Abstract 2209: A Multicenter Pediatric Implantable Cardioverter Defibrillator Retrospective Registry
There is an increasing frequency of ICD use in pediatric and congenital heart disease (CHD) patients. Until recently, prospective enrollment of ICD patients in a national registry was not available, and children and CHD patients account for a very small percentage of all ICD recipients. Therefore, we sought to retrospectively obtain collaborative data from 4 pediatric ICD implanting centers, aiming to identify implant characteristics, shock frequency, and complications in this unique patient sample.
Methods: Databases from 4 centers were reviewed and collated in a blinded fashion for review by the investigators. Demographic information, implant electrical parameters, appropriate and inappropriate shock data, and complications were recorded for all implants occurring from March 1992 – March 2004.
Results: A total of 422 patients were included, with a median age of 16 years (range 0 –54 yr) and median weight of 61kg (range 2–103kg), with 232 (55%) having structural heart disease. The most common diagnoses were tetralogy of Fallot (19%) and cardiomyopathy (18%). Implant indication was primary prevention in 34%. Electrical diseases such as LQTS, Brugada, and CPVT accounted for 30% of patients. Shock data available on 388 pts of which 99 (26%) received appropriate shocks, at a mean of 4 shocks/pt (range 1–29). Some pts did not receive a shock until second generator. Inappropriate shocks occurred in 85/388 pts (20%) with a mean of 6/pt (1– 60), mainly due to sinus or atrial tachycardias (9%), oversensing (4%), or lead failure (15%).
Conclusions: Children and CHD ICD recipients have significant appropriate and inappropriate shock frequencies. Optimizing programming, medical management, and compliance may diminish inappropriate shocks. However, despite recent concerns regarding ICD generator recalls, lead failure remains the major cause of inappropriate shocks, complications, and system malfunction in children. Future prospective assessment of ICD usage in this unique population may identify additional important factors in pediatric and CHD patients.