart disease

DILV:

Double inlet left ventricle

DORV:

Double outlet right ventricle

TOF:

Tetralogy of fallot

RRT:

Relative replacement time

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Acknowledgements

I would like to thank Dr. Itay Chay Machtei, Ph.D. Candidate University of North Carolina at Chapel Hill for his assistance in statistical guidance and analysis.

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Authors and Affiliations

  1. Department of Pediatric Cardiology, Schneider’s Children Medical Center, Petach-Tikva, Israel

    Tom Einbinder, Ayelet Machtei, Einat Birk, George Frenkel, Gabriel Amir & Rami Fogelman

  2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Tom Einbinder, Einat Birk, Gabriel Amir & Rami Fogelman

  3. Department of Cardiology, Rabin Medical Center, Petach-Tikva, Israel

    Nili Schamroth Pravda

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  1. Tom Einbinder
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Contributions

Tom Einbinder and Ayelet Machtei wrote the main investigatores. Rami Fogelman was the research supervisor George Fankel, Gabi Amir, Einat Birk, and Nili Schamroth took part in collecting the data, making the figures and reviewing the text,

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Correspondence to Tom Einbinder.

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Einbinder, T., Machtei, A., Birk, E. et al. Low Risk of Inappropriate Shock Among Pediatric Patients With an Implantable Cardioverter Defibrillator: A Single Center Experience. Pediatr Cardiol (2023). https://doi.org/10.1007/s00246-023-03280-0

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