TY - JOUR
T1 - The Use of Implantable Cardioverter-Defibrillators in Pediatric Patients Awaiting Heart Transplantation
AU - Dubin, Anne M.
AU - Berul, Charles I.
AU - Bevilacqua, Laura M.
AU - Collins, Kathryn K.
AU - Etheridge, Susan P.
AU - Fenrich, Arnold L.
AU - Friedman, Richard A.
AU - Hamilton, Robert M.
AU - Schaffer, Michael S.
AU - Shah, Maully
AU - Silka, Michael J.
AU - Van Hare, George F.
AU - Kertesz, Naomi J.
PY - 2003/10
Y1 - 2003/10
N2 - 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.
AB - 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.
KW - Children
KW - Defibrillator
KW - Heart transplant
KW - ICD
KW - Pediatric
UR - https://www.scopus.com/pages/publications/10744227188
U2 - 10.1054/S1071-9164(03)00128-3
DO - 10.1054/S1071-9164(03)00128-3
M3 - Article
C2 - 14583898
AN - SCOPUS:10744227188
SN - 1071-9164
VL - 9
SP - 375
EP - 379
JO - Journal of cardiac failure
JF - Journal of cardiac failure
IS - 5
ER -