PediatrCardiol
DOI
10.1007/s00246-010-9866-7
© Springer Science+Business Media, LLC 2010
Received: 26 August 2010
/ Accepted: 7 December 2010
Multicenter Study of the Effectiveness of Implantable Cardioverter
Defibrillators in Children and Young Adults with Heart Disease
Authors
Nicholas H Von Bergen, Dianne
L Atkins, Macdonald Dick II, David J Bradley, Susan P Etheridge, Elizabeth V Saarel, Peter S Fischbach, Seshadri Balaji, Narayanswami Sreeram, William N
Evans, Ian H Law
Source
ChildrenŐs Heart Center
Nevada, 3006 S Maryland Pkwy, Ste 690, Las Vegas, NV 89109, USA.
Email: wnevans50@aol.com.
Abstract
Implantable cardioverter
defibrillators (ICDs) are being used with increasing frequency in children and young
adults. Our aim was to examine the appropriateness and frequency of ICD
discharges in children and young adults, to compare the effectiveness of ICDs
when placed for primary or secondary prevention, and to provide time dependent analysis
of ICD discharges. Data were collectedfrom seven institutions on 210
patients\30 years of age who underwent ICD
implantation from October 1992 toJanuary 2007. Median age at implant was 15.4
years with afollow-up average of 3.3 years. Heart disease was categorized as
electrical (n = 90, 42%), cardiomyopathic (n = 62, 30%), or congenital heart
disease (n = 58, 28%). ICDs are increasingly placed for primary prevention.
There are increased appropriate ICD discharges for ICDs placed for secondary
prevention (52%) versus primary prevention (14%) at 5 years. There is no
difference in the risk of inappropriate discharges between primary and
secondary prevention indications. There is an increased risk for inappropriate
therapy in the congenital heart disease population. An increasing number of
ICDs are being placed for primary prevention in young patients, a marked shift
in practice during the last two decades. The benefits of ICDs remain greater in
secondary than in primary-prevention patients. In both groups, approximately
25% of patients received inappropriate discharges within 5 years of implant.
Patients with congenital heart disease are the most affected by inappropriate
discharges.