ICD Therapy in Children and Young Adults: Low Incidence of Inappropriate Shock Delivery

Abstract

INTRODUCTION: Implantable cardioverter defibrillator (ICD) therapy of life-threatening arrhythmias in pediatric patients is feasible; however, recent studies report a high incidence of inappropriate shock deliveries. METHODS: The data of all recipients of an ICD at the Charité, Department of Pediatric Cardiology, between January 2001 and November 2007 were retrospectively analyzed regarding underlying cardiac disorders, arrhythmias, medication, ablation procedures, leads and devices, programming, and ICD therapies. RESULTS: A total of 33 patients underwent ICD implantation, with a median age of 16.5 years (range 8-36 years) and a mean weight of 61 +/- 20.9 kg. Underlying cardiac disorders were electrical heart disease (27%), cardiomyopathy (30%), congenital heart disease (33%), and others (9%). Eighty-five percent received antiarrhythmic drugs, and 12 ablation procedures were performed in nine patients (27%). The devices were programmed individually according to the underlying diseases and arrhythmias. During follow-up, a total of 63 shock therapies were delivered in 11 patients, while a majority of 34 shocks occurred in one patient (no therapies in 22 of 33 patients). Only two such therapies were inappropriate, both delivered for atrial flutter. CONCLUSIONS: In children and young adults receiving ICD therapy, the combination of strategies to prevent ventricular arrhythmias using specific drug therapy, ablation procedures, and individual programming with improved devices and leads causes a low incidence of inappropriate shock delivery.