Eur J Cardiothorac Surg. 2025 Apr 12:ezaf134. doi: 10.1093/ejcts/ezaf134. Online ahead of print.
ABSTRACT
OBJECTIVE: This study aimed to investigate the benefits and potential risks of implantable cardioverter-defibrillators in pediatric and congenital heart disease patients in the current era.
METHODS: All patients with congenital heart disease, pediatric cardiomyopathy, or primary electrical disease, who underwent implantation of a defibrillator from 2001 to 2023 were examined. The occurrence of appropriate therapy, unplanned surgeries due to device complications, inappropriate shocks, and associated risk factors were analyzed.
RESULTS: A total of 214 patients were included, with 61% having congenital heart disease, 17% having pediatric cardiomyopathy, and 22% having primary electrical disease. The most common diagnoses were transposition of the great arteries and tetralogy of Fallot (each 12%). The median age at implantation was 23 years (interquartile ranges 15-38), and the median follow-up was 5.7 years (95% confidence interval 4.9-7.3). 196 patients met the criteria for outcome analysis, where appropriate therapy was observed in 41% (n = 80), occurring more often in patients with indications for secondary prevention than primary prevention (56% vs. 26% at 5 years, p = 0.003). The cumulative incidence of inappropriate shocks was 13% (n = 26), with patients with congenital heart disease being more frequently affected. Unplanned surgeries were required in 36% (n = 71), predominantly due to lead-related issues in those with abdominal generator placement.
CONCLUSIONS: The high rate of appropriate therapies underscores the critical importance of risk assessment in ICD selection, particularly to mitigate lead failures and unnecessary shocks. However, defibrillator therapy has a relevant rate of unplanned surgeries, with abdominal generators and epicardial/extracardiac leads being risk factors.
PMID:40220317 | DOI:10.1093/ejcts/ezaf134
