Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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ISSN 2451-2680 (online)
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Advances in Clinical and Experimental Medicine

2020, vol. 29, nr 1, January, p. 123–133

doi: 10.17219/acem/110313

Publication type: original article

Language: English

License: Creative Commons Attribution 3.0 Unported (CC BY 3.0)

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Long-term follow-up of implantable cardioverter-defibrillators in children: Indications and outcomes

Joanna Kwiatkowska1,A,B,C,D,F, Szymon Budrejko2,B,F, Marek Wasicionek3,B,C,D, F Jarosław Meyer-Szary1,C,F, Andrzej Lubinski4,B,C,F, Maciej Kempa2,B,D,E,F

1 Department of Pediatric Cardiology and Congenital Heart Defect, Medical University of Gdansk, Poland

2 2nd Department of Cardiology and Electrotherapy, Medical University of Gdansk, Poland

3 1st Department and Clinic of Pediatric, Allergology and Cardiology, Wroclaw Medical University, Poland

4 Department of Interventional Cardiology and Cardiac Arrhythmias, Medical University of Lodz, Poland


Background. Validation data of the use of implantable cardioverter-defibrillators (ICD) in the pediatric population is insufficient, with limited follow-up periods.
Objectives. The aim of the study was to report on 17 years of experience with implantable cardioverter-defibrillator (ICD) therapy in children and young adults.
Material and Methods. This retrospective review included patients below the age of 18 years at the time of ICD implantation between May 2000 and December 2017. For the statistical analysis, the sample was divided into groups by gender and the type of indications for ICD implantation (primary vs secondary prevention).
Results. The study group included 20 children (8 female, 12 male) who underwent ICD implantation for primary or secondary prevention of sudden cardiac death (SCD). The average age at the time of the initial procedure was 15.6 years (range: 3.8–17.7 years). Primary electrical disease (PED) was present in 9 patients, cardiomyopathy (CMP) in 9 and 2 others had congenital heart defects (CHDs). The median follow-up time was 6.7 years (range: 0.4–12.5 years). The outcomes of ICD therapy were analyzed. No differences between the sexes were found in terms of treatment strategy effectiveness (p > 0.05). The girls were more often treated as primary prevention (p = 0.009). After implantation, all the patients were on optimal pharmacotherapy. Alltogether there were 126 ICD interventions in 11 patients, including 23 inadequate interventions (IA) in 2 children (18.2%).Three children (15%) died due to electrical storms. In the per-procedure analysis, the overall freedom rate from ICD lead replacement was 90%, 80% and 57% at 1, 5 and 10 years of observation, respectively.
Conclusion. Implantable cardioverter-defibrillator implantation indications in children are more heterogeneous in comparison to adult population. In the pediatric population undergoing ICD implantation, the treatment strategy is influenced by gender. The rate of inappropriate ICD discharges (IA) in our group of pediatric patients was low. Rigorous pharmacotherapy and individual ICD programming seemed of paramount importance. Lead malfunctions LF constituted the most prevalent complication observed.

Key words

sudden cardiac death, implantable cardioverter-defibrillator, pediatric cardiology

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