Subcutaneous Implantable Cardioverter-Defibrillators in Pediatrics and Congenital Heart Disease: A Pediatric and Congenital Electrophysiology Society Multicenter Review

Johannes C. von Alvensleben, Brynn Dechert, David J. Bradley, Frank A. Fish, Jeremy P. Moore, Thomas A. Pilcher, Carolina Escudero, Scott R. Ceresnak, Sit Yee Kwok, Seshadri Balaji, Peter F. Aziz, John Papagiannis, Daniel Cortez, Jason Garnreiter, Adam Kean, Michal Schäfer, Kathryn K. Collins

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: The primary goal of this study was to evaluate the implant experience and midterm results of subcutaneous implantable cardioverter-defibrillators (S-ICDs) in pediatric patients and those with congenital heart disease. Background: The S-ICD was developed to avoid the lead-related complications associated with transvenous systems. The absence of intravascular or intracardiac components offers potential advantages to pediatric patients and those with congenital heart disease. Methods: This international, multicenter, retrospective, standard-of-care study was conducted through the Pediatric & Congenital Electrophysiology Society. Complications at 30 and 360 days, inappropriate shocks, and delivery of appropriate therapy were assessed. Results: The study included 115 patients with a median follow-up of 32 (19 to 52) months. Median age was 16.7 years (14.8 to 19.3 years), 29% were female, and 55% had a primary prevention indication. Underlying disease substrate was cardiomyopathy (40%), structural heart disease (32%), idiopathic ventricular fibrillation (16%), and channelopathy (13%). The complication rate was 7.8% at 30 days and 14.7% at 360 days. Overall, inappropriate shocks occurred in 15.6% of patients, with no single clinical characteristic reaching statistical significance. At implant, 97.9% of patients had successful first shock conversion with 96% requiring ≤65 J. Appropriate therapy was delivered to 11.2% of patients with an annual incidence of 3.9% and an acute first shock conversion success rate of 92.5%. Conclusions: This study found that in a heterogeneous population of pediatric patients and those with congenital heart disease, the S-ICD had comparable rates of complications, inappropriate shocks, and conversion efficacy compared with previously published studies on transvenous systems in similar populations.

Original languageEnglish (US)
Pages (from-to)1752-1761
Number of pages10
JournalJACC: Clinical Electrophysiology
Volume6
Issue number14
DOIs
StatePublished - Dec 2020

Keywords

  • adult congenital heart disease
  • electrophysiology
  • pediatrics
  • subcutaneous ICD

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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