title: Implantable Cardioverter Defibrillator Programming Characteristics, Shocked Rhythms, and Survival Among Patients Under Thirty Years of Age.
abstract: Indications for implantable cardioverter defibrillators (ICDs) in young patients have expanded and differ from those in older adults. We sought to provide descriptive characteristics and data regarding ICD therapy and outcomes among younger and older ICD recipients.
  
  
  
  Demographics, device type and programming, remotely transmitted data, shock events, and survival were compared among younger (≤30 years) and older (>30 years) cohorts with ICDs from a single manufacturer followed on a remote network. The younger cohort included 904 patients (1.6% of all implants). This group had more females (46% vs. 25%; P < 0.01), single-coil leads (21% vs. 4%; P < 0.01), and single-chamber devices (46% vs. 34%; P < 0.01). Shock incidence was higher (40% younger vs. 32% older at 4 years; P < 0.01) and survival was better over comparable follow-up (88% vs. 72%; P < 0.01). Remote monitoring was associated with improved survival in both groups (93% vs. 86% ≤ 30 years, P < 0.01; 73% vs. 66% > 30 years, P < 0.01). Shock for polymorphic ventricular tachycardia/fibrillation (VT/VF) was more frequent in younger patients (12% vs. 5%; P < 0.01); 39% of all shocks were inappropriate. A 10-fold increased risk of mortality was seen among young patients with shocks for atrial fibrillation/flutter (AF/AFL).
  
  
  
  Differences in survival, shock incidence, and prognostic significance of VT/VF and AF/AFL exist between younger and older ICD recipients. These suggest distinct differences in myocardial substrates and diseases that ultimately impact ICD management.
authors.affiliation: Keck School of Medicine of USC, Los Angeles, California, USA. philip.chang@med.usc.edu.
authors.forename: Philip M
authors.initials: PM
authors.lastname: Chang
authors.affiliation: Sanger Heart & Vascular Institute, Charlotte, North Carolina, USA.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Powell
authors.affiliation: Boston Scientific, St. Paul, Minnesota, USA.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Jones
authors.affiliation: Boston Scientific, St. Paul, Minnesota, USA.
authors.forename: Nathan
authors.initials: N
authors.lastname: Carter
authors.affiliation: Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Hayes
authors.affiliation: Keck School of Medicine of USC, Los Angeles, California, USA.
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Saxon
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D001282:Atrial Flutter / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D055815:Young Adult; D000098850:Polymorphic Catecholaminergic Ventricular Tachycardia
keywords: adult congenital heart disease; implantable cardioverter-defibrillator; pediatrics; remote monitoring