Selecting the right defibrillator in the younger patient: Transvenous, epicardial or subcutaneous?

Bogush, Nikolay; Espinosa, Raúl E.; Cannon, Bryan C.; Okamura, Hideo; Friedman, Paul A.; McLeod, Christopher J.

doi:10.1016/j.ijcard.2017.09.213

Cited by 19 publications

(15 citation statements)

References 47 publications

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“…4,[6][7][8] Primary prevention indications were determined either according to the respective guidelines and recommendations or on an individual basis with special reference to the underlying cardiac condition. [9][10][11][12][13] At the time of implantation, all the ICD systems were tested according to standard clinical practice and contemporary guidelines. 14,15 Follow-up data included in-house follow-up as well as examinations by collaborating specialists.…”

Section: Methodsmentioning

confidence: 99%

“…Implantable cardioverter-defibrillator implantation techniques have been simplified considerably in recent years thanks to significant reductions in the dimensions of modern generators and the use of transvenous leads. 9,10,13,14,20 In the past, ICD implantation was mainly performed for secondary prevention of SCD, but nowadays ICDs are often implanted for primary prevention, although this is still a field of great controversy. 4,8,13,21,22 We studied several factors to determine the effectiveness of primary vs secondary prevention of SCD.…”

Section: Secondary Vs Primary Prevention Of Scdmentioning

confidence: 99%

“…Despite the significant technological progress that has been made in recent years in the field, ICD implantation is still more complicated in children than in adults. 8,9,[35][36][37][38] There are no dedicated leads for small vessel diameters. Existing ICD devices are not adapted to the small body surface and weight of a pediatric patient, and abdominal implantation of the power generator may be necessary.…”

Section: Icd-system-related Complications and Actions Taken To Solve mentioning

confidence: 99%

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Long-term follow-up of implantable cardioverter-defibrillators in children: Indications and outcomes

et al. 2019

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Background. Validation data of the use of implantable cardioverter-defibrillators (ICD) in the pediatric population is insufficient, with limited follow-up periods. Objectives. The aim of the study was to report on 17 years of experience with implantable cardioverterdefibrillator (ICD) therapy in children and young adults. Material and methods. This retrospective review included patients below the age of 18 years at the time of ICD implantation between May 2000 and December 2017. For the statistical analysis, the sample was divided into groups by gender and the type of indications for ICD implantation (primary vs secondary prevention). Results. The study group included 20 children (8 female, 12 male) who underwent ICD implantation for primary or secondary prevention of sudden cardiac death (SCD). The average age at the time of the initial procedure was 15.6 years (range: 3.8-17.7 years). Primary electrical disease (PED) was present in 9 patients, cardiomyopathy (CMP) in 9 and 2 others had congenital heart defects (CHDs). The median follow-up time was 6.7 years (range: 0.4-12.5 years). The outcomes of ICD therapy were analyzed. No differences between the sexes were found in terms of treatment strategy effectiveness (p > 0.05). The girls were more often treated as primary prevention (p = 0.009). After implantation, all the patients were on optimal pharmacotherapy. Alltogether there were 126 ICD interventions in 11 patients, including 23 inadequate interventions (IA) in 2 children (18.2%).Three children (15%) died due to electrical storms. In the per-procedure analysis, the overall freedom rate from ICD lead replacement was 90%, 80% and 57% at 1, 5 and 10 years of observation, respectively. Conclusions. Implantable cardioverter-defibrillator implantation indications in children are more heterogeneous in comparison to adult population. In the pediatric population undergoing ICD implantation, the treatment strategy is influenced by gender. The rate of inappropriate ICD discharges (IA) in our group of pediatric patients was low. Rigorous pharmacotherapy and individual ICD programming seemed of paramount importance. Lead malfunctions LF constituted the most prevalent complication observed.

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Section: Methodsmentioning

confidence: 99%

Section: Secondary Vs Primary Prevention Of Scdmentioning

confidence: 99%

Section: Icd-system-related Complications and Actions Taken To Solve mentioning

confidence: 99%

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Long-term follow-up of implantable cardioverter-defibrillators in children: Indications and outcomes

et al. 2019

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“…We opted for the implantation of a subcutaneous rather than a transvenous ICD by reason of lower complication risk profile as well as lower risk of lead failure, especially in patients with active lifestyles. [15][16][17] Furthermore, a young patient with a favorable long-term prognosis is more likely to require multiple device replacements, which are associated with higher mortality and morbidity in case of transvenous ICD. 17,18 The patient wore a defibrillator vest as a bridge to ICD placement.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Sudden Cardiac Arrest in a Young Patient With Severe Pectus Excavatum

Rachwan¹,

Purpura

Kahwash³

2018

The American Journal of the Medical Sciences

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We report a case of sudden cardiac arrest in the setting of ventricular fibrillation in a previously healthy 19-year-old male. Chest imaging demonstrated severe pectus excavatum with Pectus Severity Index of 22.7. Extensive workup was unrevealing for other cardiopulmonary etiologies, including conduction and structural abnormalities. The patient was scheduled for a Ravitch procedure and was discharged on a wearable defibrillator vest for temporary protection against ventricular arrhythmias. Later, the patient underwent subcutaneous implantable cardioverter defibrillator placement. Sudden cardiac arrest as an initial presentation of pectus excavatum is a rare entity scarcely discussed in medical literature. In this patient-centered focused review, we explore this unique case and offer our management approach amid the lack of concrete guidelines.

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“…One of these high-risk subgroups is represented by children with CHD and inherited channelopaties. 4 Other diseases associated more often with a higher arrhythmic risk are the tetralogy of Fallot and the transposition of the great arteries (TGA). 5 After surgical treatment for tetralogy of Fallot, the incidence of ventricular arrhythmia has been reported to be as high as 1.2% to 3.0% per decade.…”

Section: Sudden Cardiac Death In Childhoodmentioning

confidence: 99%

Modern Technology for Prevention of Sudden Cardiac Death – a Clinical Update on Device Therapy in Children with Congenital Heart Diseases

Casu

2018

Journal of Cardiovascular Emergencies

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Sudden cardiac death in children is one of the most devastating conditions that can be encountered in acute cardiac care. Intracardiac device therapy, providing prompt and effective treatment in malignant ventricular arrhythmia or in severe conduction abnormalities, is a promising tool to reduce the incidence of this fatal condition. However, the implementation of device-based therapy in the pediatric population is currently limited by the lack of clinical studies on large number of subjects. As a result, indications for device therapy in pediatric patients are still unclear in many circumstances. There are also several particularities related to device implantation in pediatric age, such as the somatic growth leading to a mismatch between chamber size and lead length, or the difficulties of implantation technique in children with small body weight. This study aims to present an update on the current advantages and limitations of device-based therapy for treating severe malignant arrhythmia or conduction disorders in children at risk for sudden cardiac death.

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Selecting the right defibrillator in the younger patient: Transvenous, epicardial or subcutaneous?

Cited by 19 publications

References 47 publications

Long-term follow-up of implantable cardioverter-defibrillators in children: Indications and outcomes

Long-term follow-up of implantable cardioverter-defibrillators in children: Indications and outcomes

Sudden Cardiac Arrest in a Young Patient With Severe Pectus Excavatum

Modern Technology for Prevention of Sudden Cardiac Death – a Clinical Update on Device Therapy in Children with Congenital Heart Diseases

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