Long-term follow-up of children and young adults treated with implantable cardioverter-defibrillator: the authors' own experience with optimal implantable cardioverter-defibrillator programming.
OBJECTIVE
Young implantable cardioverter-defibrillator (ICD) recipients present a high rate of inappropriate interventions. Some of them are caused by suboptimal pre-discharge programming of the device. There are conflicting data as regards antitachycardia pacing (ATP) effectiveness in children and young adults. We report our experience with ICD programming and a rate of complications during a 10 year follow-up.


RESULTS
We analysed the use and effectiveness of ATP and complications rate in 63 patients aged 6-21 years. Antitachycardia pacing (burst or ramp) was programmed ON in 14 patients (22%), 49 patients (78%) had only ventricular fibrillation (VF) therapy when discharged after implantation. The incidence of effective vs. ineffective or harmful ATP therapy: 5% of patients vs. 19% of patients differed significantly (P < 0.05). Fourteen patients (22%) received > or =1 appropriate shock(s) for ventricular tachycardia/VF and 17 patients (27%) had one or multiple inappropriate therapy (IT). Inappropriate therapy resulted from T-wave over-sensing (nine patients), sinus tachycardia (three patients), fast atrial fibrillation (five patients), and lead insulation disruption (1%). Reprogramming of the device eliminated IT in all cases. There were 13 (21%) surgical complications. Serious psychological sequelae developed in 27 (43%) patients. There was one death during the follow-up period.


CONCLUSIONS
Antitachycardia pacing therapy is rarely effective and often harmful in young ICD recipients. In most patients, programming ICD for only VF therapy is sufficient. Routine pre-discharge programming against inappropriate interventions (especially T-wave over-sensing) helps to reduce the incidence of discharges during the follow-up. The incidence of complications and inappropriate therapies is high in young ICD recipients and affects 50% of patients.
Lewandowski
Michal
M
The National Institute of Cardiology, Warsaw, Poland. m.lewandowski@ikard.pl
Sterlinski
Maciej
M
Maciag
Aleksander
A
Syska
Pawel
P
Kowalik
Ilona
I
Szwed
Hanna
H
Chojnowska
Lidia
L
Przybylski
Andrzej
A
D000293:Adolescent; D000328:Adult; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects*; D002648:Child; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012984:Software; D013318:Stroke Volume; D013610:Tachycardia / Q000628:therapy; D017211:Treatment Failure; D014693:Ventricular Fibrillation / Q000628:therapy*; D055815:Young Adult