Journal of Interventional Cardiac Electrophysiology 6, 235–244, 2002 ©C 2002 Kluwer Academic Publishers. Manufactured in The Netherlands. Implantable Cardioverter Defibrillator Therapy for Life-Threatening Arrhythmias in Young Patients

Abstract. Objectives: This study examined the indicat-ions, efficacy and outcomes of implantable cardioverter defibrillator (ICD) use in the pediatric population. Background: ICDs are first-line therapy for adults re-suscitated from sudden cardiac death (SCD) or at high risk for life-threatening ventricular arrhythmias. Use of ICDs in children and young adults is infrequent and there are few data regarding this group. Methods: We abstracted and analyzed data for all patients in whom ICDs were implanted. Results: A total of 38 devices were implanted in 27 patients. Age ranged from 6 to 26 years (mean, 14) and weight ranged from 16 to 124 kg (mean, 47). Di-agnoses included long QT syndrome (9), hypertrophic cardiomyopathy [6], repaired congenital heart disease [5], and idiopathic ventricular tachycardia/fibrillation [4]. Indications comprised resuscitated SCD [15], syn-cope [9], and life-threatening ventricular arrhythmia [3]. Initial device placement was infraclavicular in 13, abdominal in 13 and intrathoracic in 1. Epicardial leads were used with 5 systems. A single coil lead was used in 17. Seven patients, all previously resusci-tated from SCD, experienced 88 appropriate success-ful discharges. There were 6 inappropriate discharges in 3 patients. Mean time to device replacement was 3.1 years (n = 11). Complications included 2 infected systems, 2 lead dislodgments, 2 lead fractures, 1 post-pericardiotomy syndrome, 1 adverse event with defib-rillation threshold (DFT) testing, and 1 patient with psy-chiatric sequelae. No deaths occurred with implanted ICDs. Conclusions: These data demonstrate that ICDs pro-vide safe and effective therapy in young patients. The indications for ICDs as primary preventive therapy remain uncertain