Children and young adults treated with transvenous and subcutaneous implantable cardioverter-defibrillators: A 22-year single-center experience and new perspectives

Abstract

BACKGROUND Over the last several years the evolution of transvenous implantable cardioverter-defibrillator (T-ICD) system and the introduction of subcutaneous ICD (S-ICD) have contributed to the development of the sudden cardiac death (SCD) prevention in clinical practice. AIMS To report our clinical experience with ICD therapy in children and young adults during the twenty- -two years of the follow-up. METHODS We reviewed the database of ICD recipients choosing 80 consecutive patients (pts) implanted at the age of 6-21 in 1996-2018. We analyzed the rate of appropriate (AT) and inappropriate therapies (IT), mortality, complications and new treatment options. RESULTS A total of 21/80 patients (26.25%) received ≥1 AT for ventricular tachycardia/ventricular fibrillation (anti-tachycardia pacing or shock) and 25/80 patients (31.25%) had one or multiple IT (P = 0.47). Nine patients (11%) had both AT and IT interventions. During follow-up, 2 (2.5%) cardiac resynchronization therapy (CRT) systems, and 8 (10%) S-ICDs were implanted, 3 heart transplantations were performed, and 1 severe tricuspid valve regurgitation occurred. A total of 6/80 patients (7.5%) died. All deaths occurred in the hypertrophic cardiomyopathy group. CONCLUSIONS The mortality rate was 6/80 (7.5%) in the twenty-two-year follow-up. The rate of AT vs. IT was almost equal and remained steady in the long observation period. Severe TR might be a serious clinical problem in some patients. Entirely S-ICD for SCD prevention is a feasible and safe therapy in young recipients.