Implantable cardioverter-defibrillators in children.
BACKGROUND
Implantable cardioverter-defibrillators (ICD) have been increasingly used in adult patients for the prevention of sudden cardiac death (SCD). The usefulness and feasibility of ICD implantation in children have been less well established.


OBJECTIVE
To analyse indications, results and safety of ICD therapy in children.


METHODS
ICDs were implanted in seven children, aged from 6 to 17 years. All patients underwent cardiological evaluation which included analysis of medical history, physical examination, chest X-ray, standard ECG, 24-hour Holter ECG monitoring and echocardiography.


RESULTS
In five children devices were implanted due to aborted sudden death (ventricular fibrillation) whereas in the remaining two - as a primary prevention of SCD. Three children had hypertrophic cardiomyopathy, one - dilated cardiomyopathy, one - mitral valve prolapse and QT prolongation, one - congenital long QT syndrome and the remaining patient - idiopathic ventricular tachycardia. Single-chamber devices were implanted in six children, and dual-chamber system - in one patient. In all patients endocardial leads were implanted and ICD pocket was formed under the greater pectoral muscle. During follow-up ranging between four months to 5.4 years, four children developed ventricular fibrillation or ventricular tachycardia which were terminated by appropriate ICD discharges.


CONCLUSIONS
1. ICD implantation in children is effective in the prevention of SCD. 2. In our population, the most frequent indications for device implantation were life-threatening ventricular arrhythmias occurring in patients with cardiomyopathy. 3. Cardiac arrest due to ventricular fibrillation may occur in children without a history of aborted SCD. 4. ICD implantation in children is feasible and safe.
Werner
Bozena
B
Department of Paediatric Cardiology and General Paediatrics, Warsaw University of Medicine, Warsaw, Poland.
Przybylski
Andrzej
A
Kucińska
Beata
B
Lewandowski
Michał
M
Szwed
Hanna
H
Wróblewska-Kałuzewska
Maria
M
D000293:Adolescent; D002648:Child; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000009:adverse effects / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male