Efficacy and Safety of Non-transvenous Cardioverter Defibrillators in Infants and Young Children

Overview

Journal J Interv Card Electrophysiol

Publisher Springer

Date 2018 Sep 27

PMID 30255451

Citations 7

Authors

Matthias J Muller

Jana K Dieks

David Backhoff

Heike E Schneider

Wolfgang Ruschewski

Theodor Tirilomis

Thomas Paul

Ulrich Krause

Affiliations

Soon will be listed here.

Abstract

Background: Implantable cardioverter defibrillators (ICD) protect from sudden cardiac death (SCD). In infants and young children, ICD implantation and programming is challenging due to small body size, elevated heart rates, and high physical activity.

Purpose: We report our experience applying a non-transvenous ICD (NT-ICD) system to infants and children < 12 years of age and < 45-kg body weight.

Methods: Between 07/2004 and 07/2016, NT-ICD had been implanted in 36 patients. Nine out of 36 patients (25%) had NT-ICD implantation for primary and 27/36 (75%) for secondary prevention. Underlying diseases included inherited primary electrical arrhythmogenic diseases (n = 26; 72%), cardiomyopathies (n = 8; 22%), and congenital heart defects (n = 2; 6%). The median (interquartile range) age at implantation was 6 (1.9-8.4) years, and the median body weight was 21.7 (11.2-26.8) kg. Three different NT-ICD implantation techniques had been applied over time: (1) abdominal device/subcutaneous shock coil, (2) abdominal device/pleural shock coil, and (3) subcardiac device/pleural shock coil.

Results: During median follow-up of 5.2 (2.7-7.2) years, appropriate ICD discharges were documented in 12 (33.3%) and inappropriate shocks in 4 patients (11.1%). In 12/36 individuals (33.3%), a total of 25 surgical revisions were required due to NT-ICD malfunction. Eighteen out of 25 (72%) surgical revisions were necessary in patients with subcutaneous shock coil/abdominal device position. Surgical revisions (3/25, 12%) were significantly reduced (p < 0.001) after modifying the implantation technique to subcardiac device/pleural shock coil.

Conclusions: NT-ICD was safe and effective in infants and young children. Appropriate ICD discharges occurred in a considerable number of patients. After modifying the implantation technique, the need for surgical revision could significantly be decreased.

Citing Articles

New Guidelines of Pediatric Cardiac Implantable Electronic Devices: What Is Changing in Clinical Practice?.

Silvetti M, Colonna D, Gabbarini F, Porcedda G, Rimini A, DOnofrio A J Cardiovasc Dev Dis. 2024; 11(4).

PMID: 38667717 PMC: 11050217. DOI: 10.3390/jcdd11040099.

Low Risk of Inappropriate Shock Among Pediatric Patients With an Implantable Cardioverter Defibrillator: A Single Center Experience.

Einbinder T, Machtei A, Birk E, Schamroth Pravda N, Frenkel G, Amir G Pediatr Cardiol. 2023; 45(8):1776-1783.

PMID: 37668692 DOI: 10.1007/s00246-023-03280-0.

Epicardial vs. transvenous implantable cardioverter defibrillators in children.

Le Bos P, Pontailler M, Maltret A, Kraiche D, Gaudin R, Barbanti C Europace. 2023; 25(3):961-968.

PMID: 36735263 PMC: 10062323. DOI: 10.1093/europace/euad015.

ICD Outcome in Pediatric Cardiomyopathies.

Silvetti M, Tamburri I, Campisi M, Saputo F, Cazzoli I, Cantarutti N J Cardiovasc Dev Dis. 2022; 9(2).

PMID: 35200687 PMC: 8875861. DOI: 10.3390/jcdd9020033.

Non-traditional implantable cardioverter-defibrillator configurations and insertion techniques: a review of contemporary options.

Tonko J, Rinaldi C Europace. 2021; 24(2):181-192.

PMID: 34453529 PMC: 8824518. DOI: 10.1093/europace/euab178.

References

Korte T, Koditz H, Niehaus M, Paul T, Tebbenjohanns J . High incidence of appropriate and inappropriate ICD therapies in children and adolescents with implantable cardioverter defibrillator. Pacing Clin Electrophysiol. 2004; 27(7):924-32. DOI: 10.1111/j.1540-8159.2004.00560.x. View

Stephenson E, Cecchin F, Walsh E, Berul C . Utility of routine follow-up defibrillator threshold testing in congenital heart disease and pediatric populations. J Cardiovasc Electrophysiol. 2005; 16(1):69-73. DOI: 10.1046/j.1540-8167.2005.04528.x. View

Kriebel T, Ruschewski W, Paul T . Implantation of an "extracardiac" internal cardioverter defibrillator in a 6-month-old infant. Z Kardiol. 2005; 94(6):415-8. DOI: 10.1007/s00392-005-0236-z. View

Stephenson E, Batra A, Knilans T, Gow R, Gradaus R, Balaji S . A multicenter experience with novel implantable cardioverter defibrillator configurations in the pediatric and congenital heart disease population. J Cardiovasc Electrophysiol. 2006; 17(1):41-6. DOI: 10.1111/j.1540-8167.2005.00271.x. View

