Device therapy in pediatric and congenital heart disease patients

• Main Author: Naokata Sumitomo, MD, PhD
• Format: Article
• Language: English
• Published: Wiley 2014-12-01
• Series: Journal of Arrhythmia
• Subjects: Implantable cardioverter-defibrillator; Cardiac resynchronization therapy; Sudden cardiac death; Nonendocardial electrode placement; Congenital heart disease
• Online Access: http://www.sciencedirect.com/science/article/pii/S1880427614000969

Background: Device therapy is an established therapy for preventing sudden cardiac death or managing refractory congestive heart failure in adults. However, it is performed less commonly in pediatric populations. This review aimed to examine the indications and problems associated with implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT) device implantations in pediatric and congenital heart disease (CHD) patients. Results: In a multicenter study in Japan, the cardiac condition of CHD patients improved by 83% after CRT device implantation. The need for CRT devices is more common in children than in adults. After ICD implantation, 44% of the patients experienced appropriate shocks, and epicardial lead implantation was performed in one-third of the patients. Nonendocardial electrode placement is mandatory for ICD implantation in small infants and patients with certain CHDs. Although inappropriate ICD discharges due to sinus tachycardia or other supraventricular tachycardias are common in children, the indication for ICD implantation may be higher than that reported in children. Conclusions: Despite the limited experience, limitations of device implantations owing to the size of the devices, and necessity for nonendocardial electrode placement, device implantations are required in more pediatric and CHD patients than expected.