Long-term follow-up of children and young adults treated with implantable cardioverter-defibrillator: the authors' own experience with optimal implantable cardioverter-defibrillator programming

• Published in: Europace (London, England) England), 2010-09, Vol.12 (9), p.1245-1250
• Main Authors: Lewandowski, Michal, Sterlinski, Maciej, Maciag, Aleksander, Syska, Pawel, Kowalik, Ilona, Szwed, Hanna, Chojnowska, Lidia, Przybylski, Andrzej
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Cardiac Pacing, Artificial - adverse effects; Child; Defibrillators, Implantable - adverse effects; Female; Follow-Up Studies; Humans; Male; Software; Stroke Volume; Tachycardia - therapy; Treatment Failure; Ventricular Fibrillation - therapy; Young Adult
• ISSN: 1099-5129; 1532-2092
• DOI: 10.1093/europace/euq263

Young implantable cardioverter-defibrillator (ICD) recipients present a high rate of inappropriate interventions. Some of them are caused by suboptimal pre-discharge programming of the device. There are conflicting data as regards antitachycardia pacing (ATP) effectiveness in children and young adults. We report our experience with ICD programming and a rate of complications during a 10 year follow-up. We analysed the use and effectiveness of ATP and complications rate in 63 patients aged 6-21 years. Antitachycardia pacing (burst or ramp) was programmed ON in 14 patients (22%), 49 patients (78%) had only ventricular fibrillation (VF) therapy when discharged after implantation. The incidence of effective vs. ineffective or harmful ATP therapy: 5% of patients vs. 19% of patients differed significantly (P < 0.05). Fourteen patients (22%) received > or =1 appropriate shock(s) for ventricular tachycardia/VF and 17 patients (27%) had one or multiple inappropriate therapy (IT). Inappropriate therapy resulted from T-wave over-sensing (nine patients), sinus tachycardia (three patients), fast atrial fibrillation (five patients), and lead insulation disruption (1%). Reprogramming of the device eliminated IT in all cases. There were 13 (21%) surgical complications. Serious psychological sequelae developed in 27 (43%) patients. There was one death during the follow-up period. Antitachycardia pacing therapy is rarely effective and often harmful in young ICD recipients. In most patients, programming ICD for only VF therapy is sufficient. Routine pre-discharge programming against inappropriate interventions (especially T-wave over-sensing) helps to reduce the incidence of discharges during the follow-up. The incidence of complications and inappropriate therapies is high in young ICD recipients and affects 50% of patients.