Bar-Cohen Y, Berul C, Alexander M, Fortescue E, Walsh E, Triedman J . Age, size, and lead factors alone do not predict venous obstruction in children and young adults with transvenous lead systems. J Cardiovasc Electrophysiol. 2006; 17(7):754-9. DOI: 10.1111/j.1540-8167.2006.00489.x. View

Kriebel T, Ruschewski W, Gonzalez y Gonzalez M, Walter K, Kroll J, Kampmann C . ICD Implantation in infants and small children: the extracardiac technique. Pacing Clin Electrophysiol. 2007; 29(12):1319-25. DOI: 10.1111/j.1540-8159.2006.00542.x. View

Bauersfeld U, Tomaske M, Dodge-Khatami A, Rahn M, Kellenberger C, Pretre R . Initial experience with implantable cardioverter defibrillator systems using epicardial and pleural electrodes in pediatric patients. Ann Thorac Surg. 2007; 84(1):303-5. DOI: 10.1016/j.athoracsur.2006.10.001. View

Tomaske M, Pretre R, Rahn M, Bauersfeld U . Epicardial and pleural lead ICD systems in children and adolescents maintain functionality over 5 years. Europace. 2008; 10(10):1152-6. DOI: 10.1093/europace/eun214. View

Radbill A, Triedman J, Berul C, Fynn-Thompson F, Atallah J, Alexander M . System survival of nontransvenous implantable cardioverter-defibrillators compared to transvenous implantable cardioverter-defibrillators in pediatric and congenital heart disease patients. Heart Rhythm. 2009; 7(2):193-8. DOI: 10.1016/j.hrthm.2009.10.014. View

10.

Cecchin F, Atallah J, Walsh E, Triedman J, Alexander M, Berul C . Lead extraction in pediatric and congenital heart disease patients. Circ Arrhythm Electrophysiol. 2010; 3(5):437-44. DOI: 10.1161/CIRCEP.110.957324. View

11.

Burns K, Evans F, Kaltman J . Pediatric ICD utilization in the United States from 1997 to 2006. Heart Rhythm. 2010; 8(1):23-8. PMC: 3010480. DOI: 10.1016/j.hrthm.2010.09.073. View

12.

Czosek R, Meganathan K, Anderson J, Knilans T, Marino B, Heaton P . Cardiac rhythm devices in the pediatric population: utilization and complications. Heart Rhythm. 2011; 9(2):199-208. DOI: 10.1016/j.hrthm.2011.09.004. View

13.

Koopman H, Vrijmoet-Wiersma C, Langius J, Van den Heuvel F, Clur S, Blank C . Psychological functioning and disease-related quality of life in pediatric patients with an implantable cardioverter defibrillator. Pediatr Cardiol. 2012; 33(4):569-75. PMC: 3311983. DOI: 10.1007/s00246-012-0175-1. View

14.

Jarman J, Lascelles K, Wong T, Markides V, Clague J, Till J . Clinical experience of entirely subcutaneous implantable cardioverter-defibrillators in children and adults: cause for caution. Eur Heart J. 2012; 33(11):1351-9. DOI: 10.1093/eurheartj/ehs017. View

15.

Jordan C, Freedenberg V, Wang Y, Curtis J, Gleva M, Berul C . Implant and clinical characteristics for pediatric and congenital heart patients in the national cardiovascular data registry implantable cardioverter defibrillator registry. Circ Arrhythm Electrophysiol. 2014; 7(6):1092-100. DOI: 10.1161/CIRCEP.114.001841. View

16.

Priori S, Blomstrom-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J . 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the.... Europace. 2015; 17(11):1601-87. DOI: 10.1093/europace/euv319. View

17.

Bordachar P, Marquie C, Pospiech T, Pasquie J, Jalal Z, Haissaguerre M . Subcutaneous implantable cardioverter defibrillators in children, young adults and patients with congenital heart disease. Int J Cardiol. 2015; 203:251-8. DOI: 10.1016/j.ijcard.2015.09.083. View

18.

Ackerman M, Atkins D, Triedman J . Sudden Cardiac Death in the Young. Circulation. 2016; 133(10):1006-26. PMC: 5033115. DOI: 10.1161/CIRCULATIONAHA.115.020254. View

19.

Pospiech T, Roubertie F, Jalal Z, Bordachar P, Thambo J . New Technique for Surgical Epicardial Implantation of a Cardioverter-Defibrillator in Children and Adults With Congenital Heart Disease. Ann Thorac Surg. 2016; 102(2):615-9. DOI: 10.1016/j.athoracsur.2016.02.015. View

20.

Schneider A, Burkhart H, Ackerman M, Dearani J, Wackel P, Cannon B . Minimally invasive epicardial implantable cardioverter-defibrillator placement for infants and children: An effective alternative to the transvenous approach. Heart Rhythm. 2016; 13(9):1905-12. DOI: 10.1016/j.hrthm.2016.06.024. View