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Long-term follow-up of paediatric patients with a subcutaneous implantable cardioverter-defibrillator


 
 
 Inherited channelopathies, cardiomyopathies and structural heart diseases are known to increase the risk of sudden cardiac death in children and are occasionally treated with an implantable cardioverter-defibrillator (ICD). Due to their physical growth and higher level of activity, children experience more adverse events than adults, such as lead fractures, vascular problems and infections. The subcutaneous ICD (S-ICD) was introduced to avoid these lead-related complications and is expected to be especially beneficial for children who require ICD therapy. However, long-term follow-up data of this population are lacking.
 
 
 
 To evaluate long-term clinical outcomes of the S-ICD in the paediatric population.
 
 
 
 Follow-up data were prospectively collected of all paediatric patients (age <18 years) who received their S-ICD in our tertiary centre between November 2009 and June 2019. Clinical outcomes that were assessed were appropriate or inappropriate shocks and complications that required surgical intervention.
 
 
 
 A total of 21 paediatric patients received an S-ICD, with a median age of 15 years (ranged 8–17) and a median body mass index of 18.8 kg/m2 (ranged 15.5–28.8, lowest weight 30kg). The indication for ICD implantation was mostly idiopathic ventricular fibrillation (38.1%) or genetic arrhythmic disease (28.6%). The subcutaneous lead was implanted in an S-shape to accommodate for growth in small patients, and straightening of the lead could be observed on successive chest X-rays (see figure). There was no need for lead or device revisions in this cohort. After a median follow-up of 4.3 years (IQR 2.7–6.5), five patients (23.8%) received an appropriate shock for ventricular arrhythmias and six patients (28.6%) received an inappropriate shock for supraventricular tachycardia (n=4) or double-counting (n=2). Complications that required device extraction occurred in three patients after 0.8±1.1 years and was the result of inappropriate shocks (n=1) and pocket infection (n=2). In two patients the S-ICD was extracted due to progression of their cardiac disease, of whom one needed biventricular pacing and one underwent heart transplantation.
 
 
 
 The S-ICD appears efficacious in this heterogeneous paediatric population. Although higher than reported in adults, the long-term complication rate in paediatric S-ICD recipients is similar to the paediatric transvenous ICD population.
 
 
 
 
 Type of funding source: None
