The use of implantable cardioverter-defibrillators in pediatric patients awaiting heart transplantation.
BACKGROUND
This multicenter study evaluated experience with implantable cardioverter defibrillators (ICD) as a bridge to orthotopic heart transplantation (OHT) in children.


METHODS
The application of ICD therapy continues to expand in pediatric populations, due in part to improved technology and new indications, including the prevention of sudden death while awaiting OHT.


METHODS
We performed a retrospective review of ICD databases at 9 pediatric transplant centers.


RESULTS
Twenty-eight patients (16 males) underwent implantation or had a preexisting ICD while awaiting OHT between 1990 and 2002. The median age at implant was 14.3 years (11 months to 21 years) with a median weight of 49 kg (11.7-88 kg). Diagnoses included cardiomyopathy (n=22), and congenital heart disease (n=6). Indications for ICD implantation included ventricular tachycardia/fibrillation (n=23), syncope (n=5), aborted sudden death with no documentation of rhythm disturbance (n=5), ventricular ectopy (n=1), and poor function (n=5). Of the 28 ICDs, 23 were implanted by a transvenous approach and 5 by epicardial route. There were 55 defibrillator discharges in 17 patients, 47 (85%) of which (in 13 patients) were appropriate. The 8 inappropriate discharges (in 6 patients) were triggered by sinus tachycardia, inappropriate sensing, and atrial flutter. The mean time from implantation to first appropriate shock was 6.9 months (1 day to 2.6 years). Twenty-one patients underwent transplantation during the study period, whereas 2 died while awaiting a donor. Morbidity included a lead fracture, 3 episodes of electromechanical dissociation, and 1 episode of electrical storm.


CONCLUSIONS
ICD implantation represents an effective bridge to transplantation in pediatric patients. The complication rate is low, with inappropriate device discharge due primarily to sinus tachycardia or atrial flutter. There is a high incidence of appropriate ICD therapy for malignant ventricular arrhythmias in this highly selected group of patients.
Dubin
Anne M
AM
Division of Pediatric Cardiology, Stanford University, 750 Welch Road, Suite 305, Palo Alto, CA 94303, USA.
Berul
Charles I
CI
Bevilacqua
Laura M
LM
Collins
Kathryn K
KK
Etheridge
Susan P
SP
Fenrich
Arnold L
AL
Friedman
Richard A
RA
Hamilton
Robert M
RM
Schaffer
Michael S
MS
Shah
Maully
M
Silka
Michael J
MJ
Van Hare
George F
GF
Kertesz
Naomi J
NJ
D000293:Adolescent; D000328:Adult; D009202:Cardiomyopathies / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D017147:Defibrillators, Implantable; D005260:Female; D006330:Heart Defects, Congenital / Q000628:therapy*; D016027:Heart Transplantation / Q000379:methods*; D006801:Humans; D007223:Infant; D008297:Male; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies