The Use of Implantable Cardioverter-Defibrillators in Pediatric Patients Awaiting Heart Transplantation

Anne M. Dubin, Charles I. Berul, Laura M. Bevilacqua, Kathryn K. Collins, Susan P. Etheridge, Arnold L. Fenrich, Richard A. Friedman, Robert M. Hamilton, Michael S. Schaffer, Maully Shah, Michael J. Silka, George F. Van Hare, Naomi J. Kertesz

Research output: Contribution to journalArticlepeer-review

73 Scopus citations

Abstract

Background: This multicenter study evaluated experience with implantable cardioverter defibrillators (ICD) as a bridge to orthotopic heart transplantation (OHT) in children. Methods: The application of ICD therapy continues to expand in pediatric populations, due in part to improved technology and new indications, including the prevention of sudden death while awaiting OHT. Methods: We performed a retrospective review of ICD databases at 9 pediatric transplant centers. Results: Twenty-eight patients (16 males) underwent implantation or had a preexisting ICD while awaiting OHT between 1990 and 2002. The median age at implant was 14.3 years (11 months to 21 years) with a median weight of 49 kg (11.7-88 kg). Diagnoses included cardiomyopathy (n = 22), and congenital heart disease (n = 6). Indications for ICD implantation included ventricular tachycardia/fibrillation (n = 23), syncope (n = 5), aborted sudden death with no documentation of rhythm disturbance (n = 5), ventricular ectopy (n = 1), and poor function (n = 5). Of the 28 ICDs, 23 were implanted by a transvenous approach and 5 by epicardial route. There were 55 defibrillator discharges in 17 patients, 47 (85%) of which (in 13 patients) were appropriate. The 8 inappropriate discharges (in 6 patients) were triggered by sinus tachycardia, inappropriate sensing, and atrial flutter. The mean time from implantation to first appropriate shock was 6.9 months (1 day to 2.6 years). Twenty-one patients underwent transplantation during the study period, whereas 2 died while awaiting a donor. Morbidity included a lead fracture, 3 episodes of electromechanical dissociation, and 1 episode of electrical storm. Conclusions: ICD implantation represents an effective bridge to transplantation in pediatric patients. The complication rate is low, with inappropriate device discharge due primarily to sinus tachycardia or atrial flutter. There is a high incidence of appropriate ICD therapy for malignant ventricular arrhythmias in this highly selected group of patients.

Original languageEnglish
Pages (from-to)375-379
Number of pages5
JournalJournal of cardiac failure
Volume9
Issue number5
DOIs
StatePublished - Oct 2003

Keywords

  • Children
  • Defibrillator
  • Heart transplant
  • ICD
  • Pediatric

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