Primary prevention exceeds secondary prevention for congenital heart disease (CHD) and pediatrics, and patients with nontransvenous leads are younger, with higher rates of transposition of the great vessels (TGV) and common ventricle patients compared to patients with transvenous leads, according to a new study published Oct. 6 in Circulation: Arrhythmia and Electrophysiology.

The study, led by Christopher Jordan, MD, Division of Cardiology, Children's National Medical Center, Washington, DC, used data from the ACC’s ICD Registry,  and assessed all implantable cardioverter-defibrillator (ICD) procedures for patients with CHD (atrial septal defect, ventricular septal defect, Tetralogy of Fallot, Ebstein anomaly, TGV and common ventricle) as well as all patients under 21 years old between April 2010 and December 2012. Jordan and his team looked at indications and characteristics to include implants of patients with transvenous leads and patients with nontransvenous leads, CHD type, and NYHA class.

With 3,139 CHD procedures – 1,601 for patients under 21 years and 126 for CHD under 21 years – ICD indications for CHD patients were primary prevention in 1,943 (61.9 percent) and secondary prevention in 1,107 (35.2 percent). Pediatric patients had 935 (58.4 percent) primary prevention devices and 588 (36.7 percent) secondary prevention devices, and primary prevention had higher NYHA class.

The data also showed that the age of patients with nontransvenous leads (35.9 ± 23.2 years vs. 40.1 ± 24.6 years; p=0.05) and the height of patients with nontransvenous leads (167.1 ± 18.9 cm; range 53-193 cm; vs. 170.4 ± 13.1 cm; range 61-203 cm; p <0.01) were lower than that of patients with transvenous leads. Finally CHD and pediatrics showed similar rates of transvenous leads (97 percent) and nontransvenous leads (three percent) and did not differ from the overall registry.

As the ICD Registry enhanced pediatric, non-atherosclerotic structural heart disease and CHD data collection in 2010, it improves national surveillance of pediatric and CHD patients requiring ICD therapy, the authors note.  They add moving forward, “greater participation from pediatric cardiologists will improve the NCDR’s ability to enhance understanding of the appropriate timing and indications for ICD therapy in this important and growing population.”

“With improvements in medical and surgical management of pediatric and CHD patients at risk for sudden death, the population will continue to grow in the coming decades with increased need for the development of evidence-based guidelines and indications for ICD implantation in these populations,” says Jordan. “This report should offer pediatric and CHD electrophysiology providers with important benchmarks regarding the typical implant characteristics in these populations, rates of variable lead implantation route, and associated clinical characteristics.”

Keywords: Tetralogy of Fallot, Electrophysiology, Registries, Pediatrics, Heart Septal Defects, Atrial, Heart Septal Defects, Ventricular, Transposition of Great Vessels, Ebstein Anomaly, Death, Sudden, Cardiac, Defibrillators, Implantable, National Cardiovascular Data Registries, ICD Registry

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