title: Subcutaneous implantable cardioverter defibrillators in children, young adults and patients with congenital heart disease.
abstract: The demonstration of severe complications in patients implanted with a transvenous implantable cardioverter defibrillator (ICD) has led to the development of devices equipped with a subcutaneous lead. This new technique offers numerous advantages but also certain disadvantages. Various studies or anecdotal clinical cases have specifically been conducted with this subcutaneous defibrillation system in children and/or patients with congenital heart disease. Results of these studies suggest: 1) a high feasibility despite being limited by a selection process that excludes patients requiring permanent pacing and patients declared ineligible during pre-screening; 2) good efficacy of electrical shocks in reducing induced or spontaneous ventricular arrhythmias; 3) in this specific subset of patients, 2 types of complications have been particularly described: a risk of device exteriorization and infection, and a large number of inappropriate therapies primarily related to T-wave oversensing. The subcutaneous ICD could therefore constitute the gold standard for patients with complex congenital heart disease with no venous access to the heart or with a persistent shunt increasing the risk of systemic emboli as well as in young patients with channelopathy or hypertrophic cardiomyopathy not requiring long-term pacing. Technological change (reduction in device size, better differentiation between R- and T-waves, possibility of pacing if device coupled with a leadless pacemaker) could reduce the limitations and complications and thereby increase the indications in this sub-group of patients.
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de rythmologie et modélisation cardiaque (LIRYC), Université Bordeaux, Bordeaux, France. Electronic address: bordacharp@hotmail.com.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bordachar
authors.affiliation: Université et CHRU, Lille, France.
authors.forename: Christelle
authors.initials: C
authors.lastname: Marquié
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de rythmologie et modélisation cardiaque (LIRYC), Université Bordeaux, Bordeaux, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Pospiech
authors.affiliation: Université de Montpellier et CHU de Montpellier, France.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Pasquié
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de rythmologie et modélisation cardiaque (LIRYC), Université Bordeaux, Bordeaux, France.
authors.forename: Zakaria
authors.initials: Z
authors.lastname: Jalal
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de rythmologie et modélisation cardiaque (LIRYC), Université Bordeaux, Bordeaux, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Haissaguerre
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de rythmologie et modélisation cardiaque (LIRYC), Université Bordeaux, Bordeaux, France.
authors.forename: Jean-Benoit
authors.initials: JB
authors.lastname: Thambo
mesh_terms: D000293:Adolescent; D002648:Child; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005260:Female; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D011475:Prosthesis Failure; D040521:Subcutaneous Tissue / Q000601:surgery; D055815:Young Adult
keywords: Congenital heart disease; Implantable-cardioverter defibrillator; Pediatrics; Subcutaneous