The use of implantable cardioverter-defibrillators in children

Implantable cardioverter-defibrillators have become primary therapy for most adult survivors of sudden cardiac death. However, the use of these devices in young patients who have been resuscitated from cardiovascular collapse is infrequent and requires consideration of diverse mechanisms of sudden cardiac death. The cardiovascular diseases which have been associated with sudden tachyarrhythmic death in young patients include hypertrophic and dilated cardiomyopathies, right ventricular dysplasia, long QT syndrome, idiopathic ventricular fibrillation, and congenital heart disease. Although clinical experience is limited, the prevalence of appropriate shocks in young patients who have received ICDs is approximately 50% during 2 years of follow-up. As with adults, impaired ventricular function is the strongest risk factor for sudden death after implantable cardioverter-defibrillator implantation. In this review, the clinical experience with implantable cardioverter-defibrillators (ICDs) in young patients is discussed, along with specific factors that need to be considered in this patient population. Some general recommendations regarding the use of ICDs in this population are discussed, based on the probable recurrence of a sudden arrhythmic event and outcome data for young patients after ICD implantation. The potential uses of ICDs for primary prevention of sudden cardiac death and atrial defibrillation are also discussed.