The implantable cardioverter- defibrillator (ICD) is the primary therapeutic option for survivors of sudden cardiac death (SCD) in children.
The objective of this study was to evaluate the impact of ICDs on the pediatric population in a single pediatric cardiac center. We studied the clinical characteristics and outcomes of 50 children who underwent ICD implantation.
The patients age were 4 months to 16 years (mean 9.5 years) and weighted 6-67 kg , 22 females. The indications were long QT syndrome 27 (54%), 10 hypertrophic (20%) and 3 dilated cardiomyopathies (6%), congenital heart defects 4 (8%) , ventricular tachycardia 3 (6%) and idiopathic ventricular fibrillation in 3 (6%). Sixteen patients were survivors of SCD. Three were epicardiac.
The follow-up was 2 to 60 months, at least one ICD discharge occurred in 15 of the 50 (30%) patients. Twelve received one appropriate ICD discharge, and 3 patients (6%) had one or more inappropriate discharges. The causes of inappropriate discharges were lead failure in 2 (4%) and sinus tachycardia in 1 (2%).
There were 2 deaths during the study period: one secondary to ventricular storm, and one pulmonary infection. None died suddenly.
Conclusions: ICDs provide an important therapeutic option to prevent sudden arrhythmic death in high-risk patients. These data demonstrate that ICDs provide safe and effective therapy in young patients. The complication rate is low and there are a high incidence of appropriate ICD therapy for malignant ventricular arrhythmias in this highly selected group of patients in this single center study.