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Available online 8 December 2023
Complications and inappropriate shocks in pediatric patients receiving a subcutaneous implantable cardioverter defibrilator
Complicaciones y descargas inapropiadas tras el implante de un desfibrilador subcutáneo en pacientes pediátricos
Miriam Centenoa,b,, Reyes Álvarez García-Rovésa,b,, Ramón Pérez-Caballerob,c, Ángel Arenalb,d,e, Felipe Atienzab,d,e,f, Esteban González-Torrecillab,d,e,f, Alejandro Cartab,d,e, Gonzalo R. Ríos-Muñozb,d,e,g, Constancio Medranoa,b,f, Juan M. Gil-Jaurenab,c, Francisco Fernández-Avilésb,d,e,f, Pablo Ávilab,d,e,
Corresponding author
pablo.avila@salud.madrid.org

Corresponding author.
a Servicio de Cardiología Pediátrica, Hospital General Universitario Gregorio Marañón, Madrid, Spain
b Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
c Unidad de Cirugía Cardiaca Infantil, Hospital General Universitario Gregorio Marañón, Madrid, Spain
d Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
e Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
f Facultad de Medicina, Universidad Complutense, Madrid, Spain
g Departamento de Bioingeniería, Universidad Carlos III, Madrid, Spain
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Tables (4)
Table 1. Baseline characteristics
Table 2. Subcutaneous implantable cardioverter-defibrillator data
Table 3. Transvenous implantable cardioverter-defibrillator data
Table 4. Events and complications during follow-up
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Additional material (1)
Abstract
Introduction and objectives

There is limited evidence regarding the use of subcutaneous implantable cardioverter-defibrillators (S-ICD) in pediatric patients. The aim of this study was to determine the incidence of complications in these patients at our center, according to the type of ICD and patient size.

Methods

We included all patients aged<18 years who received an S-ICD since 2016 at our center. As a control group, we also included contemporary patients (since 2014) who received a transvenous ICD (TV-ICD). The primary endpoint was a composite of complications and inappropriate shocks.

Results

A total of 26 patients received an S-ICD (median age, 14 [5-17] years; body mass index [BMI], 20.2 kg/m2). Implantation was intermuscular in 23 patients (88%) and subserratus in the remainder. Two incisions were used in 24 patients (92%). In all patients, 2 zones were programmed: a conditional zone set at 230 (220-230) bpm, and a shock zone set at 250 bpm. Nineteen patients received a TV-ICD (median age, 11 [range, 5-16] years; BMI, 19.2 kg/m2, 79% single-chamber). Survival free from the primary endpoint at 5 years was 80% in the S-ICD group and 63% in the TV-ICD group (P=.54). Survival free from inappropriate shocks was similar (85% vs 89%, P=.86), while survival free from complications was higher in the S-ICD group (96% vs 57%, cloglog P=.016). There were no therapy failures in the S-ICD group, and no increased complication rates were observed in patients with BMI ≤20 kg/m2.

Conclusions

With contemporary implantation techniques and programming, S-ICD is a safe and effective therapy in pediatric patients. The number of inappropriate shocks is similar to TV-ICD, with fewer short- and mid-term complications.

Keywords:
Implantable cardioverter defibrillators
Subcutaneous-ICD
Transvenous-ICD
Child
Adult children
Resumen
Introducción y objetivos

La experiencia con el desfibrilador automático implantable subcutáneo (DAI-SC) en pacientes pediátricos aún es reducida. El objetivo de este estudio es determinar la incidencia de complicaciones en pacientes pediátricos de nuestro centro en función del tipo de DAI y del tamaño del paciente.

Métodos

Se incluyó a pacientes menores de 18 años que recibieron un DAI-SC desde 2016 y pacientes contemporáneos (desde 2014) que recibieron un DAI transvenoso (DAI-TV). El evento principal fue el combinado de complicaciones y descargas inapropiadas.

Resultados

Se implantó un DAI-SC a 26 pacientes (edad, 14 [intervalo, 5-17] años; índice de masa corporal [IMC], 20,2). De ellos, 23 (88%) fueron implantes intermusculares y el resto, en subserrato, 24 (92%) con 2 incisiones. Se programaron 2 zonas en todos los pacientes: condicional a 230 (220-230) lpm y de choque a 250 lpm. El grupo de DAI-TV incluyó a 19 pacientes (edad, 11 [5-16] años; IMC, 19,2; el 79% monocamerales). La supervivencia libre del evento principal a 5 años fue el 80% de los pacientes con DAI-SC y el 63% del grupo con DAI-TV (p=0,54); la de descargas inapropiadas fue similar (el 85 frente al 89%; p=0,86), mientras que la de complicaciones fue mayor en el grupo de DAI-SC (el 96 frente al 57%; cloglog p=0.016). En el grupo de DAI-SC no hubo fallo de la terapia ni mayores complicaciones con un IMC ≤20.

Conclusiones

Con las técnicas de implante y programación actuales, el DAI-SC es eficaz y seguro en pacientes pediátricos, con similares descargas inapropiadas y menos complicaciones a corto y medio plazo que el DAI-TV.

Palabras clave:
Desfibriladores implantables
DAI subcutáneo
DAI transvenoso
Niño
Niños adultos

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