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- Title
Clinical Experience of Subcutaneous and Transvenous Implantable Cardioverter Defibrillators in Children and Teenagers.
- Authors
PETTIT, STEPHEN J.; MCLEAN, ANDREW; COLQUHOUN, IAN; CONNELLY, DEREK; MCLEOD, KAREN
- Abstract
Background Subcutaneous implantable cardioverter defibrillator (S-ICD) systems have no components in contact with the heart and may avoid complications such as lead fracture, venous obstruction, or endocarditis that occur with transvenous leads. Concerns have been raised regarding inappropriate shocks and pocket erosion with S-ICD systems. We have compared the performance of S-ICD and transvenous ICD systems in children and teenagers. Methods We studied consecutive patients <20 years of age who received an ICD over a 4-year period in two Scottish centers. Baseline characteristics, complications, and ICD therapy were recorded. The primary outcome measure was survival. The secondary outcome measure was survival-free from inappropriate ICD therapy or system revision. Results Nine S-ICD were implanted in nine patients. Eight transvenous ICD were implanted in six patients; two were redo procedures. Baseline characteristics were well matched. Median duration of follow-up was lower for S-ICD (20 months) than for transvenous ICD (36 months, P = 0.0262). Survival was 100% in both groups. Survival free of inappropriate therapy or system revision was 89% for S-ICD and 25% for transvenous ICD systems (log-rank test, P = 0.0237). No S-ICD were extracted, but three transvenous ICD were extracted due to infection (n = 1) and lead failure (n = 2). Conclusions In real-world use in children and teenagers, S-ICD may offer similar survival benefit to transvenous ICD, with a lower incidence of complications requiring reoperation. In the absence of randomized trials, S-ICD should be compared prospectively with transvenous ICD in large multicenter registries with comparable periods of follow-up.
- Subjects
SCOTLAND; VENTRICULAR fibrillation treatment; CHI-squared test; COMPARATIVE studies; FISHER exact test; IMPLANTABLE cardioverter-defibrillators; SCIENTIFIC observation; HEALTH outcome assessment; REOPERATION; STATISTICS; SURGICAL complications; SURVIVAL analysis (Biometry); T-test (Statistics); PRODUCT design; DATA analysis; TREATMENT effectiveness; DATA analysis software; DESCRIPTIVE statistics; KAPLAN-Meier estimator
- Publication
Pacing & Clinical Electrophysiology, 2013, Vol 36, Issue 12, p1532
- ISSN
0147-8389
- Publication type
Article
- DOI
10.1111/pace.12233