Role of transvenous implantable cardioverter-defibrillators in preventing sudden cardiac death in children, adolescents, and young adults.
OBJECTIVE
To evaluate the indications, underlying cardiac disorders, efficacy, and complications involved with transvenous implantable cardioverter-defibrillators (ICDs) in pediatric patients at the Mayo Clinic.


METHODS
The records of all patients aged 21 years or younger who underwent transvenous ICD placement at the Mayo Clinic, Rochester, Minn, were reviewed retrospectively.


RESULTS
Between March 1992 and September 2000, 16 patients (7 females; mean age, 15.4 years; range, 10-21 years) underwent transvenous ICD placement. The ICD was implanted for primary prevention of sudden cardiac death in 7 and for secondary prevention in 9. The underlying cardiac disorders included hypertrophic cardiomyopathy in 6 patients and congenital long QT syndrome in 6 patients. The mean +/- SD follow-up was 36+/-29 months (range, 5-108 months). There was no mortality. Seven patients (44%) received appropriate ICD therapy, including 6 of 9 who had ICDs placed for secondary prevention. Median time free from appropriate ICD discharge was 3 years (range, 0.2-9 years). Three patients (19%) experienced inappropriate ICD discharge. Two patients needed device replacement because of technical problems (lead fracture and device malfunction). Two patients developed pocket infection that required removal and reimplantation of the ICD.


CONCLUSIONS
In adolescents and young adults, transvenous ICDs may prevent sudden death but are not free of complications. Forty-four percent of this cohort received potentially life-saving ICD therapy, including two thirds who received an ICD for secondary prevention.
Chatrath
Ritu
R
Division of Pediatric Cardiology, Mayo Eugenio Litta Children's Hospital, Mayo Clinic, Rochester, Minn 55905, USA.
Porter
Co-burn J
CB
Ackerman
Michael J
MJ
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D024741:Cardiomyopathy, Hypertrophic, Familial / Q000150:complications; D002648:Child; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000009:adverse effects / Q000592:standards*; D004868:Equipment Failure; D005260:Female; D006801:Humans; D008133:Long QT Syndrome / Q000150:complications; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D018579:Patient Selection; D011322:Primary Prevention / Q000379:methods* / Q000592:standards; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome