Implantable Cardioverter Defibrillator Outcomes in Pediatric and Congenital Heart Disease: Time to System Revision

Abstract

The need for ICD system revision is high in this pediatric and CHD population and occurs at a rate similar to the rate of receiving appropriate therapy. These results highlight the need for judicious implant criteria and improved device longevity.

Riata lead failure in pediatric and congenital heart disease patients

“…In leads with only CCE, the indications for extraction were structural failure in one (5%) and elective extraction for advisory in one (5%) lead. 1,2,[7][8][9] In contrast to the higher rate of electrical failure, the 16% rate of CCE seen in our cohort is in keeping with previously reported rates of CCE in adult patients. A recent study of 3763 Riata leads found a cumulative incidence of electrical failure of 5.2% at 8 years, while a recent meta-analysis found an overall electrical failure rate of 6.3%.…”

“…Electrical failure was the indication for lead extraction in 12 (57%) leads, with five of these leads having concomitant CCE. 1,2,[7][8][9] This finding may be related to the Riata lead being more susceptible to the factors influencing lead failure in children and patients with CHD, including lead stress related to somatic growth and higher activity levels. In leads without structural or electrical The rate of Riata electrical failure, reported at 43% in this study, is much higher than what has been reported to date in predominantly adult patients.…”

“…1,2 The rate of electrical lead failure was even higher in our cohort of patients with Riata leads that has been identified in other cohorts of pediatric and CHD patients with variable proportions of non-Fidelis ICD leads. 1,2,[7][8][9] This finding may be related to the Riata lead being more susceptible to the factors influencing lead failure in children and patients with CHD, including lead stress related to somatic growth and higher activity levels. 1,2,[7][8][9] In contrast to the higher rate of electrical failure, the 16% rate of CCE seen in our cohort is in keeping with previously reported rates of CCE in adult patients.…”

“…1,2,[7][8][9] This finding may be related to the Riata lead being more susceptible to the factors influencing lead failure in children and patients with CHD, including lead stress related to somatic growth and higher activity levels. 1,2,[7][8][9] In contrast to the higher rate of electrical failure, the 16% rate of CCE seen in our cohort is in keeping with previously reported rates of CCE in adult patients. Parkash et al 5 On univariate analysis, there was no difference in the age at ICD implantation in patients with and without Riata lead failure in our study, although previous studies have shown that earlier age at lead implantation is associated with an increased rate of ICD lead failure in children and patients with CHD.…”

Assessing Candidacy for Primary Preventative Implantable Cardioverter-defibrillators in Pediatric Patients with Ion Channelopathies: Weighing the Risks and Benefits

“…While the use of an implantable cardioverter-defibrillator (ICD) can be life-saving, it also has the potential to cause significant morbidity, both medically and psychosocially. [1][2][3] As such, current research is examining predictors of SCD to help clinicians select those patients most likely to benefit from primary preventive ICD placement. Furthermore, though ICD placement can be a life-saving primary prevention option, because of factors inherent to the pediatric population, careful thought must be given to the specific indications for device placement in each child.…”