A study of ACC’s ICD Registry data shows that a growing number of pediatric patients are receiving ICDs, mostly for primary prevention and the management of nonischemic cardiomyopathy. The younger patients had a similar rate of inhospital complications as adult patients, but a shorter time to reintervention, according to the study published in Circulation: Arrhythmia and Electrophysiology. 

Shankar Baskar, MD, et al., examined data from 562,209 patients in the ICD Registry collected from 2010 to 2016 to compare patient characteristics and device-related complications in patients younger and older than 21 years at the time of first ICD implantation. The mean age of the pediatric cohort was 13.1 years and 73 percent of ICD implants were placed in white males. 

Study results show that 3,461 pediatric patients (60 percent) received ICD implants for primary prevention. Nonischemic dilated cardiomyopathy was the most common (39 percent) cause for pediatric implantation, followed by hypertrophic cardiomyopathy (17 percent) and long QT syndrome (13 percent). The study found over time an increasing trend of both primary and secondary implantations. 

The pediatric patients were more likely than adult patients to have structural heart disease, hypertrophic cardiomyopathy or channelopathy, and to receive a single-chamber device. When compared with adult patients, pediatric patients undergoing device placement were more likely to be female, African American or of Hispanic ethnicity. 

Pediatric patients with lower weight, Ebstein anomaly, a worse NYHA class, dual-chamber device and a CRT-D had a greater risk of complications compared with adult patients.  

The rate of inhospital complications was similar at 2.6 percent and 2.4 percent in the pediatric and adult populations, respectively (p=0.03). The mean time to early device intervention was shorter in pediatric patients (mean, 771 days vs. 979 days in adults), but the frequency of reinterventions was higher in adult patients (4.1 percent vs. 3.1 percent).  

The authors conclude that, “Inhospital complications after pediatric device implantations are rare irrespective of [defibrillation threshold] testing, and the rates are comparable to adults. Dual-chamber and CRT-D devices, in particular, were found to be associated with increased inhospital complications and decreased system survival.” 

Clinical Topics: Arrhythmias and Clinical EP, Congenital Heart Disease and Pediatric Cardiology, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Prevention, Implantable Devices, Genetic Arrhythmic Conditions, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Quality Improvement

Keywords: ICD Registry, National Cardiovascular Data Registries, Aged, 80 and over, Cardiomyopathy, Dilated, Channelopathies, Ebstein Anomaly, Cardiomyopathy, Hypertrophic, Defibrillators, Implantable, Cohort Studies, Primary Prevention, Arrhythmias, Cardiac, Hispanic Americans, Registries, Long QT Syndrome, Electrophysiology

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